Getting Back On The Field After a Concussion

By Amanda Moran ATC, LMT

Once thought of as “getting your bell rung”, concussions have been taken more seriously in the last few years. Although not all concussions result in loss of consciousness, every concussion is considered a traumatic brain injury (TBI). This injury is often prevalent in sports, but it can also result from motor vehicle accidents, slip and fall accidents, or accidental hits to the head. If you or your child sustained a concussion, do you know what steps to take to recover?

The first step is to determine if there are any red flag symptoms that should be immediately evaluated by a medical professional. Red flag symptoms include:

  1. Repeated Vomiting or Nausea

  2. Convulsions or seizures (shaking or twitching)

  3. Loss of consciousness (passed out or knocked out) even for a brief moment

  4. Slurred speech

  5. Weakness, numbness, or decreased coordination of the extremities

  6. Drowsiness or inability to wake up

  7. One pupil that is larger than the other

  8. Headache that gets worse or does not go away.

  9. Unusual behavior, increased confusion, agitation, or restlessness

If there are no red flags, the athlete should be monitored for additional symptoms that may be present. They can be classified into 4 distinct categories: Physical, Emotional, Cognitive, and Sleep/Energy. The physical symptoms relate to how the athlete’s body feels, emotional symptoms related to how a person is responsively and their affect, cognitive symptoms refer to how a person processes information, and sleep and energy symptoms are related to how those systems are impacted from the concussion.

Importance of Athletes Reporting Their Symptoms

Athletes should be honest about reporting their symptoms. If they hide their symptoms and continue to play their sport, they could experience a longer recovery time or an additional injury leading to Second Impact Syndrome. This condition occurs when an already injured brain sustains another blow, resulting in massive swelling inside the skull that can sometimes lead to brain damage or death. Upon identifying a concussion, the athlete should be removed from all physical activity including sports, gym classes, and club sports until they are medically cleared to return.

What To Do When an Athlete Sustains a Concussion

When an athlete sustains a concussion, they should be evaluated by an athletic trainer if there is one at their school. If there are no red flags that require being sent to the Emergency Room, the athletic trainer will give home care instructions to the parent. This includes monitoring for any deterioration in symptoms over the next 48-72 hours. The athletic trainer will also give suggestions for medical professionals for follow-up care. All athletes who sustain a concussion will need to be evaluated and cleared by a medical doctor before they can return to their sport. At home, athletes should be limiting their screen time as the light and ability to process information can cause an increase in symptoms.

Return To Learn Protocols

Once the athlete can tolerate a 30-minute period of concentration, returning to school should be considered. The athlete should have a gradual return to school with modifications for schoolwork, which is outlined in a protocol called “Return to Learn”.

A gradual return to school can begin with half days of school. Once the athlete can complete a half-day of school without an increase in symptoms, a full day of school can begin. Modifications for schoolwork should also be considered during this time. At the beginning of this protocol, the athlete will refrain from taking tests, should be asking for printed notes or handouts, and modify the workload to only include necessary assignments. As the athlete’s symptoms decrease and tolerance to full days of school increases, restrictions for classwork can be lifted. If an athlete has a setback with increased symptoms during the day, it is recommended they go to the nurse's office for a rest break with the possibility to return to class if symptoms decrease with the rest break.

Return To Sports

As with returning back to school, returning back to sports should also have a gradual return. Once the athlete can attend full days of school, the return to play protocol can begin. Athletic trainers will gradually increase the athlete’s cardio endurance back to in-season levels of play over the course of 5-stages. The athletic trainers will make the progressions specific to the athlete and adjust if necessary. If an athlete has an increase in symptoms during a particular stage, the athletic trainer will cease the workout for the day to allow a 24-hour rest. They will begin the stage again the following day, but if the athlete continues to have symptoms with that stage, the athletic trainer will drop the athlete down one stage in the protocol and spend some additional time working at that stage before further progression. During the progression, the athletic trainer will monitor the athlete’s heart rate and symptoms score as they perform the exercises to make sure they stay within the appropriate heart rate for that stage of the progression.

An adolescent’s brain is still developing, which is why it is important not to rush back into playing sports before the signs and symptoms have resolved. If an adolescent sustains multiple concussions over the course of their high school career or multiple concussions in a single year, termination of play may be suggested. There are many factors that go into this decision and should be discussed by the health care team with the parents and athletes included. It is most important to consider the athlete’s long-term health and safety after their time as a high school athlete.

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