As the new school year gets underway, many students are preparing to compete in a new season of athletic endeavors. As with any form of competition, there are certain risks of injury. One injury, in particular, has received increasing attention – concussions. It is estimated that approximately 300,000 sports-related traumatic brain injuries, primarily concussions, will occur this year in the United States alone. Although most concussions are mild and not life-threatening, it is crucial to recognize the warning signs of a concussion and make sure to take the proper steps, such as working with a licensed physical therapist, for a full recovery.
The evidence-based definition of a concussion is “a change in brain function following a force to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals with measures of neurologic and cognitive dysfunction.” Given the broad definition, it is more practical to recognize the signs and symptoms of a concussion to start the recovery process.
These signs and symptoms include difficulty recalling short-term events before/after a hit, appearing dazed/stunned, a lack of balance or clumsy movements, or loss of consciousness. They may also report headaches, nausea/vomiting, visual changes, sensitivity to light/noise, confusion, or just not “feeling right.” If there is any doubt about the seriousness of a concussion, it’s best to take the individual to the emergency room. These changes may be present immediately following a concussion or may take days to develop, so close monitoring is vital in order to reflect an accurate diagnosis. It is the best practice to communicate with healthcare professionals, parents/roommates, and athletic trainers/coaches to gather relevant information.
Once an individual is suspected of having a concussion and a diagnosis is made by a healthcare team member, it is vital to begin the recovery process. First and foremost, the individual should sit out from any competition for the rest of the day until a healthcare professional advises about when it’s safe to return to play and the classroom.
The first step recommended for recovery is physical and mental rest to allow the individual’s body to heal. This means sitting out from practice, games, weight training, screen time, or school assignments. After an individual is symptom-free and has returned to baseline testing (if applicable), they should start a light aerobic activity such as walking, swimming, or biking. If they remain symptom-free after light aerobic training, the individual can progress to sport-specific activity with no impact, including low-intensity sports drills.
The next step is full non-contact sports drills and resuming progressive resistance training if the individual was involved with resistance training before the concussion. Finally, the athlete should return to full practice and competition participation if they remain symptom-free. Again, it’s essential to recognize that the time spent on each stage before returning to activity progression is based on the presence or absence of the athlete’s signs and symptoms. Communication and observation are keys between all the parties involved in the athlete’s care.
Even though an estimated 80-90% of concussions resolve themselves within 7-10 days, there may be lingering symptoms that impede quality of life. Recently, it has been suggested that prolonged physical and cognitive rest may be harmful to those recovering from a concussion. As with every injury, graded rehabilitation is key to making a full recovery. However, growing evidence suggests a more active, targeted approach to recovering from a concussion to facilitate the rehabilitation process better.
Multiple health care providers working together for complete examination and rehabilitation have provided the best outcomes for affected athletes. In particular, licensed physical therapists are trained in concussion management to identify and treat remaining impairments from a concussion, most notably vestibular deficits, such as decreased balance, coordinated head/eye movements, and postural control. In addition, licensed physical therapists are also trained and skilled at treating headaches and the lack of aerobic exertion that may follow a concussion. As our understanding of this unique injury continues to develop, so will our expertise in rehabilitation.
The fall is a season of new beginnings, including athletic and academic undertakings. Knowing to recognize when a concussion occurs more quickly and how to recover from this injury will allow everyone to enjoy this fall season more safely. For more information about concussion management, schedule an appointment with a licensed physical therapist at Foothills Sports Medicine, or ask your healthcare professional about how you can protect yourself this fall season.
