Returning to Sport After Concussion: What Athletes Need to Know
Guest post by Valentine Ngo at Valor Physical Therapy
It’s the second quarter of the Miami Dolphins and Cincinnati Bengals football game when Dolphins’ quarterback Tua Tagovailoa gets thrown to the floor, hitting his head for the second week in a row on national television. When he is unable to get up, the cameras zoom in on Tua’s hands, which stiffen as he lays on the turf. The average viewer could tell that Tua’s abnormal posturing means something more sinister than a typical injury. This is a moment that has been talked about in the news, at press conferences, and among clinicians for years now. Tua’s second concussion raises many questions that fans, coaches, and doctors ask:
- Should Tua have been cleared to play football after the first concussion?
- Should he have been required to take extra precautions to prevent another head injury?
- How bad are the effects of the concussion the second time around?
- Ultimately, could this have been avoided?
What Happens During a Concussion?
During a practice, game, or competition, concussions can occur when athletes directly hit other people, when their head roughly contacts the ground, or when they experience a “whiplash” moment. If it seems like a concussion or head injury has occurred and medical staff are present, the Emergency Medical Responder (EMT, sports physical therapist, physician, etc) rushes over to the athlete and asks questions to better understand what symptoms are present. If a concussion is suspected, the athlete will be placed on a concussion protocol. If no EMR personnel is present, athletes should go to the ER for further evaluation, especially if they’re experiencing any concussion symptoms.
While the duration of the concussion protocol depends on a number of factors, every athlete always asks the important question: “When can I get back to playing my sport?” Before answering this question, it’s important to understand what happens when a concussion occurs.
Returning to Sport after Concussion: What Clinicians Look For
During the early stages of a concussion, the patient may experience loss of consciousness, confusion, and even amnesia. These also accompany neck pain, headaches, light sensitivity, fatigue, and drowsiness. These symptoms may start quickly for some athletes and delay for others. Over time, they can also feel brain fog, slow reaction times, memory issues, and difficulty with aerobic exercise. All of these symptoms can heavily influence an athlete’s ability to perform well at their sport. During physical therapy sessions, improving pain and symptoms are typically the first priority. However, these sessions look very different as these athletes approach their discharge dates.
During the “return-to-sport” phase of physical therapy, patients will be performing exercises and activities that will help them get back to playing without any symptoms. This may look similar to typical PT exercises but with an added component that is necessary to reduce the long term effects of concussions. Some of these may include:
- Agility exercises with decision-making tasks
- Quick reactive movements while looking in different directions
- Ball toss activity with a memory component
This short list includes just a few examples of how exercises can be altered to help concussion patients. If you or someone you know has sustained a concussion, being cleared by a medical professional is essential when returning back to sport. Here’s a checklist of points to keep in mind before stepping back on the field, mats, or in the pool for a competition.
Return to Sport Checklist Following Concussion
Return to Sport Checklist Following Concussion:
- No concussion symptoms present over the last week
- No physical limitations on what you can do aerobically (running, biking, swimming, etc)
- No neck pain with any movements or positions
- No presence of cognitive issues (memory loss, brain fog, etc)
- No abnormal symptoms during or after exercise
Why Second Impact Syndrome Makes Clearance Critical
The reason why completion of a concussion protocol and clearance from a healthcare professional are important is because of the implications of sustaining a second concussion while the brain is still healing from the first one. This is called “second impact syndrome” and is something that can be preventable. A concussion is also named a mild or temporary traumatic brain injury; however, the brain needs time and oxygen to heal. Without the proper rehabilitation, a second injury to the brain can cause long term effects to the athlete’s physical and mental function.
As athletes undergo physical challenges throughout the year on and off-season, concussion rehabilitation is something that many contact sport teams need to take seriously. Whether you’re an athlete, coach, or parent, understanding when it’s safe to return to sport is essential in helping to reduce the risk of this common injury.
About the Author
Dr. Valentine Ngo, PT, DPT, FRCms, AIB-VRC, EMR is the owner and lead physical therapist of Valor Physical Therapy, a cash-based clinic in Carlsbad, CA. She treats many athletes of all ages, particularly those who participate in martial arts, football, surfing, and soccer. She is passionate about helping athletes gain access to quality patient care and get them back on the mats, field, and in the water without limitations.
Learn more about Valor Physical Therapy.