Fall Sports: Concussions, How They Happen, and How to Manage Them
You’re sitting on the sidelines, proudly watching your son Johnny playing football. He gets the ball and takes off running when another player comes out of nowhere and tackles him. You see their helmets smash, and you cringe. The other guy gets up quickly, but Johnny isn’t quite there yet. He’s on his hands and knees, looking like he’s a little disoriented. Your team’s athletic trainer dashes out as Johnny stands up, staggering a little bit, and walks him off the field. As the game continues, you can see them doing some tests on the sidelines. You're breathing a little easier now, but Johnny doesn’t return to the game. “Shoot,” you think. “He’s not going to be happy about this.”
After the game, you finally get to talk to the athletic trainer and get the rundown. They tell you that Johnny probably has a concussion and will need to be out for a while. A million thoughts whirr through your head. “How long is he out for? Is this serious? He’s going to be so upset. How worried should I be? What can we do to get him back faster?”
About 2.5 million students will experience a concussion this year, with the highest risk during the fall sports season.
Who’s at risk for a concussion?
Roughly 15% of students will experience a concussion during their four years in high school. High school athletes make up most of these cases. The most concussions occur in boys’ football, followed by girls’ soccer, boys’ soccer, and girls’ basketball. Concussions can also be caused by other sports like ice hockey, lacrosse, baseball, softball, and cheerleading. (Some of these sports, like football and hockey, are expected since they involve collisions as an integral part of the game. Many parents are surprised to see sports like soccer, basketball, and baseball/softball on the list.)
Beyond the sports they play, some other things can place your child at a higher risk of concussion:
Having one or more previous concussions - If your child has had a concussion in the past, they are more likely to experience one in the future. If they’ve had more than one concussion, their risk of experiencing another is even higher.
Being female - Although males may experience MORE concussions total, there is a higher RISK of concussions in girls’ sports, especially sports like soccer and basketball.
Playing in a game vs practice - Concussion rates are higher in games and matches than in practices. Players usually play at higher speeds and take more risks during a competition than during practice.
Having a history of migraines - If your child has experienced migraines currently or in the past, they may be at a higher risk for concussion, though the exact relationship between these two factors is somewhat unclear.
Having a more aggressive style of play - If your child plays more aggressively or takes more risks on the field or court, they are more likely to experience a concussion. (This isn’t to say that aggressive play or taking a risk is bad, but it’s something for you, your child, and their coach to be aware of, especially if other risk factors are present or they are taking unnecessary risks.)
It’s important to note that helmets, mouthguards, and other protective gear may not provide a significant amount of protection against concussions. While they are important for preventing facial and dental injuries, the research doesn’t currently show that they reduce the risk of concussion, even though it seems like they should. Many athletes get a false sense of protection from wearing a helmet, causing them to take excessive or unnecessary risks. (This is NOT to say that protective equipment isn’t important in sports, because it absolutely is, but players must be aware that a helmet does not make them invincible to concussion.)
How does a concussion happen?
Most concussions are related to a blow to the head. These are often related to sports (like tackle football), car accidents (like hitting your head on the windshield), or other falls (like hitting your head on the floor). Concussions can also occur without any contact to the head if there’s enough movement of the head and neck, like what might occur during a whiplash injury, where the head whips forward and backward.
Prior research suggested that this movement of the head caused the brain to hit the sides of the skull, creating injury and an immune system response there. This idea, called the “coup-countercoup” mechanism, has more recently been debunked.
The current research suggests that the fast movement of the head following a collision stretches the nerve cells that make up the brain, disrupting their delicate organization and causing a cascade of damaging neurological activity. This activity creates inflammation and also alters blood flow, metabolism, and energy production in the brain. This cascade of activity and the resulting effects are what create the symptoms of a concussion.
What does a concussion look like?
Concussions can have many symptoms, varying significantly from person to person. Some of the most common symptoms include:
Headaches
Nausea or vomiting
Dizziness or balance issues
Sensitivity to light and/or noise
Feeling foggy
Trouble concentrating
Generally “not feeling right”
Seeming confused
Clumsy or uncoordinated movement
Being slow to respond in conversation or actions
Loss of memory before or after the hit or fall
Behavior and personality changes
Any or all of these symptoms can be present if a concussion occurs. It’s also important to watch your athlete and pay attention to how they seem, as many athletes won’t report a concussion because they don’t want to sit out.
Another thing to note is that not all athletes will lose consciousness or pass out if they have a concussion. In fact, less than 10% of concussions are associated with a loss of consciousness. That said, if your child does pass out, they likely have a concussion.
Sometimes, a hit to the head can be related to more serious brain injuries. Some key things to look out for include: a headache that worsens or doesn’t go away, repeated vomiting, unusual behavior, inability to wake up or stay awake, slurred speech, weakness, numbness, seizures, or passing out. If any of these signs are present, call 911 immediately. If you’re unsure, get your child checked out ASAP. It’s better to be safe than sorry, especially when head trauma is involved.
How do I manage the concussion?
Managing and recovering from a concussion can be a challenge, particularly if your child is an athlete pushing to get back on the field.
The biggest thing is to follow the recommendations from your child’s athletic trainer or other healthcare provider. If they say your child should be out of school, keep them out of school. If they say your child can’t play sports, they shouldn't; be playing sports. Athletic trainers and other sideline healthcare workers have your child’s best long-term interests in mind, so do your best to respect their decisions. The athletic trainer is typically there, seeing the injury as it happens, giving them a unique and often more accurate perspective than another provider seeing your child hours or days later. (If you disagree, start by respectfully discussing your issues with the athletic trainer, then proceed to get a second opinion if you still feel that it is warranted.)
The general guidelines for return to activity use symptoms to indicate what your child is ready for. This involves gradually reintroducing daily activities, school, exercise, and sports, only progressing from one thing to the next if symptoms do not return or worsen with each new step. Your child’s athletic trainer or other healthcare provider should be consistently checking in and managing each new step. It is incredibly important that your child does not return to their sport before they are recovered from their concussion. If they experience another head injury before they are fully recovered from their first, this will delay recovery and increase the risk of long-term side effects from the concussion. This can also result in Second Impact Syndrome, a serious medical condition that causes severe brain swelling. Second Impact Syndrome, while rare, can cause potential long-term damage, including paralysis and even death. Concussions are not something to take lightly. They are also called mild traumatic brain injuries, meaning that the brain is actually hurt. While it may be frustrating for everyone when your child is sitting out, you must consider if it’s worth the risk to push them back into sports too early.
Beyond that, here are some tips for managing concussions:
Identify and avoid triggers during recovery. Take some time to determine what makes your child’s symptoms worse. These can include bright lights, loud noises, and physical activity.
Allow time for rest and recovery. Even once they return to regular activities, your child may get more exhausted from things like school or homework. Give them the time they need to rest, nap, or otherwise recover. You may also have to remind them to take this time, particularly if they’ve fallen behind in schoolwork or are missing out on social activities. Prioritizing sleep is a good idea during recovery from a concussion, as your brain does a lot of repair and “housekeeping” while you sleep.
Stay hydrated. Your brain needs water to function and recover. Be sure your child is drinking enough water (roughly half your child’s body weight in ounces of water is a good place to start, so 80 oz of water for a 160 lb child, for example). Avoiding dehydrating drinks like coffee, energy drinks, and pop is important as well.
Eat consistently throughout the day. Eating consistently throughout the day helps to avoid blood sugar fluctuations that can stress out and hurt the brain. It’s important to keep the brain happy and well-fueled during recovery from a concussion. Avoid highly-processed foods. Focus on whole foods like chicken, fish, fruits, vegetables, and nuts to provide protein, healthy fats, and other essential nutrients for health and recovery.
Get 30 minutes of physical activity per day, if tolerated. Movement and exercise are important throughout the concussion recovery process. Exercise promotes blood flow and produces a substance called Brain-Derived Neurotrophic Factor (BDNF), which helps your brain repair itself. Start with low-intensity exercise like walking and slowly build up to more, following your athletic trainer or healthcare provider’s advice.
Be aware of mood changes. Some athletes experience increased anxiety or depression symptoms after a concussion. This can be related to the injury itself, as concussions can impact brain function. These changes can also be related to social pressure from family, peers, teammates, or coaches, as well as worries about missing school and being upset about sitting out from their sport.
Consider nutritional supplements to promote the healing process. Certain nutrients like omega-3s can be hard to get through your diet. Certain supplements can help with concussion recovery, including omega-3 fatty acids, melatonin, turmeric curcumin, vitamin D, vitamin C, and magnesium L-threonate. Many of these supplements are even more effective if taken before the injury occurs. It’s important to talk to a healthcare provider like a chiropractor before starting a nutritional protocol.
Know what to do if symptoms persist. Most sports-related concussions will resolve within 10-14 days after an injury, but some patients will experience symptoms for much longer. This is called “Post-Concussion Syndrome.” If this occurs, your child likely needs to be seen by a healthcare professional like a chiropractor or a neurologist for further evaluation and treatment.
For more information, visit HEADS UP To Parents, a site created by the CDC specifically to teach parents about concussions. This is a great resource for any parent with kids in sports, providing information about how to spot a concussion, how to prevent them, and where to learn more.
Concussions are significant injuries that can significantly change your child’s life, and yours as well. Knowing what to expect, what to look out for, and how to help your child through the recovery process can help to reduce some of the stress and anxiety that come from sports injuries.
One key thing to remember: Although certain sports might have a higher risk of concussions, this doesn’t mean that your child shouldn’t take part in them. Injuries can happen anywhere, like while driving or playing at recess. Learning how to work with a team, the social aspect and camaraderie, and consistent physical activity are just a few of the positive things to consider when making a decision about what sports to play.
If your child is dealing with a sports injury or wants to maximize their performance, call us at 763-373-9710 or schedule online here!
Wishing you the best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties