Understanding and Identifying Concussions

Concussion Recovery Program →

Throughout the United States, it is estimated that more than two million concussions occur each year. A majority of those concussions go undiagnosed.  A concussion is a Minor Traumatic Brain Injury (MTBI) and all brain injuries are serious. The main causes of a concussion are a direct blow to the head or a force transferred through the body to the head. Concussion can affect you by causing an alteration or temporary loss of brain function that may result in physical, behavioral or cognitive changes.

If an individual suspects that a concussion has occurred they should discontinue the activity or sport immediately. The first important step to recovery is rest (no activity). Continuing to play with the signs and symptoms of a concussion can make the athlete particularly susceptible to greater injury.  The next step will be to take the athlete to the emergency room or to a physician to assess for other injuries, such as a skull fracture, neck injury or bleeding on the brain. Once these other injuries are ruled out it will be at the physicians’ discretion if the individual can return to activity, school, work or athletics.

The length of time from diagnosis to full recovery is crucial.  There is an increased risk of significant damage if an athlete plays through a concussion and suffers a second. This can cause an extended recovery or severe brain swelling (second impact syndrome) with chance of there being more severe consequences as a result. The time frame will vary from person to person as to when the individual will be symptom-free and able to resume activity.  However, a good concussion management and rehabilitation program will help significantly.

This means that a simple “ding” or a “bump” to the head should not be taken lightly.  Concussions are not as easy to determine as other injuries, the signs and symptoms may take hours or days to fully present themselves. If you or someone you know reports or displays any signs of a concussion contact our office right away and get scheduled to see our physicians. The sooner the concussion recovery program can be initiated the better the outcomes are going to be.

What signs and symptoms to look for:

  • Headache or pressure in head
  • Dizziness
  • Nausea or vomiting
  • Blurred/double vision
  • Sensitivity to light
  • Difficulty concentrating
  • Difficulty remembering/loss of memory
  • Spots before eyes
  • Sensitivity to sound
  • Ringing in ears
  • Feeling “in a fog”

Things you can do at home:

  • Avoid loud noises (music, TV, band practices, or listening to a music device)
  • Limiting texting, reading, video games, typing, or internet use.
  • Avoid any over-the-counter medications (Advil, Motrin, Ibuprofen, and Aleve) that may mask symptoms, unless advised otherwise by a physician.
  • If you are a student: the school nurse, athletic director, administer, and/or guidance counselor should be contracted to postpone any quizzes or exams that may be needed.

It is the job of the athletes, parents and coaches to report a potential concussion to the league and/or the sports medicine team.  There can be zero tolerance for anyone attempting to hide the signs and symptoms of a concussion or for failing to report one. There can be serious consequences to the athlete’s health and well-being when ignoring a concussion or sending them back to play too soon.  Especially for adolescent or teenage athletes as they tend to down play the extent of their injuries.  This goes for concussions as well.  It is important to educate administrators, coaches, parents and students on the sign and symptoms of concussions for the athlete’s safety.

Concussion Management Plan & Policy 

When determining whether or not an athlete can return to play from a concussion a structured plan and policy must be followed. In the section below is the policy that we recommend be followed for your student-athlete.

Return to Play Policy

  1. In accordance with OHSAA rules and Ohio State law, any student-athlete suspected of a concussion must be evaluated and obtain a release form from a licensed physician. If the student-athlete did not suffer a concussion, the release form must clearly state that, otherwise return to play guidelines will be implemented.
  2. The King-Devick Test in association with Mayo Clinic will be administered scores will be recorded 24-72 hours after suspected head injury or concussion, if possible. These scores will be compared to baseline scores and be made available to parents, student-athletes and attending physicians. King-Devick Tests must be normal when compared to baseline test results for a student-athlete to progress to the next step in the return to play process.
  3. In order to start the return to play protocol the student-athlete must have no exertional activity until they are asymptomatic. Once asymptomatic the student-athlete will complete each step in the return to play protocol and remain asymptomatic for 24 hours before moving to the next step. If concussion signs and symptoms return then the student-athlete must return to the previous step.

Step 1: low-impact activity; 20-30 minutes of stationary bicycling or walking on a treadmill.

Step 2: Progress to aerobic activity that is sport specific exercises such as skating in hockey, running in soccer, football, or baseball.  Additionally progressive strength training activities may be included.

Step 3: Non-contact skill drills are incorporated like dribbling or shooting in basketball, technique drills in football, fielding and batting for baseball.

Step 4: Full practice with contact.

Step 5: Return to competition/game.

Additional signs observed by teammates, parents and coaches include:

  • Appears dazed
  • Vacant facial expression
  • Confused about assignment
  • Forgets plays
  • Is unsure of game, score, or opponent
  • Moves clumsily or displays incoordination
  • Answers questions slowly
  • Slurred speech
  • Shows behavior or personality changes
  • Can’t recall events prior to hit
  • Can’t recall events after hit
  • Seizures or convulsions
  • Any change in typical behavior or personality
  • Loses consciousness

Adapted from the CDC and the 5th international Conference on Concussion in Sport Document created 10/1/2016

What should I do if I think my child has suffered a concussion?

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately.

No athlete should return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. OHSAA Policy requires athletes to provide their school with written clearance from a licensed physician. You should also inform your child’s coach if you think that your child may have a concussion. Remember it’s better to miss one game than miss the whole season. And when in doubt, the athlete should sit out.

Further concerns should be addressed to Dr. Michael Lyons and the staff of Advanced Sports Medicine & Athletics


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