Concussions and Student Athletes: Symptoms, Treatments, & Preventative Measures

Concussions are one of the top ten most common sports injuries, especially within contact sports.¹ In fact, the CDC estimates between 1.4 and 3.8 million concussions occur in the United States every year.²

With concussions being so prevalent among athletes, it’s important to know how to treat this injury properly. Below is a rundown of the signs and symptoms of concussion, as well as treatment options and prevention methods for healthcare professionals.

Key Takeaways

• Concussions are classified as mild traumatic brain injuries
• Most are caused by falls or when hit by an external force
• Symptoms vary widely, ranging from physical to cognitive to emotional
• If an athlete sustains a concussion, they should be removed from play immediately
• Recovery usually takes 7 – 10 days, but it could take longer

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What is a concussion?

What are the symptoms of a concussion?

How do you treat concussions?

How do you prevent concussions?

What is a concussion?

A concussion, also known as a sport related concussion (SRC), is classified as a mild traumatic brain injury (mTBI) caused by “blunt force or acceleration/deceleration injury to the head.”³ One of the leading causes of concussions is falls, but athletes can also sustain concussions when hit directly in the head, face, or neck by an external force like a ball or another athlete.⁴ Less than 10% of athletes that suffer a concussion experience loss of consciousness.⁵

Concussions, though common, do pack quite a punch – they can literally alter brain chemistry and function. Within the first 15 minutes to four hours after impact, the brain experiences an “energy crisis”: the neurons’ energy flow to the brain is disrupted, impacting the brain’s ability to process information.³ Biochemical changes in the brain continue to occur up to 15 days post-injury, peaking around three days after a concussion.³

What are the symptoms of a concussion?

Since concussions impact the brain at a biochemical level, the symptoms are numerous and diverse, ranging from physical to cognitive to emotional. Symptoms can last for a few short minutes or for months, so recognizing the signs is imperative in treating concussions effectively.

Physical Symptoms

The physical symptoms of a concussion may be the easiest to recognize and can include:⁵

• Headache (most common)
• Dizziness
• Impaired balance and coordination
• Nausea or vomiting
• Fatigue
• Impaired vision (double vision or blurriness)
• Slurred speech
• Light and sound sensitivity
• Glassy eyes
• Seizures
• Difficulty sleeping OR increased sleepiness

Athletic trainers and medical professionals should also be aware of the common visual signs of concussion in athletes. These visual signs, which are exhibited after impact, include being slow to get up, impaired motor coordination, and blank or vacant stares.⁶

Cognitive Symptoms

Concussions affect the brain as much as they do the body. Sport-related concussions can be especially impactful within the first 24 – 72 hours after injury,⁴ and cognitive symptoms can include:⁵

• Impaired short- or long-term memory
• Confusion
• “Fogginess”
• Difficulty concentrating
• Slowed processing and reaction times⁴

Emotional Symptoms

While emotional changes are not usually associated with concussion symptoms, there are quite a few ways concussions can affect an athlete’s emotional state. Symptoms of this nature include:⁵

• Irritability
• Restlessness
• Anxiety
• Depression
• Mood swings
• Aggression
• Decreased tolerance of stress
• Change in personality or behavior

How do you treat concussions?

Sideline Evaluation

The first critical step in treating concussions is taking the athlete out of play immediately—failure to do so could result in worse injury or second-impact syndrome.⁵ The athletic trainer or medical professional on site can then perform a sideline evaluation, addressing any first aid concerns before testing for a concussion.⁴ Commonly used tests for initial concussion screenings are the SCAT5 and the Standardized Assessment of Concussion test (SAC), though neither should replace a full neurological evaluation. The athlete should not be allowed to return to play on the day of the injury.⁴

Sideline Evaluation Tools

Continued Treatment & Return to Sport

For the next 24 – 48 hours after injury, a period of time called the “acute phase,”⁴ it’s important for the concussed athlete to rest both physically and mentally to allow the brain to heal from impact.⁵ During this rest period, do not overload either the brain or the body with activity.⁵

After that initial rest period, the athlete can gradually become more active but must stay below their “exacerbation threshold,” which is the point at which activity worsens symptoms.⁴ This gradual return to normal activity should be an individualized graded plan, meeting the needs of the individual athlete and their unique symptoms.² Athletes should not participate in contact-risk activities during this time.²

Certain physical therapy treatments have been found particularly helpful for certain symptoms. For example, vestibular physical therapy may help reduce dizziness and improve balance in concussed athletes.⁵ For headaches, a physical therapist may prescribe certain stretches, strength and motion exercises, eye exercises, specialized massage, or even electrical stimulation.⁵

Vestibular Exercise Products

While the majority of concussions resolve within 7-10 days,³ it may take up to 30 days depending on the severity of the injury.⁴ Often, the length of recovery time is linked to the severity of the athlete’s initial symptoms—the more serious the symptoms, the longer the recovery time.⁴ It’s also important to note that while the functional symptoms may have lessened or disappeared within 7 – 10 days, the biochemical changes may not have diminished.³ Recovery from a concussion may also be longer for those who have suffered from past concussions.⁵

Once the athlete’s symptoms have resolved, it is safe for them to return to play.⁵ Neurocognitive testing, standardized checklists, or the athlete’s pre-injury baseline performance are good indicators of recovery from concussion.

How do you prevent concussions?

Unfortunately, there isn’t much research or data that speaks into proven methods for preventing concussions, especially in contact sports like hockey or football where helmets are mandatory.⁴ However, a study involving skiers and snowboarders suggests helmets do reduce overall head injuries in those respective sports, and disallowing body checking in youth ice hockey (ages 13 and below) also reduced the risk of concussions.⁴ The data regarding mouthguards in contact sports is mixed.⁴

Overall, a good rule of thumb for concussion prevention is athlete education. Ensuring athletes are aware of the risk factors and are taught proper techniques for actions like tackling and falling is important for reducing the risk of concussion, especially in high concussion risk sports like soccer, American football, and Australian rugby.² Many football leagues, including the NFL, are also working toward increased safety by implementing new rules such as limiting contact in football practice, banning certain drills, enforcing stricter penalties, and teaching improved tackling techniques.⁷

The Q-Collar was specially designed to help decrease an athlete’s risk of concussion – testing has shown it can reduce deceleration by up to 30%.

Recap

Concussions are one of the most common sports related injuries,¹ with between 1.4 and 3.8 million occurring every year in the United States.² Classified as a mild traumatic brain injury, concussions cause a wide range of symptoms, including physical, cognitive, and emotional symptoms, with duration depending on the severity of the injury. The best treatment for a concussed athlete is rest, with an individualized graded activity plan to help them return to play. While recovering, it is important not to overload the athlete either mentally or physically to avoid worsening the injury and lengthening the recovery process.

Additional Resources

• Athletic Trainers Discuss Concussions

References

1. “Top 10 most common sports injuries.” UnityPoint Health. (n.d.). Retrieved May 20, 2022, from https://bit.ly/3QHBDoF
2. Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S., Gioia, G. A., Gronseth, G. S., Guskiewicz, K., Mandel, S., Manley, G., McKeag, D. B., Thurman, D. J., & Zafonte, R. (2013). Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24), 2250–2257. https://bit.ly/3SKquoD
3. Wolf, C., & Fast, K. (2017). "Put Me Back In, Coach!" Concussion and Return to Play. Missouri medicine, 114(1), 36–39. Retrieved from https://bit.ly/3zOC7ST
4. McCrory P, Meeuwisse W, Dvorak J, et al. “Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.” British Journal of Sports Medicine 2017; 51:838-847. https://bit.ly/2X0ncRz
5. Mucha, A. (2018, March 7). Physical therapy guide to concussion. Choose PT. Retrieved May 9, 2022, from https://bit.ly/3QhlfLv
6. Elbin RJ, Zuckerman SL, Sills AK, Crandall JR, Lessley DJ, Solomon GS. Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League. Neurosurgery. 2020 Sep 1;87(3):530-537. doi: 10.1093/neuros/nyaa072. PMID: 32294198.
7. National Football League. (n.d.). Youth Football Safety and Injury Prevention. NFL Flag. Retrieved July 13, 2022, from https://bit.ly/3driSHt

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