It’s all in your head — sports related concussions

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November 22, 2013

In the last few years, increased attention has been paid to sports related concussions and their effects. In October 2013, the Institute of Medicine issued a summary of recommendations addressing sports related concussions in youth. After reviewing recent research on the topic, they concluded that there is a lack of data on how common sports related concussions are and made a comprehensive list of ways to gather additional information on how and when concussions occur, as well as the effects of these injuries. One of the barriers in gathering information about concussions is that young adults are often reluctant to report the injury. Often, they are worried about letting down their teammates or coaches.

What do we know? The committee did note an increased incidence of concussions in the last decade that may be related to increased awareness, recognition and reporting. For males in the high school and college levels, the highest incidence occurred in football, ice hockey, lacrosse, wrestling and soccer. For females in the same levels, the highest incidence was in soccer, lacrosse, basketball and ice hockey.

Diagnosis is based on symptoms, which are largely subjective, i.e., not easily measured and not perceived the same way in different people. Symptoms like headache, neck pain, nausea, ringing in the ears, dizziness, fatigue or a dazed feeling can start days to weeks after the injury. There is little in terms of objective studies since concussions cannot be picked up on blood tests or imaging. We know very little about the short or long term effects of concussions though there is ongoing inquiry into the links to memory loss, chronic traumatic encephalopathy and Alzheimer’s.

So how do we protect against sports related concussions? Unfortunately, we’re not really sure. At this time our best bet is to recommend protective headgear that is well maintained and worn properly. There is some evidence to support their utility. Mouth guards and facial protection are important to use to help guard against skull or facial injuries but they do not protect athletes from concussions. To avoid head injury, it’s also important to remember that water depth of greater than 9’ is needed for diving and appropriate footwear is important, especially in wet areas.

A newer recommendation in the management of concussion has been “cognitive rest.” The premise is that the brain, like an ankle or knee, should be allowed to “rest” after an injury and gradually be put to work again. Cognitive rest means refraining from activities that require excessive mental exertion including: reading, homework, video games, watching tv, and sending text messages. As you can imagine, this recommendation is difficult to enforce in a child or adolescent. Many experts recommend a step-wise return to academic work with modifications like frequent breaks or half-days to gradually increase the time and intensity of cognitive effort. The evidence to support this recommendation is limited but the theory seems to be gaining support.

The big question is usually – when can I play again? Young adults are often eager to get back into the game but this may be detrimental to their recovery. Many physicians will advise waiting until the athlete is symptom free before returning to play. There are also step wise guidelines for reintroducing physical activity but it’s important to coordinate the plan with a health care provider.


“Sports Related Concussions in Youth: improving the Science, Changing the Culture.” Executive Summary, Institute of Medicine. October 2013.

McLeod, Tamara, Gioia, Gerard. “Cognitive Rest: The Often Neglected Aspect of Concussion Management.” Athletic Therapy Today. 2010; 15(2) 1-3.

De Kruijk JR, Leffers P, Meerhoff S, Rutten J, Twijnstra A. Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest. J Neurol Neurosurg Psychiatry. 2002;73(2):167–172.