Jason Stephens | May 7, 2021 | Brain Injuries
Generally, a concussion falls among the milder brain injuries. But that does not mean that you should ignore a concussion.
The damage from a concussion might only reveal itself in the days and weeks after the initial injury. Repeated brain trauma can lead to degenerative brain diseases like chronic traumatic encephalopathy (CTE).
Because of this, you should limit your activities after a concussion until you have been assessed by a doctor and cleared to return to sports.
Here are the things you should know about concussions and the risks of playing sports too quickly after a brain injury.
Concussions and Other Brain Injuries
The brain sits inside the skull, where it is cushioned by the cerebrospinal fluid. When the brain experiences trauma, brain tissue can die. Since the brain controls all of the voluntary and involuntary actions in the body, a brain injury can result in symptoms ranging from confusion to coma.
Brain injuries take a few of the following forms, depending on how the injury occurred.
Concussions occur when head trauma from a fall, car accident, or contact sports causes the brain to shift in the cerebrospinal fluid. The cerebrospinal fluid pushes on the brain as it shifts. This pressure causes widespread but typically mild brain trauma. The brain may bruise and swell after the concussion, which is known as “post-concussion syndrome.”
A contusion happens when a powerful impact to the head causes the brain to slam into the inside of the skull. The impact causes the brain to bruise, bleed, and swell. Contusions are usually more severe than concussions.
Diffuse Axonal Injuries (DAI)
DAIs result from a whipping motion of the head and neck. As the head moves back and forth, axons — long neurons in the brain — tear apart. DAIs can appear with sports injuries, whiplash, and shaken baby syndrome.
Symptoms of Concussions
Concussions produce physical, mental, and emotional symptoms.
Some of the most common symptoms of a concussion include:
- Loss of coordination
- Blurry vision
Doctors rate concussions using the severity and duration of symptoms. The Glasgow Coma Scale is the most commonly used test to assess sports concussions.
This test uses the three following factors to rate concussions as mild, moderate, or severe.
In mild cases, patients spontaneously open their eyes on their own or in response to verbal commands. In severe cases, patients might not open their eyes for several minutes after the injury.
In mild cases, patients can respond coherently to verbal commands and questions. In moderate cases, the patient may suffer from confusion but will still be capable of responding. In severe cases, a patient may be agitated, unable to respond, or only be capable of responding with gibberish.
A patient with a mild concussion can move in response to commands. A moderate concussion might prevent a patient from moving except in response to pain. In a severe case, patients cannot move or may have abnormal responses to sensations.
What Are the Risks of Returning to Sports Too Quickly?
If a concussion victim returns to contact sports before fully recovering, a few consequences can result.
The brain needs time to recover after a concussion. Under normal circumstances, concussion symptoms take anywhere from one week to three months to clear up. But sometimes, structural damage to the brain can cause post-concussion syndrome.
In post-concussion syndrome, the symptoms persist beyond the normal recovery period. Returning to normal activities too quickly can cause the symptoms to last longer than they normally would.
A second concussion can set back recovery from the first. Worse yet, damaging an already injured brain can cause new symptoms to appear or increase the severity of existing ones.
Chronic Traumatic Encephalopathy
Chronic traumatic encephalopathy (CTE) arises from repeated brain injuries. CTE does not require multiple concussions. Instead, CTE only requires enough damage to cause the tau proteins in the brain to break down.
As the brain accumulates damage, the body replaces the tau proteins that provide structure to the brain with tau proteins that stick together. These proteins gum up the brain and lead to a progressive, degenerative brain disease. CTE can cause dementia and erratic or aggressive behavior.
Safe Recovery from Concussions
Patients may require days, weeks, or even months to recover fully from a concussion. Rather than imposing a strict timeline, the U.S. Centers for Disease Control recommends a staged return to activities. Once an athlete engages in the activities of a stage without experiencing concussion symptoms, they may move to the next stage.
Stage 1: Return to Non-Sports Activities
After the patient stops experiencing symptoms while resting, they can return to their normal non-sports activities like work, school, and non-impact exercise. If the symptoms return or new symptoms arise, they should rest until the symptoms go away before attempting Stage 1 again.
Stage 2: Light Aerobic Exercise
The patient can engage in light exercise, including low-impact activity like jogging.
Stage 3: Moderate-Intensity Exercise
The patient can add moderate conditioning exercises, such as light weightlifting.
Stage 4: High-Intensity Exercise
The patient can engage in high-impact, high-intensity exercises, such as running and regular weightlifting. The patient can resume non-contact sports drills.
Stage 5: Return to Practice
The patient can return to practice and full-contact drills but should avoid full competition.
Stage 6: Return to Competition
At Stage 6, all restrictions on activity are lifted. The athlete is able to fully return to participation in competitive sports.
What If a School or Team Returns an Athlete Too Soon?
Schools and teams have a legal responsibility to take reasonable measures to safeguard the athletes in their care. If an athlete suffers a brain injury because a school or team pushes them to return too quickly after a concussion, the athlete may seek compensation from the school or team.