What Is a Concussion?
A concussion is a traumatic injury to the brain that alters mental status or causes other symptoms. Many people assume that you must lose consciousness to have a concussion. However, significant injury can occur without losing consciousness at all. Contact athletes may report ringing in the ears when they have suffered a blow to the head. These symptoms are often consistent with concussion.
How Is a Concussion Diagnosed?
When a concussion is suspected, a trained coach, certified athletic trainer, or the team physician should immediately perform an initial “sideline” evaluation, including:
- Symptoms list review
- Focused neurological exam
- Focused orientation exam that tests short-term memory
- Focused orientation exam that tests long-term recall such as name, birth date, place of birth, score, or last meal
- Assessment of the athlete’s ability to stay attentive to a complex task such as reciting months backwards
If left undiagnosed, a concussion may place an athlete at risk of developing second impact syndrome — a potentially fatal injury that occurs when an athlete sustains a second head injury before a previous head injury has completely healed.
What Are the Signs and Symptoms of a Concussion?
Concussion symptoms include the following:
- Balance problems
- Difficulty communicating and concentrating
- Dizziness
- Drowsiness
- Fatigue
- Feeling emotional
- Feeling mentally foggy
- Headache
- Irritability
- Memory difficulties
- Nausea
- Nervousness
- Numbness or tingling
- Sadness
- Sensitivity to light or noise
- Sleeping more than usual or difficulty falling asleep
- Visual problems — blurry or double vision
- Vomiting
When Is it Safe to Return to Play?
All athletes who sustain a concussion — no matter how minor — should undergo an evaluation by a qualified healthcare provider before returning to play. Athletes can return to play after they are completely free of all symptoms of a concussion and remain symptom free during and after physical testing.
Returning to sports too soon can place an athlete at risk for prolonged recovery, worsening symptoms, and additional injury. A gradual return-to-play progression is recommended, allowing athletes to slowly increase physical activity while monitoring for any recurrence of symptoms. If symptoms return at any stage, activity should be stopped and the athlete should be re-evaluated.
The most important factor in determining readiness to return to sport is complete symptom resolution. Athletes should be symptom free at rest, during normal daily activities, and throughout increasing levels of exercise before returning to full participation. Working closely with a healthcare provider helps ensure a safe recovery and reduces the risk of future complications.