2 min read • November 13, 2022
Posted in
By Daniel Fishel
Simple answer: If you have a concussion during a game, you are unable to play sports for at least the rest of that day.
A concussion is a specific type of head injury that can range from mild traumatic brain injury to severe brain injury. Concussions happen by a force delivered to the head, but there is no known force threshold known to cause a concussion. Light hits at certain angles may cause a concussion, while very hard hits at others may not.
If a player is hit and loses consciousness, even for a second or two, it is defined as a concussion. However, “blacking out” is not required to define concussion. Other concussion symptoms may include short term memory loss, confusion, dizziness, nausea, headaches, ringing in ears, balance problems, blurred vision or distorted vision (seeing stars), sensitivity to light or noise, trouble concentrating, or sudden changes in mood or affect.
Head injuries used to be graded on a scale from 1-5, but recent changes to protocols in the NFL and lower leagues emphasizing player safety separate head injuries into two categories: concussion or no concussion.
If a player suffers a head injury, it is crucial to undergo a medical evaluation on the sideline by a medical professional. If the player is determined to have a concussion, they are unable to return to play safely.
To play immediately after a head injury puts an athlete at high risk. They are then placed in a return to play protocol, or “concussion protocol.” This can be coordinated through a concussion clinic, a primary care provider, the athletic training staff, or other licensed healthcare provider who is experienced in treating concussions.
Rest and healing are essential after a sports concussion, and that is where the protocol begins. A concussed player should rest in a dark, quiet room and get lots of sleep. The old adage “do not let them go to sleep” is based on fear of a more severe head injury--a slow brain bleed—which can be ruled out with appropriate evaluation by a medical professional.
They should stay away from screens, including televisions, smart phones, and any forms of electronic gaming in the immediate post-concussion period. After 24-48 hours, they should begin to resume their day-to-day life, work, or schooling if the symptoms are manageable.
Early return to normal life after an initial rest period is associated with better outcomes than extended periods of rest. When symptoms are completely resolved with daily life, the athlete their return to activity with light exercise, such as a stationary bike or slow jogging.
If no symptoms return, the next day they will advance to more intense, sport-specific exercise for a limited amount of time. In the NFL, this is 30 minutes per day. This is also the time when neurocognitive testing (testing balance, memory, concentration, and/or other mental tasks) can be done to ensure the player is back to their baseline as tested before the season.
Again, the player can progress the next day if there is no return of symptoms, and if applicable they are shown to be back to their neurocognitive baseline. They then can practice and exercise as they normally would, with the exception of contact.
In football, this means they can run, catch, and throw, but they cannot tackle or hit sleds. If fully tolerated, they are cleared for full contact in practice, and may return to competition if contact is fully tolerated as well.
If at any point symptoms return, the activity is stopped and tried again the next day. Even if symptoms are brought on by activity, they should be improving day-to-day. If symptoms are worsening, the player should undergo another medical evaluation by a licensed healthcare provider and is a sign they are advancing through activities too quickly.
The above is the basic protocol for the NFL and the California Interscholastic Federation (CIF). Many sports organizations and state boards have their own return to play protocols in place, which are usually quite similar to these.
Players with multiple concussions in a season or over a lifetime are likely to require longer periods of rest and progressive exercise before return to play.
At a bare minimum following the NFL protocol, a player can return to play 6 days after their injury.
There are huge risks to returning to play too soon. If a player were to suffer a second head injury before they are allowed to recover from the first injury, second impact syndrome may occur.
Second impact syndrome is a very severe, albeit rare, complication of concussions which causes rapid brain swelling, coma, and death.
Sports participation is extremely small in importance compared to a player’s life, so it important for any suspected concussion to be evaluated and treated properly. Short of this rare, catastrophic scenario, there are other risks involved in returning to play too soon.
In general, the injury threshold, or level of force required to cause a concussion, is lowered until full recovery. Any head trauma before the brain is fully healed is more likely to cause a second concussion and is likely to cause more severe and longer lasting symptoms.
Playing football obviously puts one at risk for traumatic brain injury. Recent rules changes have attempted to make the game safer, with some success, but it remains a physical game and head injuries do happen.
Concerns about chronic traumatic encephalopathy (CTE) and other permanent brain damage have caused many NFL players to retire in the prime of their careers. It is one of the hottest topics in sports medicine, and an area that is the target of lots of ongoing research and rapid changes.
It is important for athletes and their families to weigh the benefits of playing sports against the risk of any injury, but especially while being treated for concussion, or after multiple concussions.
Different sports carry higher or lower risk. For example, it may be reasonable to get back to playing golf much sooner than playing rugby. The benefits of sports participation are significant and wide ranging, with physical, mental, and social aspects.
An athlete may need to factor in a chance for a scholarship, or to make a living in a professional career. There are no strict rules or even broad guidelines for these decisions, and should be made on an individual basis between the athlete, their family, and their physician.
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