Concussions: A Guide for Players and their Parents

Concussions: A Guide for Players and their Parents

  • Concussion; or mild traumatic brain injury: “trauma-induced alteration in mental status that may or may not involve loss of consciousness”. This trauma can come from a direct force (like a head-to-head collision) or an indirect force (such as whiplash). This results in the brain not working as it should, as well as potential for brain swelling and other more serious conditions.
  • In sports medicine, we are working to promote the terminology of concussion or mild traumatic brain injury. This is opposed to old terms like “ding” and “bell ringer”, or other terms that minimize the seriousness of head injuries.
  • Signs and Symptoms of a Concussion:
  • Important note: you do not have to have a certain number or combination of these symptoms to have a concussion.
  • Red Flags= go to Emergency Department/call 911:
    • Decreasing level of consciousness, loss of or in-and-out of consciousness
    • Increasing confusion
    • Increasing irritability
    • Numbness in arms or legs
    • Pupils become unequal in size
    • Repeated vomiting
    • Seizures
    • Slurred speech, inability to speak
    • Inability to recognize people or places
    • Worsening headache
    • Intense or worsening neck pain
  • Dos and Don’ts after a Concussion Diagnosis (generally before you see a physician, then clarify care instructions with them):
    • You can:
      • Take acetaminophen (Tylenol) for headaches if needed (inform doctor if taken)
      • Use an ice pack on head/neck for comfort
      • Eat a carbohydrate-rich diet
      • Sleep!
      • Rest (no strenuous activity)
    • You don’t have to:
      • Check eyes with flashlight (light can exacerbate symptoms; if you otherwise notice an irregularity in the eyes such as a difference in pupil size, this is a red flag)
      • Wake up frequently (unless your doctor instructs this)
      • Test reflexes
      • Stay in bed
    • You should not:
      • Drink alcohol
      • Drive a car or operate machinery
      • Engage in physical activity that makes symptoms worse
      • Engage in mental activity that makes symptoms worse
    • Return to Play (RTP): this is a gradual progression of stages to follow after physician clearance. This involves a rest period, followed by a steady increase in activity (dependent upon symptoms) until we can ensure a safe return to full levels of activity. With club sports, this can be difficult to manage with the Fusion AT. Keep track of your symptoms, what they are and their severity. I have included an example of a plan that players can follow with the help of parents and coaches. If you have a school AT, they should be able to help. How this should work:
      • Stage 1 lasts until there are no symptoms at rest, at least 24 hours
      • Stages 2-5: try the stage, if you have symptoms develop or worsen, go back to the previous stage. No symptomsà after 24 hours progress to next stage.
      • Stage 6: if the player feels comfortable and confident with progression through stages 1-5, full-go in training and games
    • Multiple concussions:
      • If you have had multiple concussions, a more conservative RTP plan should be used (for example: slower progression through the stages)
      • Second-Impact Syndrome: sustaining a second brain trauma before the first trauma has resolved. This happens when an athlete returns to play too soon after a concussion, either during the same game or even later in the recovery process. This can result in much more severe brain injury, even death.
        • There is always risk in sport for concussion—especially in contact and collision sports. Remember this when making decisions about your long-term health.
      • Role of an Athletic Trainer (AT):
        • Recognize signs and symptoms of a concussion and/or see head trauma on the field
        • Remove the player from the game/activity
        • Perform a medical evaluation
        • With the clinical diagnosis (based on signs and symptoms) of a concussion, the AT will remove the player from the rest of the game. Next: a discussion with the athlete, parents/guardians, coaches about red flags and next steps. The AT will refer the player (generally to their primary care physician), who will need to provide clearance for the player to return to practice/games.
        • The AT documents this interaction.
        • After physician clearance, the AT can help with a return-to-play plan.
          • Physician clearance: you see a doctor (MD, DO) that helps diagnose, manage/treat your concussion and then clear you for participation in activity/sport when they determine it is safe. It is good practice to get a physical letter of clearance to provide to school, sports, etc.
        • ATs are not present at training, and are present at games depending on level of competition. Referees and coaches should remove players that sustain a head injury, and it is better to play it safe than sorry—see a physician before return to training or play.
      • FAQs:
        • We cannot predict injury severity and precise recovery time right after injury. However, most concussed athletes return fully within 2 weeks. This can be affected by things such as: specific symptoms experienced, age, and previous history of concussion.
        • For pediatric concussions (children and adolescents): recovery can take longer than for adults; they also require a longer and more gradual RTP progression
        • Protective equipment (helmets, headgear, mouthguards) reduce risk of injuries such as skull fractures, teeth/mouth injuries. There is no strong evidence showing that this equipment can prevent concussion.
        • School and schoolwork: if mental activity like reading and concentrating are making your symptoms worse, a note from your doctor and conversations with teachers/administrators/school nurse/school AT can help with solutions for modifying your schoolwork. Especially now with a lot of virtual learning, screens can worsen symptoms—having the option to print out work and do it on paper can be helpful.
        • For more information: see the CDC website on concussion, they have links specific to coaches, parents, officials, and players:
        • WFBH Sports Medicine Resources:
          • Greensboro: Scott Flowers, PA-C (Proehlific Park); Urgent Care—Pisgah Church
          • High Point: Dr. John Tipton (Lindsay St. and Premier); Urgent Care—Palladium
          • Winston-Salem: Dr. Heath Thornton (Miller St. and Piedmont Plaza); Urgent Care—Piedmont Plaza (also: Clemmons)

This is mostly based on the National Athletic Trainer’s Association Position Statement: Management of Sport Concussion.

Broglio, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training. 2014;49(2):245-265.

This document can be found along with other NATA Position Statements at:

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