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Ask the Expert: Concussions

brain diagram

Q1. What is a concussion?

The term concussion comes from the Latin word concutere, which means to shake violently. Based on our current understanding, a concussion is defined as a complex pathophysiological process affecting the brain and largely reflects a functional disturbance, which is generally self-limited. It can be caused by either a direct blow to the head or by an indirect force to another part of the body that is transmitted up to the head causing the brain the hit the inside of the skull.

Q2. What are the symptoms of a concussion?

There are many symptoms that can occur with a concussion and each one can present differently, which is why it is important to increase concussion education and awareness among players, parents, coaches, and other medical professionals. Headache is the most common symptom reported with dizziness being the second most common, though it is possible to suffer from a concussion without either of these symptoms. It is important to recognize that loss of consciousness only occurs in about 10% of concussions, which means that loss of consciousness will not occur with most concussions. Many other symptoms including nausea, vomiting, neck pain, blurred vision, sensitivity to light or noise, feeling in a fog, or general changes in behavior should raise suspicion for a concussion and should prompt medical evaluation.

Q3. What should be done when someone suffers a concussion?

If someone suffers a concussion while playing sports, the athlete should be immediately removed from play without the ability to return even if symptoms appear to resolve shortly afterwards as symptoms occasionally don’t show up for 24-48 hours. They should then be evaluated by a medical provider who is knowledgeable in concussions in order to determine if the athlete needs to undergo further evaluation in the emergency room or if they can safely return home with specific instructions and precautions discussed with the parent or person that will be caring for them over the next several hours. While individuals with suspected concussions may have more serious head injuries, it is important to understand that emergency room physicians may not be trained to recognize concussions symptoms and it may be prudent to see a physician that specializes in these injuries, often primary care sports medicine physicians. Prior to returning to play, the athlete should be evaluated by a physician who is experienced in the treatment of concussions. They will help to determine when the athlete is safe to begin a graded return-to-play protocol. Return to full, unrestricted play should only occur if there is no recurrence of any symptoms while increasing both mental and physical activities. Whether an individual is a student-athlete or working adult, a return-to-learn or return-to-work program should also be instated to ensure readiness for cognitive activity.

Q4. How long do concussions usually last?

Most concussions are self-limited and will resolve within 7-10 days for fully developed adults, while children tend to take longer to recover, typically 2-3 weeks. That said, only about 75% of concussions resolve within this “normal” window. It is important to recognize that every concussion can present differently and recovery can also vary from individual to individual and from concussion to concussion. Following a concussion, the athlete should continue to work with their health care provider to develop an individualized treatment plan in order to achieve full resolution of symptoms and return to their previous level of activities.

Q5. How many concussions can someone have before they should stop playing sports?

There is no specific number of concussions that determines when someone should stop playing sports. However, concerning signs may include if concussions are appearing to be sustained more easily (lowering of threshold), occurring more frequently, or having a longer duration of symptoms and prolonged recovery with each subsequent concussion. Each case should be treated on an individual basis and it is encouraged to discuss any of these concerns with your healthcare provider.

Reviewed on September 17, 2020 

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.