Concussion? Why You Need to Take It Slow

‘Warrior’ mentality can put athletes in peril
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For young athletes who suffer concussions, a slow and closely monitored approach to returning to sports is the best way to avoid further injury, says physician Anne Rex, DO, who specializes in sports and exercise medicine.

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‘Students first, athletes second’

“The ability to return to the gym or to a sport relies on patients being completely asymptomatic from concussion symptoms,” says Dr. Rex. “Once they are fully integrated back into school work and tolerating it well, they can begin a stepwise approach to returning to play.”

“Student athletes are students first, and athletes second,” says physician and sports and exercise medicine specialist Richard Figler, MD. “They will recover more efficiently if they pace themselves and listen to their symptoms.”

Concussion symptoms include headache, sensitivity to light or sound, irritability, changes in sleep habits or patterns, difficulty focusing, feeling in a fog, or experiencing pressure in the head. These symptoms can clear with rest, but can return with any activity that stimulates the brain. That indicates the brain is still healing, and not ready for the stimulus that caused the return of symptoms.

Once a patient is able to go 24 hours without symptoms at home, he or she should return to school for partial days, says Dr. Rex. Students need to take their time transitioning back to academics.

“A huge portion of return to play is getting back to full cognitive function,” Dr. Rex says. “Students may need extensions for projects or homework, or other academic arrangements.”

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It takes most patients at least a week, but often longer, to get back to full activity once they are symptom-free, she says. “With the help of an athletic trainer or physical therapist, they can increase their exertion each day, making sure they tolerate the progression without triggering symptoms,” she continues. “Each day, you add more of their regular activities.”

‘Warrior mentality’ a challenge to recovery

“No doubt there’s a warrior mentality out there, with football and with other sports,” says Dr. Figler. “We know athletes say what they need to in order to get back out on the field. This can be extremely detrimental in the short- and long-term, and significantly prolong their recovery.”

“There is nothing that tells us whether the concussion has cleared, except for the honesty of the student athlete,” Dr. Rex says.

Suffering a second concussion before the first has healed can have potentially catastrophic consequences, says Dr. Figler.

“On the severe end of the spectrum, although rare, it can cause brain hemorrhage or even death,” he says. “On a lesser scale, if you go back out on the field and symptoms reoccur, you will have more difficulty functioning normally, and the symptoms may be even more severe when they return.”

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Parents should be watchful for signs that a student athlete might be trying to do too much, too soon.

”Don’t ask them how they feel  – they’ll say they’re fine,” says Dr. Figler. “Ask pointed questions, like ‘Do you have a headache?’ or ‘Did you sleep well last night?’ Observe them closely for abnormal behavior, like being more tired than usual or falling asleep earlier than normal.”

“Student athletes should not return to play until they are off all medications for concussion symptoms like headache, and they are symptom-free with normal mental activity,” he says.

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