Advice From an Expert: Navigating and Preventing a Concussion

Nearly all sports and physical activity come with some risk for concussion, which is why knowing the warning signs and how to minimize your risk of experiencing one is important.

Michael Dougherty, ATC, a sports concussion program manager at AdventHealth, answers the important questions below to help you navigate signs of a concussion and the steps you’ll need to help you throughout your recovery.

Q: What signs and symptoms should a person look for if they think they may have experienced a concussion?

A: If you suspect you or someone else may have experienced a concussion, it is crucial to recognize its potential signs and symptoms, which typically fall into four categories: physical, cognitive, emotional and sleep-related.

Physical Symptoms

Physical symptoms are often the first indicators of a concussion and may include:

• Balance issues
• Blurred or double vision
• Dizziness, nausea or vomiting
• Feeling sluggish or fatigued
• Headache or pressure in the head
• Sensitivity to light or noise

Cognitive Symptoms

A concussion can affect mental functions. You may experience:

• Confusion or disorientation
• Difficulty concentrating or remembering
• Feeling mentally “foggy” or slowed down
• Trouble with problem-solving or processing information

Emotional Symptoms

Mood changes are common during a concussion and may include:

• Anxiety or nervousness
• Irritability or increased emotional sensitivity
• Sadness or depression

Sleep-Related Symptoms

Disruptions in sleep patterns are also typical, such as:

• Difficulty falling asleep
• Persistent fatigue
• Sleeping more or less than usual

It’s worth noting that symptoms can vary widely between individuals. Some of the symptoms may appear immediately while others may begin hours or even days after the injury.

Additionally, more severe symptoms, like repeated vomiting, worsening headaches, seizures, uneven pupil size or loss of consciousness, require immediate medical attention.

Seek help from a health care provider trained in concussion management to ensure proper care and minimize the risk of long-term complications.

Q: What should a person avoid doing while recovering from a concussion?

A: When recovering from a concussion, it’s essential to avoid activities and environments that could worsen symptoms or delay healing.

Avoid Physical Activity That Worsens Symptoms

Relative physical rest is critical. Avoid contact sports, high-risk activities or strenuous exercises until cleared by a physician. Engaging in light, symptom-tolerable activities like gentle walking may aid recovery under medical supervision. Your physician may refer you to therapy where a tailored exercise program guided by a physical therapist can help reintroduce movement safely.

Limit Cognitive and Sensory Stress

Reduce cognitive exertion by avoiding excessive screen time, prolonged reading or tasks requiring intense focus, especially early in recovery. Manage sensory triggers like bright lights and loud noises. It can be helpful to wear hats with brims, sunglasses or noise-canceling headphones as needed and to plan “exit strategies” for overwhelming environments.

Avoid Substance Use and Unhealthy Diet Choices

Focus on a brain-healthy diet, including hydration and nutrient-rich foods like leafy greens, berries and fish.Steer clear of alcohol, excessive caffeine and stimulants, as these can exacerbate symptoms or interfere with brain healing.

Prioritize Gradual Return to Learning and Activities

The physician may recommend a “return-to-learn” strategy to help manage academic or work demands while ensuring recovery. This may include extra time to complete tasks or breaks to balance cognitive activity with rest.

Monitor Emotional and Mental Well-being

Mood swings and anxiety are common. Cognitive behavioral therapy (CBT) can help manage emotional challenges during recovery.

Sleep Hygiene

Good sleep habits are crucial for concussion recovery. Sleep helps the brain heal, can reduce symptoms like headache and fatigue, and supports cognitive and emotional stability.

With these recommendations, you can improve your chances of a quicker recovery and reduce the risk of prolonged symptoms.

Q: What does treatment for a concussion and the recovery process look like?

A: Treatment and recovery from a concussion are highly individualized. Each case varies in severity and response to care. Most individuals recover within two to four weeks, though approximately 20 to 30% of people may experience prolonged symptoms lasting weeks, months or even years in rare cases.

A typical treatment and recovery process uses a multidisciplinary approach involving a combination of strategies:

• Education and symptom management: Patients are educated on managing their symptoms, avoiding triggers and maintaining hydration and nutrition
• Medications: Prescribed for managing severe symptoms, such as headaches or nausea
• Therapies: Depending on symptoms, therapies like vestibular, physical or speech therapy may be used to address balance, mobility or cognitive issues
• Activity gradation: A gradual return to physical and cognitive activities, including work or academics, is encouraged under medical guidance
• Specialist referrals: Persistent or severe cases might require consultations with neurologists, mental health professionals or rehabilitation specialists

For athletes under age 18, adherence to the state laws for returning to organized sports, including a physician’s clearance to perform the graded return-to-play protocol and physician sign-off to return to competition, is crucial to avoid complications like second-impact syndrome.

While recovery timelines are influenced by factors like age, injury severity and prior medical history, most individuals achieve full recovery with appropriate care and rest.

Q: When can someone who has experienced a concussion return to playing sports?

A: To return to sports, an athlete must complete the following steps:

1. Be symptom-free: The athlete must no longer experience symptoms of concussion, such as headaches, dizziness or difficulty concentrating
2. No longer need concussion-related medication: They should not require medication to manage concussion symptoms
3. Receive a normal neurological evaluation: A health care provider must confirm that their neurological examination is normal
4. Return to regular academics: The athlete must fully participate in school activities without special accommodations for concussion
5. Achieve baseline neuropsychological testing: If neuropsychological testing is available, the athlete must return to their pre-concussion baseline

Once these criteria are met, a licensed physician must complete and sign the appropriate state form to initiate the graded return-to-play protocol. This protocol consists of four stages:

• Stage 1: Light aerobic activity, such as walking or stationary cycling, without resistance training
• Stage 2: Moderate aerobic exercises with limited body and head movement
• Stage 3: More intense, sport-specific drills without physical contact
• Stage 4: Full normal practice, including physical contact if applicable

Each stage increases in intensity and duration of activity and the athlete will only be able to progress to the next stage if they remain symptom-free. If symptoms recur at any stage, the athlete must stop the activity and repeat the previous stage once symptoms subside.

After completing all four stages, your physician will review your progress and give you final clearance to return to competition.

Q: Can you provide insight on the return-to-learn program?

A: Effective concussion management for student-athletes must include a well-structured return-to-learn process. Extended absences from the classroom can make it increasingly challenging for students to catch up academically, even after missing just one to three days. This disruption can adversely affect their grades and overall academic performance.

To support recovery while minimizing academic setbacks, transitioning the student back to the classroom (as soon as it is safe) with appropriate accommodations to manage symptoms and reduce stress is critical. These accommodations can include:

• Access to class notes in advance to facilitate comprehension
• Alternative use of certain class periods (e.g., using PE or music classes as study hall) to provide additional rest or study time
• Extended time for assignments and tests to account for slower processing speed
• Modified workloads by reducing the number of assessments or assignments required
• Shortened school days to prevent cognitive overload

The return-to-learn plan should be tailored to the specific needs of each student-athlete, considering their unique symptoms, academic demands and recovery progress. Collaboration between medical professionals, educators and the student’s family is essential to ensure a safe and effective transition back to full academic participation.

Q: What safety tips can you offer to help reduce a person’s risk of sustaining a concussion?

A: There are several things you can do to reduce the risk of concussions, including:

• Follow rules and techniques: Adhere to safety guidelines and learn proper techniques for contact sports, avoiding aggressive or dangerous play
• Strengthen neck muscles: A strong neck may help reduce the force transferred to the brain during an impact
• Use proper equipment: Ensure helmets and other gear fit correctly and are in good condition

Helmets cannot prevent concussions but can reduce the risks of more severe head and facial trauma when worn properly. Always wear a helmet when participating in collision sports such as football, hockey and lacrosse, as well as during activities like biking, skateboarding or motorsports.

Caring for Your Whole Health and Helping You Heal

If you or a loved one experiences a concussion, our concussion rehabilitation specialists are ready to provide compassionate care and help you get back to the life you love. Learn more today.