When you think about a concussion, what is the first thing that comes to mind? For many, it’s football. We think back to a high school, college or professional football game where we watched a player get carried off the field after a hard hit. But is this where our minds should jump? Sure, concussions are sometimes part of football, but there are many other sports where concussions occur as well. A recent article was published about a surge in ER visits from injuries and concussions from soccer and according to the American Association of Neurological Surgeons, cycling contributes to the highest number of estimated head injuries treated in the US. In fact, there are many places outside of sports where concussions can occur as well, including the workplace.
Regardless of how someone gets a concussion though, there are typically certain questions we want answered. Below, ATI’s Sports Medicine Supervisor, Peter Braun, MS, LAT, ATC, answers some of the most frequently asked questions that come up when discussing concussions.
What is a Concussion?
A concussion is a type of brain injury due to a bump/blow to the head or body which causes the diffusion of force through the brain, disrupting normal neurologic function. These impairments are often rapid in onset and generally short-lived (about 1-2 weeks) with no structural abnormalities seen on standard neuroimaging.
What are Concussion Risk Factors?
Commonly, greater risk can be seen with an increase in exposure to contact (e.g., football, rugby, lacrosse, soccer, wrestling, competitive cheerleading, etc.); however, there may be a lot of variation within each sport. For example, factors such as number of contact days during practice, the utilization of proper technique, as well as adherence to sport rules and regulations play a large role in risk for head injury. Incidence of this injury can also occur outside of athletic activity and are often associated with car or work related accidents. It is important to highlight that a concussion can happen to anyone and often can be seen with everyday occurrences such a slip and fall or bump to the head.
How Do You Get a Concussion?
The brain is suspended in fluid within the skull. This fluid allows the brain a little space and freedom to shift around which is very important to protect the brain and absorb common everyday forces to the head from movement and activity. With more substantial forces, the brain can move too far and hit the walls of the cavity which creates a diffusion of force across the brain tissue, resulting in a concussion. Even though it is often the mechanism for injury, direct contact to the head does not have to occur in order for someone to sustain a concussion. Any force to the head, face, neck or body that yields an acceleration or deceleration of the brain could cause the brain to shift within the skull and may result in injury.
What are Some Signs and Symptoms of a Concussion?
Signs and symptoms can be broken down into 4 categories: Physical, Cognitive, Emotional and Sleep. Physical symptoms can manifest as headaches, dizziness, nausea, sensitivity to light/noise, visual problems, as well others. Concussions can affect an individual’s cognitive ability by causing them to have difficulty with remembering, processing, or concentrating. Other symptoms that are important to be aware of, but that are often over looked, are irritability, sadness, nervousness and any increase in emotion as well as disturbances in sleep.
What Should You Do If You Have a Concussion?
If you think you have a concussion, you want to make sure you are seen by a physician (MD or DO). Many states differ in the laws associated with concussions, but a trained physician with experience in concussion care will be able to best create a treatment plan and strategy to return to school/work/sport. It is imperative to understand that during recovery from a concussion the brain is in a vulnerable state and if another hit to the head occurs there can be serious and irreversible damage. That means it is incredibly important to refrain from any physical activity until you are evaluated. Early on, the physician will often recommend symptom tolerated cognitive activity such as reading and schoolwork at home for abbreviated lengths of time as to not increase or worsen symptoms. After an individual can tolerate cognitive activity at home for 30-45 minutes, they will usually start progressing back to school. Returning to a normal schedule may help eliminate some difficulties with anxiety or sleep. Once a student athlete can function fully, without symptoms throughout a full day of school, they can then begin a stepwise progression back to sports. A key symptom of concussion is exercise intolerance, so the purpose of a gradual return to activity is to promote recovery and ensure that the athlete does not produce symptoms following physical exertion. Usually, this stepwise progression is 5 to 6 stages once symptom free and there must be approximately 24 hours between stages. If symptoms arise during activity then the athlete needs to stop and return to the previous asymptomatic stage once recovered.
Who Should You See After a Concussion?
A concussion does not require immediate medical attention; however, if you’re unsure and think it may be more serious, it’s better to be safe and get evaluated immediately. Any complaints such as significantly worsening headaches, decrease in alertness or consciousness, watery fluid from ears or nose, repeated vomiting, neck pain, seizures, unequal or dilated pupils, or any signs of stroke mandate immediate emergency room evaluation. If concussion symptoms are mild to moderate and do not worsen over time, then care is not urgent and an appointment with a primary care physician or specialist is appropriate.
Do You Need to Be Frequently Woken Up After a Concussion?
If you’ve sustained a concussion there is no need to be woken up throughout the night. It is actually beneficial to get solid, restful sleep. The only scenario when it would be appropriate is if there is a more severe injury suspected, in which case you should be under emergency care and surveillance.