Changing How Concussions Are Treated

Concussions can be scary. Unlike cuts or broken bones, you can’t see the wound – but you know something is wrong. Fortunately, we are constantly learning more about sport-related concussions, allowing us to be more efficient and effective in recognizing, diagnosing and treating this condition.

The British Journal of Sports Medicine recently published updated guidelines – based on input from more than 100 concussion researchers and clinicians – that is expected to guide and modify the way these sport-related head injuries are handled.

We’ve already come a long way in recent years, but these changes will further refine diagnosis and how concussions are treated.

Concussion Risk in Sports

Sports offer a multitude of benefits including improved resilience, social connectedness, physical and mental health and more. Sports are truly beneficial but do come with a risk for injury, including concussion.

Concussions are mild traumatic brain injuries that can occur both in contact and non-contact sports. Anytime your head suffers a violent shaking or force, there is the potential for a concussion to occur. This could be a direct blow to your head or a whiplash movement causing your brain to move within your skull. They’re more common in sports like football, soccer and hockey, but they can happen with any sport.

We’ve become more aware of the dangers of concussions with research showing they can cause serious health problems. These injuries have been linked to chronic traumatic encephalopathy (CTE), a rare disorder caused by repeated head injuries that has been found in the brains of football players and boxers.

Concussions are particularly dangerous if an individual experiences a second concussion before the first one has enough time to heal. This can cause a serious, though rare, complication known as second impact syndrome, where rapid brain swelling can be fatal.

That’s why it is so important for coaches, trainers and parents to be aware of concussion symptoms.

Concussion Signs and Symptoms

A concussion is a functional injury. During a concussion, your brain cell functioning is altered, creating chemical and metabolic changes in your brain. This disrupts the normal functioning of your brain, which can create a wide range of symptoms. Among the most common:

• Headache
• Nausea or vomiting
• Confusion
• Temporary loss of consciousness
• Dizziness
• Vision problems (including double vision)
• Difficulty sleeping or staying awake
• Ringing in the ears
• Light and noise sensitivity
• Unexplained tiredness
• Difficulty concentrating
• Unexpected mood changes (including depression, irritability and anxiousness)
• Mental fogginess

Updated Concussion Guidance

The expert panel has recommended updated age-appropriate tools to help identify and manage concussions and new strategies to help medical professionals, coaches and parents determine when an athlete is ready to return to school and sport.

The researchers and clinicians looked at how to handle an athlete’s rehabilitation after the injury. Historically, athletes have often been cautioned to do nothing but rest after an injury – even to the point of essentially sitting in a dark room – until the symptoms go away.

But that approach can actually be detrimental to recovery. The updated recommendations call for a symptom-limited approach to activity, rather than strict rest. This could include regular everyday activities as long as they aren’t significantly aggravating your concussion symptoms. The panel also highlighted evidence suggesting that light aerobic exercise can have recovery benefits within the first 48 hours after an injury.

Among the recommendations is a four-step return-to-learn strategy, which should be customized for each person based on their unique needs and symptoms:

1. Daily activities that do not result in more than a mild exacerbation of symptoms (including reading and other basic activities, with limited screen time)
2. School activities (homework, reading and cognitive activities outside of the classroom)
3. Return to school part time (starting with partial days or longer rest breaks as needed)
4. Return to school full time (this gradual process ends when a full day can be tolerated with no more than mild exacerbation of symptoms)

The six-step return-to-sports strategy suggests that each step take a minimum of 24 hours, advancing only if there is no more than mild exacerbation of symptoms:

1. Symptom-limited activities (walking and similar activities)
2. Light- to moderate-aerobic exercise (walking, stationary cycling and light resistance training)
3. Individual sport-specific exercise (individual drills away from the team environment)
4. Non-contact training drills (more challenging drills in the team environment)
5. Full-contact practice (normal training activities) – Medical clearance is recommended prior to initiation of any contact
6. Return to sport with medical clearance (normal game play)

The expert panel recommends a more targeted approach to concussion rehabilitation, with an emphasis on cervico-vestibular rehabilitation for issues with the inner ear and neck. This specialty area focuses on symptoms such as dizziness, headache, neck pain and balance. The vestibular system plays a vital role in stabilizing your gaze when you move quickly. An athlete needs to be able to see clearly while running to catch a ball or avoid something coming at them. Specialized physical therapy can treat these impairments, facilitating safety with return to sport.

The most important factors in concussion management are seeking medical attention if a concussion is suspected and having a team working together to quickly identify and treat this injury. That requires a collaborative effort that involves athletic trainers recognizing the symptoms, sports medicine doctors diagnosing the injury, and rehabilitation specialists promoting education and recovery.