 What is a concussion and what can cause a concussion? Concussion is a mild brain injury that can cause temporary changes to the brain in the way it functions. They can be caused by either a direct blow to the head or to the body that causes a force onto the brain. The force causes the soft brain to move quickly within a hard skull, and that causes changes on a cellular metabolic level. These changes are temporary, but if not treated properly can be dangerous. Why are concussions dangerous? Well, concussions are an invisible injury. We can't pick them up on X-rays, standard MRIs, or CAT scans. We know that changes really occur on a cellular level, and during that time the cells are very vulnerable to more injury. So it's important that we arrest the individual who has been concussed, so they don't sustain another concussive blow to the head or body. If the brain takes another hit to the head, the cells can go into cell death. If individuals are experiencing concussions repeatedly over the course of their career, they can develop prolonged problems, particularly with memory, depression, anxiety, and we see that a lot with our professional football players and hockey players. When do concussions typically occur? Concussions can occur in virtually any sport. We see them more commonly occurring in contact sports, such as football, lacrosse, hockey, and soccer. They can also occur outside of sports, particularly with falls or after motor vehicle accidents. What are the symptoms of concussion, and how would I know if someone has experienced a concussion? That's a really good question. The symptoms of concussion are wide and vary from individual to individual. Physical symptoms such as headaches, dizziness, sensitivity to light or noise, and some knowledge that can occur. Individuals can also develop issues with cognition. They'll feel like they're in a fog, or not themselves, and will have problems with memory and with concentrating. They will also have issues with sleep. Typically, they'll have more interrupted sleep, and will be feeling very fatigued throughout the day. And they'll also be more emotional, experiencing more signs of anxiety, nervousness, or depression. It's important that you realize that every individual will present with different signs and symptoms of concussion. They may present initially with one set of signs and symptoms, but that can change through the process of healing. When do the symptoms of a concussion begin to show, and how long do they last? Symptoms of concussion can occur right after a concussive causing blow, or can really develop within the first few hours. They typically last anywhere from one week to three weeks, but some actually can improve within the first few days, and others continue with symptoms up for longer than a few weeks to months. What should be done if a concussion is suspected? Well, if a concussion is suspected, it's important that you seek medical care promptly. If you're an athlete and a concussion, or symptoms of concussion develop on the field, it's important that you discuss your symptoms with the athletic trainer. If you don't have access to an athletic trainer, it's important that you discuss it with either your primary doctor, who's comfortable with concussions, or a sports parent doctor. If symptoms worsen, and if you're ever in doubt, it's okay to go to the emergency department to get evaluated. When should someone go to the emergency department, rather than being evaluated by their primary physician or sports specialist? That's an important question. Primary care physicians or sports trained physicians can evaluate a concussion. However, there are some signs that you need to be aware of that prompts more further medical care. You're really looking out for any worsening of headaches, changing cognition or alertness, any vomiting, changing pupil size, bruising along the head after the injury, and even discharge, such as a bloody or clear discharge from the nose, ears, or eyes. These symptoms show signs of more serious conditions that need to be evaluated quickly in the emergency department. How are concussions treated? Concussions are treated on an individual basis. Everyone will come in with different types of symptoms. The mainstay will be initially rest. Resting from physical activity is key and important. An individual should also rest cognitively, meaning you should stay away from stimulating activities like the television, the computer, and even cell phones. These items have been known to trigger symptoms and also worsen symptoms. After the initial medical evaluation, an individual may be referred to physical therapy for further work on balance if the individual is presenting with a balanced deficit. If the individual is presenting with cervical spinal strains, we would recommend physical therapy to work on myofascial release, strengthening, and range of motion. What is a concussion clinic and what makes Winthrop University Hospital's concussion clinic different? Well, a concussion clinic often times uses a multi-disciplinary approach in evaluating and treating an individual who has been concussed. Typically an individual will be assessed by a sports physician and possible therapy may be initiated. At Winthrop University Hospital concussion clinic, we try to get the athlete or patient in to see the sports trained physician quickly and promptly. We will initiate therapy soon after the medical evaluation and we utilize objective testing such as our Biodex machine, which really helps gauge any balanced deficits and works an individual through the process of regaining balance. We also have athletic trainers who work on the return and play protocol, which is essential in getting an athlete back into play. We have all of this under one roof in one facility, which allows for great continuity of care and also allows for great communication between the medical team and the individual and family. What is a return to play program and how does it affect student athletes? Well, a return to play program was really designed to progress an individual back into sports under a supervised environment. It's a New York state law that a high school individual who did sustain a concussion be worked through a proper return to play program. At Winthrop University Hospital, we actually will guide the athlete and individual back through the return to play program back into sports and activity. If the individual is asymptomatic, we can initiate the return and play protocol, which usually takes about five to six days. The individual will initially begin with low-impact activities such as the elliptical or the stationary bike. Heart rates monitor during this time, and if all goes well and no symptoms develop, they can be progressed into further exercise. Over the next few days, they will be progressed into resistance training, agility drills, and plyometrics. If they remain asymptomatic, again, they can be progressed further into more sport-specific activities. If, again, no symptoms develop, they can be progressed into contact sports. If at any point during this time they develop symptoms, they need to be rested. That basically tells us that the brain is not quite ready to be progressed in a physical activity. Again, the individual needs to be asymptomatic for at least 24 hours before restarting the program. This return to play program, which has been developed and utilized at Winthrop University Hospital Clinic, allows for a safe progression into sports. What could happen if someone with a concussion returns to sports too soon? If an individual returns to play too soon, it can have various effects. Definitely symptoms can worsen, and they may be prolonged and may not actually improve. They may end up with chronic symptoms of concussion such as chronic headaches, chronic changes in their concentration, and chronic issues with anxiety and depression. We see that a lot in our professional athletes who don't get treated promptly after concussion. There are more detrimental and catastrophic effects if a concussion is not treated promptly and if an individual continues to play after sustained concussion. We have seen cases where an individual sustains a second concussive blow to the head, which can cause significant bruising and swelling of the brain, and unfortunately can cause catastrophic death. It's important that if you do suspect a concussion, that you do seek medical care promptly.