Guidelines for Managing Student Athlete Concussions

Agreement among medical experts is nearly unanimous that critical steps must be followed to manage concussions sustained by student athletes. The following guidelines, recommended by the American Medical Society for Sports Medicine and the American Academy of Neurology, will minimize the risk of a more serious brain injury by assuring that concussions are properly diagnosed and that healing is complete before the player returns to the sport.

Remove the Athlete From Play

Coaches want their best players in the game. In the past, a coach might ask a player who sustained a concussion "How many fingers am I holding up?" If the player answered correctly, the coach would leave the player in the game. Head injuries that did not affect a player's mobility were dismissed with phrases like "He just got his bell rung, he'll be okay."

Players also felt pressure to stay in the game. "Playing hurt" was viewed as a sign of toughness, leadership, and team loyalty. Unlike twisted ankles and other physical injuries that impair performance, concussions were not regarded as "real" injuries. Teammates expected other players to "shake off" the effects of a concussive injury and to keep playing.

Neurological studies make clear that every brain injury is serious. Any suspicion of a concussion needs to be evaluated. A concussion is obvious when a player loses consciousness, but most concussions are not so easily diagnosed. Any of the following symptoms should give rise to a suspicion of concussion:

  • Glassy eyes, a blank stare, or a glazed look
  • A feeling of grogginess or drowsiness
  • Headache
  • Blurred vision
  • Dizziness
  • Slurred speech
  • Memory loss
  • Delayed answers to questions
  • Disorientation or confusion
  • Inability to concentrate or focus attention
  • Behavioral or personality changes
  • Nausea or vomiting

When a player sustains a blow to the head or shows any evidence of a concussion, the player needs to be removed from the game and evaluated.

Evaluate the Player

If the player lost consciousness or is not moving, check the player's airway to make sure that it is not obstructed and that the player is breathing normally. Also check the player's chest or pulse for the presence of a regular heartbeat. Take care, however, not to move the player's head or neck. Doing so could worsen any spine injury that may have occurred. Only a properly trained paramedic or other medical professional should move a player who is incapable of moving under his or her own power.

Once the player is on the sideline, a qualified health care professional should conduct an evaluation. A number of concussion assessment tools have been developed, ranging from symptom checklists to tests of postural stability to computer-based tests that measure the speed at which mental tasks are performed. Some tests are designed to be administered on the sideline, but that should only be done if a trained health care professional is available to conduct and evaluate the test.

A player who experiences a second concussion before recovering from the initial concussion has an increased risk of sustaining a serious and lasting brain injury. That risk can only be prevented by withholding a concussed player from play. If any suspicion of a concussion remains after a player has been assessed on the sideline, the player should not return to the game that day. Instead, the player should be evaluated thoroughly by a licensed health care professional who has been trained to diagnose concussions. If that professional diagnoses a brain injury, the player should not resume playing the sport until a health care professional approves the return to play.

Monitor the Player

The player's parents, school officials, or some other responsible person should monitor the player for several hours after the concussion is sustained. Bleeding or swelling of the brain may not be immediately apparent. If the player begins to complain of headaches, nausea, dizziness, or other symptoms of a brain injury after the initial symptoms appear to have resolved, the player should be returned to a clinic or emergency room immediately for a follow-up evaluation.

Follow Medical Recommendations

Rest is the best cure for a brain injury. A health care provider may recommend that a player avoid physical activity for several days after the concussion occurs. Depending on the player's symptoms, activity may be increased gradually after the player has rested.

The healing period for a brain injury depends upon the severity of the concussion, whether the player experienced prior concussions, and the player's overall condition. Players who have not reached adulthood tend to have longer healing periods than players who are college age. There is some evidence that the risk of sustaining a more serious concussion exists for at least ten days after an initial concussion occurs.

Until the brain injury has healed completely, it is critical that the player should not return to play. With a health care professional's consent, the player may begin to ease his or her way back into the sport by participating in non-contact practices. A basketball player, for instance, may be able to practice free throws but should not participate in drills where the risk exists of being hit with an elbow or knocked to the floor. The point at which the player should be allowed to run or engage in strenuous exercise involves a judgment call that should be made by the player's doctor, not by the coach or the player.

Return To Play

The player should return to play only after he or she has been cleared by an independent, licensed health care provider who has been trained in the diagnosis and management of concussions. It may be useful to provide the player with brief psychological counseling. Known as "cognitive restructuring," counseling helps the player cope with the effects of the concussion, avoid fear of symptoms that are unrelated to the injury, and regain confidence.