The first thing to do if you think that you have suffered a concussion while playing sports is to get off the field of play and tell your coaches, parents, or athletic trainer.  Athletic trainers have specialized training in concussion injuries and are your best resource for concussion injuries in the community.

Athletic trainers are available at most high schools to evaluate athlete injuries.  TRIA also has an athletic training room open Monday through Thursday from 2:00-6:30, Friday from 2:00-5:30, and Saturday from 9:00-12:00 to assess your injuries and advise on whether further medical care is necessary.  Coaches have to do mandatory concussion training.  Letting one of these people know can help you get to the right person to manage the injury. 

Do not try to play through the concussion symptoms that you are experiencing.  Trying to play through concussion symptoms only makes the injury worse.  Most athletes will start to experience more headaches, dizziness, fogginess, nausea, and fatigue by pushing through their symptoms. This only delays the brain’s recovery after a concussion.

The brain will use up all of its energy reserves while trying to heal so it needs to borrow energy stores from muscles and other areas of the body.  If you work out too much then you deprive the brain of the energy it needs to recover and your symptoms will last longer.

Seek a medical evaluation by an appropriate health care provider specifically trained in concussion management, such as a sports medicine physician or athletic trainer.  According to MN state law, athletes with concussion symptoms need medical clearance before returning to play.

Concussions are often difficult injuries to assess.  Unfortunately, we do not have one single test to diagnosis a concussion or predict the length of recovery.  That’s why it is important to have a full medical evaluation to make sure the injury is fully assessed and a treatment plan is in place.

TRIA has assembled a specialized concussion care team to handle concussion injuries and return to play decisions.  Our goal is to accurately diagnosis concussions, develop treatment plans individualized for each athlete, and identify those at risk for longer term symptoms. 

Rest is important for the reasons previously described and so you do not feel worse during the day.  Pacing your daily activities and tasks will help you manage academic requirements so that athletes do not get too far behind in their studies.

Getting far behind in school often leads to anxiety and a sense of being overwhelmed.  Being in the right frame of mind, feeling well physically, and having a positive outlook on your recovery, will help you manage concussion symptoms better.

Once you’re feeling back to normal with day-to-day routines are you ready to jump right back into play?  NO!  Before returning to the field of play, you should follow a stepwise return to play protocol that tests your body’s response to physical exertion.  Sometimes after a concussion injury you will feel fine at rest but when you exercise or do coordinated athletic drills, concussion symptoms will return.

Following the recommended five step return to play protocol helps an athlete know whether symptoms are completely gone before risking further injury in a game setting.

5-Step Return to Play Protocol to be started once symptom free at rest:

Step 1: Light aerobic activity
The Goal: Only to increase an athlete’s heart rate.
The Time: 5 to 15 minutes.
The Activities: Exercise bike, walking, or light jogging.
No resistance training, jumping or sprinting.

Step 2: Moderate activity
The Goal: Limited body and head movement.
The Time: Reduced from typical routine.
The Activities: Moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Step 3: Heavy, non-contact activity
The Goal: More intense but non-contact
The Time: Close to typical routine
The Activities: Running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.

Step 4: Practice & full contact
The Goal: Reintegrate in full contact practice.

Step 5: Competition
The Goal: Return to competition.

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Working with concussion patients, I hear a lot of questions and concerns from both the athlete and their families surrounding the diagnosis of concussion. Hockey players at all levels make up a large percentage of our patient population. Here are a few of the most commonly heard misconceptions surrounding concussion management.

1. You must avoid all activities after a concussion.
   • Avoiding activities that trigger an increase in symptoms are important to limit early on, but avoiding all activity is not necessary. A progressive, symptom – dependent progression of activity is recommended. A full return to sports should be done after being cleared by an appropriate medical professional.
2. To truly have a concussion, you must lose consciousness or “blackout”
   • Only five to ten percent of concussions result in a loss of consciousness. A concussion is caused by either a direct blow to the head, neck, face, or by a force directed somewhere else in the body that transmits force to the head. Symptoms can occur immediately or may evolve over time. In fact, there is debate on whether a loss of consciousness can even be an indicator of concussion severity. Recent consensus states that a loss of consciousness does not affect the long term prognosis or the overall recovery for a patient post-concussion.
3. The best helmet or mouth guard can prevent a concussion.
   • There is no evidence that protective equipment will prevent a concussion. Mouth guards and helmets have an important role in preventing dental and skull injury as well as more severe traumatic brain injuries so should still be worn for those reasons, but do not provide prevention against a concussion. The risk of concussion is not affected by the brand, age or style of a helmet or a mouth guard.
4. It is important to awaken a person post-concussion every 20 minutes, and shine a light in their eyes to check their status.
   • A change in pupil reaction, or large change in mental status indicates a more serious brain injury. These changes would not occur if the patient had suffered only a concussion. A clinical evaluation by an appropriate medical professional can help assist in the diagnosis of a concussion versus a more serious brain injury.
5. MRI/CT are necessary to diagnose a concussion.
   • A concussion is a functional change rather than a structural injury to the brain, so no abnormalities are typically seen on standard imaging like an MRI or CT scan. A brain MRI or CT scan contributes little to the diagnosis of a concussion and should only be used if the medical professional is suspicious of a structural problem – for example, hemorrhage, skull fracture etc.
   • The diagnosis of a recent concussion usually involves a clinical assessment of several domains such as:
     1. Symptoms – headache, fogginess, emotional symptoms
     2. Physical signs – amnesia, potential loss of consciousness
     3. Behavior changes – irritability
     4. Cognitive impairments – slowed reaction time
     5. Sleep disturbance – such as insomnia

Some of the information above was taken from the Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport.

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About TRIA Orthopaedic Center

TRIA is a comprehensive center for orthopaedic medicine, providing incomparable clinical and surgical care, world-class research, and innovative programs. TRIA Orthopaedic Center has over 40 highly-trained physicians with a variety of sub-specialties such as sports medicine, acute injury, shoulder, hip, knee, spine, hand and wrist, foot and ankle, and fractures. TRIA’s sports medicine specialists have served as official team physicians for Minnesota’s professional sports teams for over 25 years. TRIA offers walk-in care through the Acute Injury Clinic, 8:00 a.m. to 8:00 p.m. seven days a week, no appointment needed. From diagnosis to treatment, to rehabilitation and even surgery, it is all at one convenient location at I-494 and France Avenue in Bloomington, Minnesota. For more information, visit tria.com.

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