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Concerned About Sports Concussion Symptoms? Q&A With a Sports Doc

If you’re a parent of an athlete, you’re probably concerned about sports concussion symptoms. Your Teen asked Dr. Richard Figler, who practices sports medicine at the Cleveland Clinic, to help us understand when to worry.

Q: What causes a concussion?

Figler: A concussion is an injury to the brain that typically does not cause structural damage. It is usually caused by a traumatic force to the brain—either a direct blow to the head or a hard blow to the body that results in rapid head movement. Concussions can result from a hard hit or just a glancing blow.

Q: What are the signs and symptoms of a concussion?

Figler: Concussion symptoms can range from mild to severe. They can include a headache, blurred or double vi­sion, hypersensitivity to bright lights or noises, nausea, vomiting, balance issues, orientation problems, amnesia, fatigue, or lack of concen­tration. Signs and symptoms usually show up immediately, but occasionally they present a few days later. Most people who have concus­sions do not lose consciousness.

Q: Are there different kinds of concussions?

Figler: At one time, concussions were graded and classified as either simple or complex depend­ing on how long it took for the signs and symp­toms to clear. We no longer grade or classify concussions; we just know that some concus­sions take longer to heal than others.

Q: What influences the manage­ment of concussions?

Figler: Loss of consciousness, although not neces­sarily a predictor of severity, is usually dealt with differently, especially on the field of play. Someone who is unconscious is typically treated similar to a neck injury. Safety is par­amount in that situation and we tend to err on the side of caution. Otherwise, we usually tailor treatment according to the concussion symptoms. For example, if someone is very sensitive to light, they may need to wear sunglasses inside to avoid making their symp­toms worse.

Q: What should parents do if they suspect their teen has a concussion?

Figler: Remove the teen from all physical activity and tone back on mental activity. Make sure symp­toms are not worsening, and breathing and speaking are normal. Don’t let your teen return to play until a health care professional with ex­perience in concussions gives clearance.

Q: When would a CT scan or an MRI be necessary?

Figler: Typically, a trained professional examines the patient and determines whether any imaging like a CT scan or MRI is warranted, based on the severity of symptoms or worrisome neu­rological signs such as focal weakness or loss of vision. The imaging looks for injuries to the brain such as bleeding, however, imaging studies are typically normal in concussions.

Q: How soon can a teen resume normal activity?

Figler: When a teen is 100 percent symptom free, they can begin a graded exercise program. This is a five to six day process in which sport­ing activity is slowly reintroduced; preferably with supervision by medical personnel trained in concussion management. The athlete will progress to increasingly more strenuous exer­cises as long as they remain symptom free at each step, both during and after their activity. In essence, they have to “pass” each step along the way. For those that have symptoms lasting beyond a week, they will progress at a slower rate, as determined by the physician.

Q: What happens when an athlete returns to playing the sport too early?

Figler: The risks of returning too early can be very dangerous, and advising an athlete to return before healing from a concussion can have long lasting and potentially catastrophic con­sequences. There is a condition called second impact syndrome, which occurs when the brain sustains another injury while it is trying to heal. Unfortunately, there are athletes who have suffered permanent neurological dam­age, and in rare instances, some have died.

In most instances, returning too soon will result in a prolonged recovery. The brain needs to heal before the athlete goes back to play. Athletes that return too soon typically experience a worsening of concussion symptoms that extends recovery time. Masking a head­ache from a concussion with medicine will also prolong recovery.

Q: Many parents are concerned about concussion in teens, especially in a sport like football. What can be done to prevent it while playing sports?

Figler: At this time, there is no way to entirely prevent concussions, but there are precautions that lessen the chance of head injury. Equipment should be used properly; chinstraps should be buckled, air bladders in helmets should be pumped up, helmets must fit properly and equipment should be worn correctly and consistently. Also, coaches should be teach­ing their athletes proper tackling techniques. Important safety precautions can reduce the number of sports related concussions.

Q: Are teens more prone to concussions than adults?

Figler: There are several reasons why teens may be more prone to concussions.

  1. We think that teen brains are still matur­ing and, therefore, don’t withstand injury as well as adult brains.
  2. More teens participate in sports, so the in­cidences of concussion become higher than in any other population.
  3. Teens tend to take more risks.

Thankfully, education and media awareness about concussions are leading to faster diag­noses, allowing the athlete to receive proper care sooner.

Q: What should parents ask coaches re­garding safety?

Figler: Parents should ask whether coaches and train­ers are educated in recognizing concussions. Have they attended clinics or seminars edu­cating them about the signs and symptoms of concussion? It is important to make sure that equipment is up-to-date and in good repair. Student athletes should also be trained to rec­ognize the signs and symptoms of a concus­sion. By being aware, an athlete may be able to recognize concussion symptoms and get their team­mate the appropriate treatment.

Q: What are the consequences of repeated head trauma?

Figler: A repeat concussion that occurs before the brain heals from the first concussion can slow recovery or increase the likelihood of long-term effects. Repeated head traumas in high school and college-aged students have been associated with depression, Parkinson-like symptoms and learning issues. Research is ongoing.

Q: What is Second Impact Syndrome (SIS) and what can happen?

Figler: SIS is a rare condition in which a second concus­sion occurs before a first concussion properly heals. The brain can swell, causing compres­sion over the spinal cord. If there is still rela­tive swelling from the initial injury, the brain responds to the excessive pressure. SIS can re­sult in permanent brain damage or death.

Q: Are there certain sports in which players are more prone to concussion?

Figler: Football, hockey, lacrosse and wrestling are the most common concussions in youth sports, but athletes that play any sport are at increased risk. We have seen con­cussions in basketball, baseball, cheerleading, gymnastics, and even golf and band.

Dr. Richard Figler

Dr. Richard Figler practices sports medicine at the Cleveland Clinic.