Concussions differ so widely that it takes skilled health care providers and trainers to properly assess, treat and make decisions on return to play (RTP) with a variety of assessment tools. Remember that nerve cells in the brain are extremely fragile and vulnerable to re-injury at this time and there are good systems in place to minimize the individual’s risk of further damage.  Premature mental tasks, physical tasks and stress delays healing and therefore direct communication amongst school staff, coaches, trainers, physical therapists and providers offers maximum success for a full recovery.

Once the person’s symptoms have subsided at rest and with mental challenges (headaches, dizziness, visual disturbances, increased sensitivity to light and sound, agitation, loss of memory, uncoordinated movements and loss of balance are examples), they are likely ready for conditioning. According to the American College of Sports Medicine and other published literature on the safety and efficacy of  the rehabilitation process, the following 5 day progression can be implemented.

Day 1: Light aerobic exercise for 5-20 minutes which can include a stationary bike, stair climbing, rowing, a brisk walk, or elliptical machine, to name a few options.

Day 2: Aerobic exercise at moderate intensity and to continue up to 20 minutes, as tolerated

Day 3: Interval training, sprinting or otherwise high intensity aerobic exercise

Day 4: Contact exercises begin but in controlled, supervised setting

Day 5: Return to sports without limitations/restrictions

It is so important it bears repeating that this is not “one size fits all.” Individuals must be assessed all along to observe for any changes in coordination, balance and ability to concentrate and follow directions, as well as be symptom free.

Concussions are a common topic as regulations are in place amongst team sports in the United States. Information floods the internet for parents, coaches and caregivers, and for the lay person, this can be overwhelming. My goal here is to highlight a few facts and offer suggestions to help avoid unnecessary dangers to kids having had suffered a concussion.

Concussions can happen by any blow to the body which results in a disruption to a normally functioning brain and causes neuronal shearing. This may not include a hit to the head (less than 10%) and often does not include unconsciousness. Most incidents include a resolution of symptoms in 2-3 days. Also, whiplash associated disorders (WAD) are common in conjunction with concussions due to the rapid deceleration of the neck on the head. Symptoms from WAD can take longer to subside.

Typical complaints after concussion include, but are not limited to, headaches, nausea, dizziness, balance issues, difficulty with memory, depression, double or blurred vision, light/noise sensitivities, confusion, and sluggishness. Furthermore, what a coach, parent or friend might see are clumsy movements, mood changes, personality changes and/or difficulty answering simple questions.

Here is what everyone needs to know and follow. Any person who is suspected of suffering a concussion needs to be systematically evaluated by a trained health care provider and at that point determined if imaging of the brain and/or neck is warranted. The good news is that the examination is thorough, objective and offers a lot of information very useful for rehabilitation purposes, should that need arise. Only after this evaluation will it be determined if the person is safe to return to play (RTP). Because the nerves in the brain are injured, they are very susceptible to re-injury and the likelihood of long term damage rises. Multiple concussions are dealt with much more conservatively as the health risks rise.  Almost half of athletes do not report symptoms after suffering a concussion. Be aware and on the lookout for symptoms and complaints to show up a few days after the incident. This warrants a visit to a trained health care provider for guidance on activity restrictions, rehabilitation strategies for optimal healing, and a safe plan for RTP.

My next week’s blog will discuss successful rehabilitation strategies to minimize long term adverse effects, provide education and use a systematic approach to evaluating safety in returning to activities.