Concussions are mild traumatic brain injuries where the brain impacts the skull, causing damage to brain tissue [1-4]. They commonly happen during sports but can occur in many other situations as well [1,3-5]. Concussion symptoms can vary greatly, with some experiencing only mild discomfort and recovering quickly, while others may be debilitated for months before being able to return to normal activity [2,3]. Correctly identifying when someone has experienced a concussion and taking appropriate steps for rest and treatment help improve the situation. Most cases of concussion only require low to moderate levels of management, however, it is also important to recognize that a concussion is a serious condition that can have long-term consequences [1-3].
Several popular sports carry a relatively high risk for concussion, including American football, wrestling, and basketball. Significant focus has been placed on the risks of concussion among young athletes (children to college-aged) and appropriate treatment. A large prospective study gathered data from 25 high schools across 11 years, recording rates of concussion in 12 sports. Data confirmed that football is a central risk factor, as well as lacrosse to a lesser extent [5]. Even so, anyone can experience a concussion if they experience a forceful impact to any part of the body that then jostles the head [1,3]. Falls and car accidents are common causes among adults [1,3,4].
Fortunately, the medical and athletic community has become more aware of the prevalence, management, and consequences of concussion and other traumatic brain injuries. For example, during the 2000s and 2010s, researchers identified links between repeated concussions in NFL players and an array of serious neuropsychiatric disorders, including chronic traumatic encephalopathy, dementia, and mood disorders, and the fallout from the findings and the NFL’s initial actions led to nationwide discussion on brain health [6].
Repeated brain injuries can certainly lead to deterioration over time, especially when occurring without full healing in between, which is why rest and gradual, careful return to activity is critical in concussion management [3,4]. Signs and symptoms to look out for include headache, dizziness, nausea, fatigue, sensory sensitivity, difficulty concentrating, and memory problems. Loss of consciousness directly after the impact may occur, as may brief convulsions. Persistent or worsening confusion, weakness, numbness, or slurred speech indicate a more severe injury [1-3].
For a mild concussion, management generally involves strict rest from physical and mental activity for the first few days – the patient should avoid screens, anything that requires concentration, and situations that could lead to additional injury. Athletes should be immediately removed from play [2,3]. As symptoms improve, individuals can slowly return to normal life, starting with light activity and working back to more strenuous activity (e.g. studying, sports). Any worsening of symptoms should prompt taking a step back in activity levels [2]. One common myth is that individuals with concussions should not sleep – in general, proper sleep accelerates healing. For more severe cases of concussion, the risk of sleep is that it is harder to identify signs of serious deterioration when the patient is not awake and interacting with the person/people providing observation [7].
More severe concussions may require emergency medical attention and imaging to determine whether a brain bleed or clot resulted from the injury – these are extremely urgent situations that need advanced care [1,3,4,8]. Those who are at higher risk of a brain lesion include patients with loss of consciousness, vomiting, neurological deficit, an existing bleeding disorder, or older age [8].
Prevention is an essential complement to concussion management. Protective gear, especially in younger children, reduces injury in the event of impact during a sport [3]. Many sports teams implement baseline testing so that an athlete’s physical and cognitive function can be tested after a potential concussion-causing event [2]. For those who have previously experienced a concussion, it is important to be aware of environmental and behavioral risks that may lead to another concussion.
References
- MedlinePlus. “Concussion.” National Library of Medicine, n.d. https://medlineplus.gov/concussion.html
- CDC. “Brain Injury Basics.” HEADS UP | Centers for Disease Control and Prevention, n.d. https://www.cdc.gov/headsup/basics/index.html
- familydoctor.org. “Concussion in Kids.” familydoctor.org | American Academy of Family Physicians, Updated January 2021. https://familydoctor.org/concussions-in-kids/
- Ropper AH & Gorson KC. Concussion. N Engl J Med 2007; 356:166-172. DOI: 10.1056/NEJMcp064645
- Lincoln AE, Caswell SV, Almquist JL, et al. Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study. Am J Sports Med 2011; 39(5):958-963. DOI: 10.1177/0363546510392326
- CNN. “NFL Concussions Fast Facts.” CNN, Updated April 2022. https://www.cnn.com/2013/08/30/us/nfl-concussions-fast-facts/index.html
- Raypole C. “Sleeping After a Concussion: What You Should Know.” Healthline, June 2019. https://www.healthline.com/health/concussion-and-sleep
- Ibañez J, Arikuan F, Pedraza S, et al. Reliability of clinical guidelines in the detection of patients at risk following mild head injury: results of a prospective study. J Neurosurg 2004; 100(5):825-834. DOI: 10.3171/jns.2004.100.5.0825