A concussion can be nerve-wracking for athletes, parents and coaches, especially when it happens during a game, at practice or while playing with friends. Whether your athlete plays a contact or individual sport, a concussion can happen. And while they are a common sports injury, knowing the facts about concussions can make a huge difference in care, recovery and play.

At our Sports Medicine Center, concussion experts like Brittney Millett, MS, LAT, ATC, provide comprehensive, evidence-based care for young athletes. We caught up with Millett, who serves as the Concussion Program coordinator, to get expert advice and insight into what parents need to know about concussions.

What is a concussion?

A concussion is a mild injury to the brain caused by a significant blow or jolt to the head, neck, or body that temporarily disrupts how the brain normally works. That can look different for each athlete, from a tackle in football where an athlete hits their head on the ground, to a gymnast landing awkwardly when tumbling, causing their head and neck to quickly move back and forth.

Concussion symptoms and signs

Athletes should stop playing sports and seek medical advice if a concussion is suspected. Common signs and symptoms of a concussion include:

• Headache
• Nausea and/or vomiting
• Balance problems/dizziness
• Fatigue or drowsiness
• Sleeping less or more than usual
• Trouble falling asleep
• Blurry or double vision
• Sensitivity to light or noise
• Feeling of being in a "fog"
• Trouble concentrating or remembering
• Feeling more irritable or sad than normal
• Nervousness

Emergency warning signs of a brain injury

While all concussions should be taken seriously, some concussion symptoms may require emergency evaluation. If an athlete is experiencing any of the following symptoms, get them help immediately:

• Consciousness issues such as loss of consciousness, extreme tiredness or inability to stay awake
• A headache that gets progressively worse or is severe
• Any neurological changes, including weakness, numbness or sudden difficulty walking
• Slurred speech, extreme confusion, or inability to recognize people or places
• Repeated nausea or vomiting, convulsions or seizures

What should you do if you think your athlete has a concussion?

Immediately removing the athlete from play is the first line of defense once a head injury happens. If a concussion is suspected, Colorado Senate Bill 40 states that the athlete should be removed from play immediately and not return the same day. Further, before returning to play, the athlete must receive written clearance from a healthcare professional allowing them to return.

Can concussions be prevented?

Though there’s no way to prevent concussions entirely, there are ways to reduce an athlete's concussion risk. For all players, our experts encourage training in proper heading techniques, good body positioning skills, and improved core and neck strength to prevent or limit the consequences of blows to the head.

Encouraging fair play and stricter penalty enforcement does seem to help reduce the overall number of sports injuries, but the effect on concussion rates is not clearly established.  And rule changes, such as reducing the number of contact practices, teaching heads up in tackling technique and eliminating body checking in hockey, are being evaluated to see if they have an impact on overall concussion rates.

Common concussion misconceptions

Many injuries come with myths about symptoms, prevention and treatments, and concussions are no exception.

Myth: You must pass out to have a concussion

One of the most common misconceptions is that an athlete must lose consciousness to have a concussion — but that couldn’t be further from the truth. Getting knocked out after an impact can be a sign of a concussion, but it’s important to remember that getting knocked out is not required for an injury to be a concussion. Fewer than 10% of concussions involve being “knocked out”.

Myth: You must hit your head to have a concussion

While it may be surprising, you don’t have to hit your head to have a concussion. Whiplash from a car accident or a fall that transmits force through the neck to the brain can cause symptoms of a concussion.

Myth: Helmets prevent concussions

Many people believe a helmet can prevent concussions in young athletes. However, a proper helmet for each sport doesn’t prevent injury entirely. That’s why it is important to have a well-fitting, padded helmet that is specialized for the sport, which may reduce concussion rates and severity of injury. Helmets should be worn for all collision sports, as well as recreational activities that carry a risk of falling from a height or fast speeds, such as biking, skiing, snowboarding, skateboarding, rock climbing and riding ATVs.

Millett also fields questions about aftermarket add-on shell products that can be added to helmets, such as extra padding. It’s important for parents and coaches to know that the version of the padded cap that is mandated at the NFL level and used at the elite college level is “not recommended for use” for high school or below per the manufacturer. A recent study shows that these add-on caps available to younger athletes do not provide any meaningful benefit. What’s more, removing or adding padding negates the helmet’s safety requirements.

Myth: Mouth guards prevent concussions

Kids should always wear mouth guards during collision sports to protect their teeth from dental trauma. But like helmets, mouth guards are a safety tool, and the evidence for reducing concussions is limited. Some research surrounding ice hockey and rugby has shown wearing a mouth guard reduces concussion rates, and athletes who wear mouth guards in sports where they aren't required seem to have a lower rate of athletes who don’t wear mouth guards. However, more research is needed to better understand this. Further, custom mouth guards are no more effective than standard "boil-and-bite" mouth guards, so just make sure whichever you use fits well and is worn properly.

Myth: Sleep is bad after a concussion

“If a parent is concerned about alertness or responsiveness, they may occasionally check on their kid during the night to make sure they are doing OK,” says Millett. “However, not allowing them the sleep or waking them frequently during the night can prevent their brain from much-needed healing.”

While it’s true that one of the main symptoms of a concussion is increased tiredness, an athlete’s brain needs sleep to recover. Athletes should continue their regular sleep cycle and incorporate short naps, as needed.

Myth: Ibuprofen isn’t safe

For uncomplicated, closed head injuries, our experts recommend short term use of over-the-counter pain medications to help manage headaches such as acetaminophen (Tylenol) or NSAIDs such as ibuprofen or naproxen. In this case, aspirin should be avoided. Talk to your health care provider if you have questions about medications after your child sustains a concussion.

Myth: Symptoms can appear days later

“Typically, concussion symptoms develop immediately, within minutes or hours, but it is very unlikely for symptoms to develop several days after the injury,” says Millett.

It’s true that concussion symptoms can be delayed, but it’s very unusual for symptoms of a concussion to emerge after 72 hours. If symptoms don’t start soon after the injury, experts like Millett look for reasons why the athlete didn’t recognize or report the symptoms or consider other reasons that could explain how the athlete is feeling.

Myth: There are no treatments for a concussion

Most athletes who sustain a single sports-related concussion recover within a few days to a few weeks. Problems can last longer, but this is rare. For kids who are not recovering as expected, there are treatments to help improve their symptoms. Physical therapy can help with headaches, balance problems, coordination, neck function, range of motion, visual difficulties, and other concussion symptoms.

While strict rest is not helpful after concussion, and after an initial period of relative rest for 24 to 48 hours, experts encourage light and progressive aerobic exercise as treatment during concussion recovery.

Myth: Baseline testing detects concussions

There are many concussion management products on the market. Technology can provide supporting evidence, however, no single test can diagnose a concussion in athletes. Certain athletic programs require athletes to take a computerized baseline test before competing on a sports team. These tests evaluate the athlete's cognitive functions to establish a baseline in the event of a concussion during the season. If an athlete is suspected of having a concussion during the season, a second test can be administered and compared to the baseline test.

“These tests are appealing because they have the potential to provide additional information about an athlete’s cognitive function and motor control after concussion,” Millett says. “However, kid’s neurocognitive development changes so quickly that baseline testing is of little use in adolescent athletes. Unfortunately, these tests may not be as reliable or useful as originally thought, and the value of baseline testing remains scientifically questionable, especially for younger athletes.”

Millett points to research that indicates other evaluations and measures may be more useful and cost effective for identifying and clearing a concussion.

Myth: Once they feel better, they can play again

Colorado law protects players from returning to their sport too quickly. According to regulations, athletes who have had a concussion cannot return to play until they are assessed and cleared by a healthcare provider. While feeling better is a good sign, that doesn’t mean they are ready to return to sports. Families should discuss with their provider the return to sports protocol, which follows a gradual stepwise process to safely return athletes to competitive play.

How are concussions treated?

There’s no one-size-fits-all treatment for a concussion. An athlete’s care plan will depend on their symptoms, age, activities and how they’re progressing through recovery. While some may recover with relative rest and gradual return to school and physical activity, others may benefit from additional therapies to address symptoms. A healthcare provider can help develop a treatment plan that’s tailored to an athlete’s individual needs and may recommend other interventions to support recovery.

The first 24 to 48 hours

Relative rest, or slowing down, for the first one to two days is important for an athlete’s brain and body to heal post-concussion. Getting plenty of sleep at night, staying hydrated, eating balanced meals and resuming a typical daily routine can help, too.

“Getting back to light exercise and returning to school can be beneficial for brain function and anxiety as long as there isn’t a risk of falling or forceful contact,” says Millett.

Athletes don’t need complete darkness with no activity to recover from a concussion. There is also no compelling evidence that indicates screen time, including watching TV, texting or reading, will prolong concussion symptoms.

During the first day or two, most athletes also return to school and based on severity, may need some accommodations or an individualized comeback plan to properly return to learning.

Returning to school after a concussion

Many students never miss any school or only miss a day or two following a concussion. Keeping a child out of school for a prolonged period often causes unintended academic, social and emotional disruptions. As symptoms improve, most students can return to school and may benefit from temporary support during recovery.

Returning to sports after a concussion

First and foremost, all athletes are required to be medically cleared before returning to sports and should never return to play on the same day as a suspected concussion. Returning to sports too soon increases the risk of another concussion and may prolong recovery. Taking the time to fully heal helps protect a developing brain and supports a safe return to activity.

Get more information from our experts on returning to play after a concussion.

Mental health after a concussion

Concussion recovery isn’t just physical — it can be emotional too. Changes in mood, stress and anxiety can occur during concussion recovery, especially if the injury interferes with school, sports or other social activities. However, Millett doesn't expect kids to have prolonged mental health concerns after a concussion. Always seek care if mental health symptoms arise or seem severe.

When should my child see a concussion specialist?

Most children recover from a concussion within days to a few weeks with guidance from a healthcare professional. However, some children may benefit from an evaluation by a concussion specialist, especially if their symptoms are severe, don’t improve as expected or make daily life difficult. Consider seeing a concussion specialist if:

• Symptoms last longer than two to four weeks
• There's a history of multiple previous concussions
• Symptoms are severe or worsening
• There are pre-existing conditions, such as migraines, ADHD, learning differences, anxiety or depression that may complicate recovery
• Extended guidance is needed to safely return to sports

Our specialists can provide a comprehensive evaluation, coordinate care with other specialists, and develop an individualized treatment plan to get players on the mend.

For appointments or to get more information about our Concussion Program call: 720-777-2806.