My Husband’s Concussion Story
Around 8 years ago, my husband sustained a concussion and subdural hematoma from a surfing accident. The day it happened he had nearly all the red flags, and yet concussion didn’t cross my mind. I remember him vomiting profusely and rapidly and saying he just wanted to sleep. We went to urgent care and the proper care for concussion was still missed. In hindsight we should have gone to the ER. A few days later he started complaining about numbness down his whole right arm and face so I sent him for a CT scan. He ended up in the hospital for 5 days because his brain was bleeding. Miraculously he didn’t need brain surgery and recovered fully although it took many months.
This personal experience plus currently parenting two high school athletes has driven me to understanding the latest research on concussion. One of the reasons I want to provide parent tips on concussion is because I know how overwhelming and traumatic it feels when a concussion occurs. Trying to think clearly during a traumatic event is quite difficult.
What is a Concussion?
A concussion is a mild traumatic brain injury (mTBI) usually resulting from a blow to the head from a fall, car accident, or sports injury. A concussion can also be caused by a hit to your body that whiplashes the head and neck. In the United States, each year, there are an estimated 1.7 million – 3.8 million concussions that present to the emergency room. This number is most likely higher as it only constitutes people who have sought medical care.
A concussion does not always need a trip to the ER like my husband’s experience did. Yet it is still important to report it to your primary doctor, PT, coach, or athletic trainer as symptoms can still appear within a few days. A concussion is a clinical diagnosis meaning no brain abnormality is seen on standard structural exams like CT or MRI.
Trained health professionals use objective and subjective testing to determine if a concussion has occurred and how to choose the best action plan for the individual. Seek someone experienced in evaluating concussion to determine the severity for when it is safe to return to sports and learning activities.
When in doubt check it out!
Symptoms & Red Flags
The severity of symptoms within the first few days after a concussion is the most consistent indicator of one’s prognosis. The good news is improvement is typically seen in one to two weeks post-injury.
The most typical complaints post injury are fatigue, and headache. Since the brain is the injured tissue, symptoms can range in a variety of categories including: emotional, cognitive, physical, visual, sleep, and vestibular. Some examples of symptoms from these categories include, irritability, poor concentration, poor memory, light sensitivity, difficulty focusing visually, noise sensitivity, nausea, and dizziness.
Getting the right care for these categories requires help from multiple disciplines of health care professionals. If you have the right health professional from the beginning, they can listen to your story and connect you to the best person to help your specific complaints.
At the onset of a concussion, monitoring the red flags helps you know when to seek help.
Red Flags that require immediate attention:
- Loss of Consciousness (less than 10% lose consciousness)
- Repeated Vomiting
- Slurred Speech
- Double or Blurred Vision
- Severe Headache that is worsening
- Dizziness and Loss of balance
- Drastic Mood changes
- Extreme Fatigue/can’t be awakened
- Memory Loss
- Numbness in limbs
The length of recovery is highly individualized. Around 30% of people can have symptoms that last for weeks to months which is called Post Concussion Syndrome (PCS). According to the 2017 Berlin Consensus statement, persistent symptoms are those that last greater than 1 month in the youth population; 10-14 days in adults. PCS is characterized by continued disruption of physical, sleep, emotional, and cognitive areas. It does not correlate with the severity of injury, but a previous history of concussion increases the likelihood of it developing.
Concussion management used to be “rest in a dark room for a week until symptoms subside.” While a dark room can help reduce visual over stimulation, current research recommends relative rest limited to activities of daily living and reduced screen time, up to the first 2 days after injury. Reduce screen time in the first 48 hours after injury is warranted but use your own judgment as far as symptoms are concerned. Light activity such as walking or stationary cycling is encouraged after the 24-48 hours because movement is healthy for the brain and body and promotes healing.
Too much strict rest leads to de-conditioning. Think of a concussion like you would an ankle sprain. It needs to be a gradual process of returning to function and activity. You wouldn’t stay off the ankle forever nor would you run the day after the injury. You gradually put more weight/load on the ankle until you can resume normal activity again. With concussion, it is recommended to gradually increase your tolerance to both mental and physical activities.
Since the symptom range varies it is a good idea to catalog your triggers (either mental or physical). For some it may be visual activities like reading, gaming, or phone use. It may be social interactions. Triggers may be movement induced or from activity’s that require concentration like studying.
Once you know the triggers then you can determine your threshold. For example if 5 minutes of reading is too much, then keep it at 3-4 minutes and gradually increase daily. This is highly individualized and ideally you want to seek specific professional help.
Quality sleep is another important component of concussion management. Sleep disturbance in the 10 days after a sport related concussion can increase the risk of persisting symptoms.
The 6th international conference statement on sport related concussion was released in 2023. Good news, the benefits of exercise far outweighs the risks!
Returning to activity is one area in which I really enjoy helping my concussion patients problem solve. The brain needs stimulation, the key is determining what kind and how much.
Individuals with a sport related concussion can return to light-intensity physical activity, such as walking that does not increase beyond mild exacerbation in symptoms, during the initial 24–48 hours following a concussion.
Aerobic exercise (below symptom threshold) within 2–10 days of sport related concussion is effective for reducing the incidence of persisting symptoms and is effective for recovery in athletes who already suffer from concussion related symptoms for greater than a 1 month period.
When beginning aerobic activity you will want to keep tabs on your heart rate and your symptoms. On a scale of 1-10, rate your current symptoms at rest. Begin the exercise/activity and stop if there is an increase in more that 2 points on that scale. Knowing your heart rate at the time of symptom exacerbation gives a better idea on the threshold for exercise intensity.
Athletes can continue to increase their duration and intensity based on symptom exacerbation. Symptoms should be mild and brief less than 1 hr and mo more than 2 point increase on a symptoms scale.
Athletes should avoid the contact sports until determined by a qualified health professional for a safe return.
Return to Sport Rules
Student athletes are always eager to know when they can return to sport. It is recommended that they return to learning first. They are a student before they are an athlete. Optimizing mental performance before physical helps the brain not be too over stimulated during exercise. As well sports require a certain amount of alertness, concentration, memory, and visual focus that should not get overlooked. Both returning to learning and returning to sport should be directed by a licensed health professional.
The aim to return to sport:
- Be symptom free for 24 hours
- Ability to participate in cognitive tasks such as school work and classroom environment
- Ability to elevate heart rate without symptoms (specifically tested by professional)
- Ability to participate in multidirectional movements and increased training load
- Non contact drills before adding contact
- Returning to practice before returning to game time
A health professional’s goal after concussion is to ensure athletes can succeed with challenges to multiple sensory, motor and cognitive systems. Returning too early to exercise delays the brain’s healing and function and increases the likelihood of both a second concussion and musculoskeletal injury.
A meta analysis by the American Journal of Sports Medicine found athletes with a history of concussion are 2× more likely to experience a lower extremity injury than those without a previous concussion. There are also increased odds of an ACL injury after concussion. A possible connection exists between concussion and impaired proprioception as a causative factor in ACL injury. Psychological distress and sleep disruption associated with concussion also play a factor in increasing injury risk.
This knowledge is a reminder to always report concussion in your student athlete’s history. As well, their clinical assessment for return to sport should include physical symptoms, cognitive function, lifestyle factors, psychosocial context, and neuromuscular risk factors to ensure the safest return possible. For a personalized whole person approach, book now.