How is a concussion diagnosed?
Dr. Bottiglieri: Symptom reporting by the injured athlete remains the most important factor for diagnosing a concussion. Concussions won’t be detected on routine brain imaging, though we do sometimes get CT scans or MRIs to check for complications like brain bleeding or a fractured skull. So unless there’s an outward sign, we rely on self-reporting and examination. This is challenging because it means we rely on children, adolescents, and highly motivated collegiate or professional athletes to report an injury during practice or a contest. The desire to keep playing versus the potential for catastrophic injury can lead to conflict for individuals who might not want to admit they are injured. But if an athlete says they have any symptoms of a concussion, they should be pulled and checked out by a medical professional. A trusted health care partner in an athletic program or a physician is essential for accurate decision making and timing of return to play.
Dr. Noble: The worst-case scenario is not reporting symptoms and then getting another head injury before the brain is healed. If someone hasn’t fully recovered from a concussion, returns to the sport too early and then gets hit in the head again, the new brain injury can be far more serious. That’s why it’s important to teach athletes from a young age that it’s OK to say they’re hurt. They should be cleared to play by their doctor before returning to the sport.
What should you do to recover from a concussion?
Dr. Bottiglieri: If diagnosed with a concussion, activities that require focus and concentration, like reading, writing or working on a computer, should be limited for the first few days after a concussion, or only done if feeling well and not causing worsening of symptoms. The same way a pitcher would rest their arm if they sprain their elbow, you want to give your brain time to heal. At the same time, athletes should not completely avoid all these activities, as being away from friends, family, and the routines of life can be upsetting too, especially for young athletes.
Exercise is also key to recovery. Gradually introducing exercise is therapeutic and promotes healing. If concussive symptoms start to subside after a day or two of rest, the person can do some light aerobic exercises. If the symptoms get worse, they should stop. But if they’re able to handle a brisk walk or 15 minutes on a stationary bike, then more intensive workouts can be gradually introduced. Sometimes there are other injuries which happen with a concussion like whiplash (a neck sprain), and for that we may advise physical therapy.
Is it safe to go to sleep after a concussion?
Dr. Noble: There is a myth that after a concussion a person should not go to sleep. The key issue is it is important to be able to observe someone for a few hours after they have had a concussion. For instance, during that time window there is a serious, but thankfully rare, complication that may occur: a life-threatening bleed in the head. So if someone looks like they are going to sleep shortly after being pulled to the sideline, or they look tired and unwell within the first hour of a concussion, they should be kept awake until they see a medical professional.
Dr. Bottiglieri: Sleep is one of the most important parts of treatment. It’s restorative, regenerative, and it’s one of the key things we emphasize in concussion treatment. With all the pressures of academics, work, and sports, it’s important to emphasize to athletes the need to take time to focus on recovery, with an aim to have life and sports return to normal as soon as possible.