What is a concussion?
A concussion, or mild traumatic brain injury, is a brain injury that occurs when the brain moves quickly within the skull.
This sudden movement interferes with brain function, which causes a disruption and affects how parts of the brain communicate.

Concussions are serious. Medical providers refer to a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious. 

How can you suffer a concussion?
Concussive injuries are not unique to athletic events. Any time there is a bump, blow, or jolt to the head or a hit to the body that causes the head and brain to move rapidly back and forth a concussion can occur. This can include car accidents, collisions in sporting events, or even a fall during recreational activity. It is important to remember that concussive injuries DO NOT require a direct hit to the head. 

What are the symptoms of a concussion?
The most common concussion symptoms are listed below. If you experience 1 or more of these symptoms after sustaining a hit to the head or body, you may have a concussion and you should be evaluated by a licensed health professional

Concussion Signs Observed

  • Can’t recall events prior to or after a hit or fall.
  • Appears dazed or stunned.
  • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
  • Moves clumsily.
  • Answers questions slowly.
  • Loses consciousness (even briefly).
  • Shows mood, behavior, or personality changes.

Concussion Symptoms Reported

  • Headache or “pressure” in head.
  • Nausea or vomiting.
  • Balance problems or dizziness, or double or blurry vision.
  • Bothered by light or noise.
  • Feeling sluggish, hazy, foggy, or groggy.
  • Confusion, or concentration or memory problems.
  • Just not “feeling right,” or “feeling down”.

How long does it take for symptoms to appear?
Concussions vary by person and incident. Individuals who show or report one of the above symptoms, or report "not feeling right" after a bump, blow, or jolt to the head or body, may have a concussion or more serious brain injury. Although signs and symptoms generally show up soon after the injury, the signs and symptoms of a concussion can take minutes, hours or even days to appear. It is important to continuously check for signs of a concussion right after the injury and a few days after the injury. If symptoms worsen you should seek medical attention. 

What should I do if I think myself or my child/athlete has suffered a concussion?
If you think an athlete has a concussion, remove the athlete from play immediately. The athlete should sit out of play the day of the injury and should not return to play until a licensed medical professional says he or she is symptom-free and safe to return. Children or teens who return to play too soon -while the brain is still healing - are at greater chance for having a repeat concussion. Repeat concussions can be very serious. 

Are there specific tests to diagnose a concussion?
There is no specific test to diagnose a concussion and a concussion can not be seen on CT or MRI scans. However the above mentioned symptoms can indicate a head injury has occurred, notifying medical professionals to complete neurological testing.

Licensed health professionals can perform an Acute Concussion Evaluation (ACE) on any individual whom they suspect has suffered a concussion, allowing for early diagnosis, management, and appropriate referral. This evaluation generally consists of a symptom questionnaire, neurological exam, balance testing, and sometimes neuropsychological testing. 

Neuropsychological tests are designed to measure cognitive skills and abilities such as intelligence, problem solving, memory, concentration, impulse control, and reaction time, to name a few. Both computerized and standard paper-and-pencil tests are utilized to gather evidence-based, comprehensive data on cognitive functioning. These tests work best in concussion diagnosis if there is a pre-injury baseline for comparison. 

I have a concussion. What should I do to help my brain heal?
Like most sports injuries, rest is the best treatment for concussion. This includes both physical and mental rest. Physical rest means no physical activity that will raise your heart rate until you are 100% symptom-free. Mental rest means no activities that stimulate your brain and require concentration, such as screen time (TV, computer, phone), reading, and schoolwork. Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion to aid the healing process. There is no medication that can help your brain heal.

How long does it take for symptoms to resolve?
Most people with concussions recover in 7-14 days. However, recovery time strongly varies depending on the individual and the seriousness of the injury. Symptoms may last for a short period of time, such as a few plays or minutes of a game, or can persist for weeks or months. 

How do I know if I can return to playing my sport?
A previously concussed athlete should only return to sports with the approval of a licensed health professional. The Center for Disease Control and Injury Prevention (CDC) and American College of Sports Medicine (ACSM) recommend a 5-step return to play progression. This is a gradual process that should be completed over days, weeks, or months. If at any point in the progression the athlete experiences concussion symptoms, he or she is pushing too hard and should stop the activity and return to rest. 

Is there any safety equipment that will reduce the risk of sustaining a concussion?
Wearing a helmet is a must to help reduce the risk of a serious brain injury or skill fracture. However, helmets are not designed to prevent concussions. Researchers and helmet manufacturers are constantly improving helmets in order to make them as protective as possible but there is no "concussion-proof" helmet. Therefore, even with a helmet, it is important to avoid direct hits to the head.

What are the symptoms of a more serious brain injury?
In rare cases a more serious brain injury can occur in which a collection of blood (hematoma) can form on the brain following a hard hit, causing the brain to squeeze against the skull. If you notice any of the following symptoms following a hard hit, call 9-11 and seek medical attention immediately
  • One pupil larger than the other
  • Drowsiness or inability to wake up 
  • A headache that gets worse and does not go away
  • Slurred speech, weakness, numbness, or decreased coordination
  • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching)
  • Unusual behavior, increased confusion, restlessness, or agitation
  • Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Are there any long-term effects of sustaining a concussion?
We are still learning what the long-term effects of concussion are. The severity and location of the injury likely plays a role in if cognitive deficits and behavioral issues emerge later in life. Research suggests that sustaining multiple concussions increases one's likelihood of experiencing long-term deficits. For example, if someone has already received one concussion, they are 1-2 times more likely to receive a second one. If they've had two concussions, then a third is 2-4 times more likely, and if they've had three concussions, then they are 3-9 times more likely to receive their fourth concussion. 

            Long-term effects that can emerge after suffering multiple concussions include:
  • Memory problems
  • Lack of inhibition
  • Intense anger and/or aggression
  • Personality changes
  • Inattention and lack of concentration
  • Problems organizing, planning, and problem solving
  • Language impairment
What is post-concussive syndrome?
While rare after only one concussion, post-concussive syndrome is believed to occur most commonly in patients with a history of multiple concussions. Post-concussive syndrome is diagnosed in a individual who experiences symptoms that last for days, weeks or even months following a head injury. Talk to a licensed medical provider if you are concerned about post-concussive syndrome. 

I have heard about CTE in the news. What is CTE and should I be worried?
Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in individuals with a history of repetitive brain trauma, including symptomatic concussions as well as sub-concussive hits to the head (small hits that do not cause symptoms). Recent reports have been published of confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia. To learn more, visit the Boston University CTE Center's website.