Concussions are relatively common. Fortunately there have been campaigns to increase awareness, so more kids are being properly identified. There are still many myths related to concussion that need to be clarified.
Common myths and misinformation about concussions:
1. A normal head CT means no concussion and a full return to play is okay.
Concussions are not diagnosed by CT. Brain bleeds and masses can be seen on CT, but the damage done to the brain during a concussion is not seen on a CT.
Concussions are diagnosed based on symptoms, such as headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. Not all symptoms need to be present to make the diagnosis. Some symptoms develop over time and are not present at the time of injury.
A CT scan is usually not needed with head injuries. They involve radiation so are not without risk themselves. Unless there are signs of a possible bleed in the brain, skull fracture, or the type of injury suggests the need for a CT, a CT scan is not needed in the evaluation for concussion.
2. A minor hit to the head never causes concussions.
The force of a hit does not determine the severity of the injury.
It’s actually the force of the head moving back and forth, not an actual hit, that leads to changes in brain cells and chemical changes in the brain. A jolt to the body can also cause a concussion if the impact is strong enough to cause the head to forcefully move.
Some people with more significant problems initially also seem to heal more quickly than others with more mild injury.
It is very hard to predict how long it will be until all symptoms are resolved.
The most important thing is that if you have symptoms of a concussion, your brain needs rest and you should be seen by a doctor who is up to date on current treatment protocols for concussions.
3. After two weeks you can return to play without further testing.
Sadly I’ve had more than one patient who was given this advice from a medical professional, whether on the sideline at a game or in an emergency room or urgent care.
Although most concussions resolve within 2 weeks, not all do and returning to play before the brain is healed can lead to a more serious condition called “second impact syndrome.” Second impact syndrome is a very rare condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results, including death.
After a concussion clearance to return to play should only happen when the child, teen, or adult is re-examined and found to be symptom free.
Returning to play is done in a stepwise fashion, with each step lasting at least one day and only progressing to the next step if symptoms don’t resume. This starts with light exercise when there are no symptoms at rest, then progresses to moderate activity followed by heavy activity without contact, then full practice with contact (if the sport is a contact sport) and finally full competitive play if each step can be done without return of symptoms. If symptoms return, you back up to lighter activity.
Returning to play too quickly can prolong healing time and even lead to long term consequences.
Do not return to any activity that causes symptoms to worsen!
4. If a coach doesn’t recognize the concussion, it’s minor enough to return to play.
Coaches cannot see everything that happens on a field. If you had a head injury, tell your coach.
Even if you’re the star player.
You will do your team a favor if you take time to heal and can play again versus stay in the game and get more severely injured and are then out for good.
See these real stories of concussion survivors.
Someone who is trained in concussion evaluation should do a sideline evaluation.
If there is any chance of concussion, you should not return to play at all that day or until you are cleared by a doctor who understands concussions.
5. IMPACT testing is necessary.
IMPACT testing is a computerized test that measures neurocognitive functioning.
Neurocognitive testing can be done with other testing methods, but IMPACT testing is a specific computerized program.
If a neurocognitive baseline is done at least every 2 years, it can be compared to the same test after a concussion to check on status. Testing should only be done by a professional trained to perform and interpret the test.
Neurocognitive testing is one tool to help manage concussions and determine when it is safe to return to play, but at this time concussions are diagnosed based on symptoms and physical exam, not this testing.
6. Complete bed rest until all symptoms are gone is best.
Bed rest for the first day or two can help enforce brain rest and allow healing, but may not be required and prolonged bed rest is specifically not recommended.
Prolonged bed rest can increase stress in children who miss substantial amounts of school. This stress is thought to possibly prolong healing.
Depression is more common if bed rest is enforced beyond 48 hours. Socialization with friends and family can help provide emotional benefits that aid in healing.
This does not mean that people should participate in all social settings. They will likely need relative quiet, so even going to a sporting event to watch can lead to return of symptoms.
7. Concussions only impact sports.
Concussions take kids out of play, but other activities should also be limited until they are tolerated.
Lights, sounds and even smells can trigger symptoms after a concussion.
Things that take focus or a lot of brain work may cause symptoms to worsen. These include reading, watching television, or playing video games.
If anything leads to worsening of symptoms, it should be avoided.
Initially a child might need total restriction from these activities, and then can slowly add them back in small increments as tolerated.
Many kids need to have breaks during school and a decreased workload.
They shouldn’t take standardized tests until they can focus for a prolonged time.
If computers are used for school, it might be necessary to use paper books and worksheets and to limit computer use until it can be tolerated.
- headache (most common)
- balance problems/dizziness
- double or blurry vision
- sensitivity to light and noise
- fatigue or drowsiness
- changes in sleep patterns
- trouble comprehending and/or concentrating
- irritability, nervousness, or sadness
- feelings of being “just not right” or in a “fog”
Danger signs that deserve immediate evaluation:
- not knowing people or places
- unusual behavior
I thought I added #8 above, but edited this to add it after it was posted earlier today…
8. Wake a child with a concussion often to be sure they seem normal.
This is a common misconception. And a scary thing to do.
No child wakes easily from sleep.
It used to be thought that we should wake people up after a concussion to be sure they could arouse well, but studies show that isn’t necessary.
Most people with a concussion want to sleep, and that’s okay. Brain rest is actually what’s recommended.
After a concussion, if a person is awake and able to hold a conversation and there are no other symptoms, such as dilated pupils or trouble walking, it is okay to allow sleep.