Concussion Management

The Centers for Disease Control (CDC) estimates there is 1.6-3.8 million concussions in sports and recreational activities every year. However, because not all individuals seek medical attention this number is greatly underestimated.

What is a concussion? A concussion is a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.”

Symptoms of a concussion can present very differently among individuals. Some of the more common signs and symptoms include headache, feeling “foggy”, dizziness, difficulty concentrating, being easily confused, slowed thought processes, difficulty remembering, nausea, lack of energy, blurred vision, sensitivity to light and/or noise, and abnormal mood changes.

Post Injury Management:
When a concussion occurs it is important for the following initial steps to be taken.

• Rest, rest, rest (remove from athletic participation, decrease screen time, decrease other physical and cognitive exertion activities). Past literature used to suggest to not let the patient sleep or to wake them up throughout the night, however this is no longer the case and it’s important to let them rest unless otherwise instructed by a physician.
• See a physician that specializes in concussion management within the first 1-3 days after injury
• Stay hydrated
• Avoid physical or mental exertion, especially in the acute phases
• Decrease any activities that increase symptoms, such as TV, electronics etc.
• Avoid medications other than acetaminophen (Tylenol)
• Eat a well-balanced diet
• Academic accommodations (Physicians can prescribe accommodations to help students navigate the return to learn process.)
• Avoid ingesting alcohol, drugs or other substances

Home care:
After a concussion is diagnosed their needs to be communication between all those involved. This includes family, school personnel (coaches, teachers, counselors etc.), school medical personnel (ATCs, school nurse), and community referral sources (team physician, physical therapist and other healthcare providers). The home healthcare plan should involve frequent follow-ups with the continuing monitoring of concussion signs and symptoms. Patients and their parents or significant others need to be aware of the signs and symptoms that indicate a deteriorating condition and warrants immediate referral to the ER. Those included are listed below.

• Decreasing level of consciousness
• Increasing confusion
• Increasing irritability
• Loss of or fluctuating level of consciousness
• Numbness in the arms or legs
• Pupils becoming unequal in size
• Repeated vomiting
• Seizures
• Slurred speech or inability to speak
• Inability to recognize people or places
• Worsening headache

Return to Play Criteria:
It is important to note no patient/athlete diagnosed with a concussion should return to sport or physical activity the same day of injury. Once an individual/athlete is diagnosed with a concussion the return-to-play progression does not start until he/she no longer reports any concussion related symptoms, has a normal clinical exam, and performs at or above preinjury levels of functioning on all objective concussion assessments.

According to the National Athletic Trainers Association (NATA) there are six stages when following a return-to play progression.
• Stage one: No activity
• Stage two: light exercise: <70% age-predicted maximal heart rate
• Stage three: sport specific activities (non-contact)
• Stage four: noncontact training drills, resistance training
• Stage five: unrestricted training (full contact)
• Stage six: return to play

It should be noted that there needs to be at least 24 hours between each stage. If at any time a certain activity returns symptoms or a decrease in test performance is seen, the activity should be immediately stopped and started again in 24 hours at the same stage the symptoms occurred previously.

Allyssa Hoopman, ATC
Certified Athletic Trainer
Physical Therapy Consultants, Inc.


information obtained from:

Broglio, Steven P., et al. “National Athletic Trainers Association Position Statement:
Management of Sport Concussion.” Journal of Athletic Training, vol. 49, no. 2, 2014, pp. 245–265., doi:10.4085/1062-6050-49.1.07.

March 7th, 2018

Posted In: General

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