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Concussion Management

A concussion is a complex pathophysiological process affecting the brain, usually induced by traumatic biomechanical forces. It is a functional, rather than structural, injury that results from shear stress to brain tissue caused by rotational or angular forces—direct impact to the head is not required. 

What does that mean? It makes a concussion complex – it’s is not a bruised brain. Certain forces on the brain cause a destructive neurometabolic cascade of events in which the brain is injured beyond a normal mishap. That kind of stress dysfunction usually resolves spontaneously, but not always.  

Concussions are a common injury and relatively short-lived, with most people recovering within 2-3 weeks. Even though these symptoms resolve quickly, the athlete requires care from a physician who specializes in concussion to help with return to play/return to academic decisions. Things can get much worse if return to play is premature including the deadly second impact syndrome.  In 15-30% of cases, people have “prolonged recovery” and require medical attention to improve. It takes between 22-30 days for the brain to fully recover metabolically – even if symptoms are fully gone. Following this time period, another reason may be the driving factor for continued symptoms. Some of the common factors are physiologic, vestibulo-ocular, and cervicogenic. We have specialists in these areas that can progress a patient safely and return to function.  

Symptoms and complaints can consist of, but are not limited to: 

  • Headache 
  • Dizziness 
  • Sleep impairments 
  • Blurred vision 
  • Fatigue 
  • Light/sound sensitivity 
  • Nausea/vomiting 
  • Drowsiness 
  • Light-headedness 
  • Confusion 
  • Depression 
  • Disorientation 
  • Inability to focus 
  • Anxiety 
  • Irritability 

So if you have a concussion, how long before you can return to sport? 

Concussions are like snowflakes, no two are exactly alike. Some that seem serious at first resolve quickly and others that seem small can linger. So be patient and give your brain time to recover….we are talking about your brain! 

In the state of North Carolina, a concussion protocol is required to be completed with a physician who specializes in concussion management for an athlete to return to play. The athlete will go through stages of activity without symptoms and assure that eye movement, balance, and neurocognitive testing return to baseline before being cleared. There is a return to play protocol that takes an athlete through stages and at minimum will take a week to complete. This protocol usually begins once symptoms subside. 

You will progress from minimal cardio/strength activities to non-contact sport and finally to contact. These stages ensure the athlete is safe to return. It is important to complete all six steps of the process prior to returning to avoid lasting injuries. 

For those having prolonged recovery, concussion rehab with a vestibular certified therapist can greatly impact your progress and minimize recovery time.  

Do you have questions about an injury such as: 

  • I hit my head, does this mean that I have a concussion?  – not necessarily – it takes between 70g-120g of force to sustain a concussion, so small/light hits don’t typically injure the brain. However, if you have a mechanism of injury and at least one symptom, then you should have this checked out.  
  • How long should I rest afterwards? – About 24-48 hours max. After this, short walks and attempting normal daily activities symptom free will help the brain to recover quicker.  
  • The sunlight hurts my eyes, should I wear sunglasses all the time? – No. Think of how your eyes feel after a mid-day movie… wearing sunglasses in all situations will cause your eyes to become very sensitive and in some cases even more so than before the injury. 
  • Do children or adults heal faster from concussion? – Actually, the recovery time frame for a child is longer than that of an adult. They may need longer time away from school or with modifications upon return than an adult.  
  • Does heading the ball lead to concussions? – No. About 70% of concussion injuries come from player-to-player contact – such as head to head, head to elbow, head to knee. Other injuries can occur via goal post, ground or the ball hitting the head without intent.  
  • Am I more likely to get injured in a game or practice? – Being injured in a game is 3-14x more likely than being injured in practice. Certain positions are also more likely than other such as a goalie in soccer or a QB in football.  

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