When it comes to concussions “better safe than sorry” definitely applies. Early removal from play and activity, monitoring for neurological changes, and a gradual return to learn and play are key.
If you suspect a concussion:
- Immediately remove from play
- Notify medical team and monitor closely
- Don’t allow athletes to “ workout through it”
- Schedule follow up with Alpha Sport Performance Medicine
Watch out for these dangerous symptoms:
- Worsening headache
- Repeated vomiting
- Seizures
- Unequal sized pupils
- Increasing confusion
- Weakness in limbs
Concussion Management includes:
- Day 0- Immediate removal from play and activity
- Day 1-2 – Relative Rest
- Day 2- Follow up with medical provider
- Day 2-4 Week- Gradual Return to Learn & Play Protocol
A concussion is a traumatic brain injury that needs to be taken seriously. Understanding the different phases of treatment will ensure athletes recover properly while minimizing their risk for long term brain injury.
Knowing how to treat a concussion is crucial for sports medicine clinicians, coaches, athletes and parents. These are our concussion management guidelines.
The Immediate On-Field Management of a Suspected Concussion
If you suspect a concussion:
- Remove athlete from play NO EXCEPTIONS
- Maintain cervical spine precautions if needed
- Monitor athlete’s symptoms and conduct basic neurological checks
- Awake and alert?
- Where are we? Who’s on the team?
- Can you repeat these five words?
- Seek emergency care if any red flag symptoms are present
- Do NOT allow athlete to return to play the same day
Red Flag Symptoms:
- Worsening headache
- Repeated vomiting
- Slurred speech
- Unequal sized pupils
- Seizures
- Weakness in arms and legs
- Increasing confusion
- Loss of consciousness
SIDELINE EVALUATION OF A CONCUSSION
How do we evaluate for a concussion?
- Begin with standardized evaluation like the Sport Concussion Assessment Tool 5th edition (SCAT5)
- Evaluate symptoms
- Repeat neurological checks
- Administer additional tests as needed
- Maddocks questions
- King Devick test
- Balance testing
- Document time of injury, witnessed signs, and initial testing scores.
THE FIRST 1-2 DAYS
The first 24-48 hours after a concussion are crucial. Athletes should:
- Avoid athletic activity
- Limit screen time
- Get rest, both physically and cognitively
- Avoid loud environments and lots of bright lights
- Follow up with your medical provider in 24-48 hours
After 24-48 Hours
After 24-48 hours, if athletes are symptom free they can gradually begin a return to learn and play protocol. The athlete should not:
- Drive
- Compete in sports
- Return to school (full attendance)
A symptom free athlete can BEGIN the graduated return to play protocol.
Symptoms of a concussion can appear instantly or hours after the initial injury. If symptoms such as headache, dizziness, nausea, lack of ability to concentrate, or fatigue become worse or appear after 24-48 hours, athletes should seek medical attention.
THE GRADUAL RETURN TO PLAY PROTOCOL
Once an athlete has been evaluated by a medical professional and is symptom free, they can begin a graduated return to play protocol.
It is important to only progress to the next level if you have been completely symptom free at the current stage.
Remember, each step in the protocol can take at least 24 hours.
Return to Play Protocol
- Level 1 – Resume daily activity as long as it doesn’t bring on symptoms. Begin light aerobic exercise such as walking.
- Level 2 – No symptoms with daily activity. Add sport specific exercise such as skating for hockey or running for soccer.
- Level 3 – No symptoms with daily activity and sport specific exercise. Add sport specific drills and light weight lifting.
- Level 4 – No symptoms with daily activity, sport specific exercise, and sport specific drills. Athlete can participate in contact practice.
- Ready to Return – Athlete has been cleared by their medical professional to return to play.
CONCUSSIONS AND RETURN TO LEARN
Just as athletes need to go through a gradual return to play protocol, they should also go through a return to learn protocol.
This allows athletes to slowly work their way back to full cognitive load. It is recommended that athletes:
- Take frequent breaks
- Work up to regular school hours
- Reduce homework load
- Ask for extensions on assignments
- Take tests in a quiet environment.
- If needed, ask for note taking assistance.
Throughout the return to learn process, the athlete and caregivers should keep track of their cognitive energy. If it feels like too much, scale back.
Who Needs to be Involved in Return to Play Decision?
Ideally concussion management will be handled by a team of people.
Athletes should never feel uncomfortable telling their coach, trainer or doctor about symptoms.
Medical Clearance to Return to Play:
Before an athlete returns to play, they should be:
- Asymptomatic at rest
- Completed all grades of activity
- Have a normal neurological examination
- Cognitive function is similar to their baseline (pre-injury level)
Your medical provider may also require neuropsychological testing before returning to play. Alpha Sport Performance Medicine uses the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT).
RETURN TO FULL CONTACT
An athlete can resume full contact sports once they have been through all grades of activity without symptoms and have been cleared by their medical professional.
SECOND IMPACT SYNDROME
When an athlete sustains a second brain trauma before symptoms from the first have resolved it’s called Second Impact Syndrome.
Second Impact Syndrome is one hundred percent preventable by following return to play guidelines.
HELP PREVENT CONCUSSIONS
There is no sure fire way to prevent concussions, but there are ways to reduce risk.
Always make sure athletes:
- Are wearing properly fitted protective equipment
- Learn and utilize proper technique
OTHER CONCUSSION PREVENTION TIPS
- Get enough sleep
- Manage stress
- Gradually increase workload
Frequently Asked Questions
Q: What should I do if I suspect a concussion?
A: Remove the athlete from play and seek medical attention. They will not return to play that day.
Q: How long should I rest if I have a concussion?
A: Concussion recovery includes relative rest for the first 24-48 hours. Complete rest is followed by a gradual return to learn and play.
Q: What are red flag symptoms I should watch for after a concussion?
A: Seek immediate medical attention if you experience worsening headache, repeated vomiting, seizures, unequal sized pupils, weakness in limbs, or increasing confusion.
Q: When can athletes return to contact sports?
A: Athletes may return to contact sports after being cleared by their medical professional.
Q: Can concussions have lasting effects?
A: Yes. That is why it is so important to properly manage and treat them. Concussions that are not managed correctly put athletes at risk for long term brain injury.