Sports injuries: Concussions

Sports & Injuries

Concussions: the impact on you as an athlete

By Colin Sisco, DPT

                Head injuries can occur in almost all recreational activities. The Centers for Disease Control and Prevention (CDCP) estimates as many as 3.8 million sports and recreation related concussions occur in the United States every year and there are about 900 sports-related traumatic brain injury deaths each year.

          A concussion may or may not cause loss of consciousness. Symptoms usually include confusion, head ache and blurred vision. In the more extreme cases vomiting and loss of consciousness can occur. Because of the varied symptoms that can be present, the injury may not always be easy to recognize at first.

         In the population of young people (15-24 years old), the CDCP  estimates that concussions account for nearly one in 10 sports injuries, making sports second only to motor vehicle accidents as the leading cause of brain injury.  The reason for this, according to a 2009 study conducted by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, may be due to athletes returning to the playing field too soon. In fact, their study concludes that 40% of high school athletes who suffer concussions return to the field of play prematurely,  putting themselves at greater risk for more severe injuries.

 Signs of concussions can be divided into two categories: Immediate signs (seconds to minutes) after the injury, and Later signs (hours to days post injury).

Immediate signs (seconds to minutes):

  • Impaired attention, vacant stare, delayed responses, inability to focus
  • Slurred or incoherent speech
  • Significant incoordination
  • Disorientation
  • Emotional reactions that are out of proportion to the current situation
  • Memory deficits
  • ANY loss of consciousness


Later signs (hours to days):

  • Persistent headache
  • Dizziness
  • Poor attention and concentration
  • Memory dysfunction (loss?)
  • Nausea or vomiting
  • Easily fatigued
  • Irritable
  • Intolerant to bright lights and or loud noises
  • Anxiety and/or depression
  • Sleep disturbances

    As with all injuries, there are variations in the severity of concussions. The severity is often used in determining when a person can return to play. These are defined below:

Grade 1:1. Transient confusion

2. NO loss of consciousness

3. Concussion symptoms or mental status abnormalities resolve in LESS than 15 minutes

Grade 2:1.Transient confusion

2. NO loss of consciousness

3. Concussion symptoms or mental status abnormalities resolve in MORE than 15 minutes

Grade 3: 1.ANY  loss of consciousness, either brief (seconds) or prolonged (minutes)

       When to return to play, a decision often made on the sideline, is a critical issue. The effects of multiple injuries are more severe and can lead to long-lasting problems.

 The general rules for returning to play are guided by the severity:

1. When there are no more symptoms, and

2. Symptoms and neurological assessments are normal (both at rest and during  exercise).

Guidelines for return to activity:

Grade 1:1.First time: 15 min or less

2. Multiple times: 1 week

Grade 2: 1.First time: 1 week

2.Multiple times: 2 weeks

Grade 3: 1.First time: 2 weeks

2.Multiple times: 1 month or longer

          The evaluation of the athlete can be relatively easily done to assess the severity of the injury. In the absence of a healthcare professional, the following testing can be administered. The athlete should be able to answer all questions correctly.

 On-Field Cognitive Testing:

Orientation:Ask the athlete the following questions.
  • What stadium/field is this?
  • What month is it?
  • What day is it?
  • What city is this?
  • Who is the opposing team?


Anterograde amnesia:  Ask the athlete to repeat the following words.
  • Girl, dog, green


Retrograde amnesia:
  • What happened in the prior quarter/period?
  • What do you remember just prior to the hit?
  • What was the score of the game prior to the hit?
  • Do you remember the hit?
Concentration: Ask the athlete to do the following.
  • Repeat the days of the week backward (starting with today).
  • Repeat these numbers backward 63 (36 is correct), 419 (914 is correct)


Word list memory:  Ask the athlete to repeat the three words from earlier.
  • (Girl, dog green)


 Any failure should be considered abnormal.  Consult a physician following a suspected concussion.

Play hard, Play safe! 

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