Head Knowledge to Get Back in the Game

By Karyn Odway

Student athletes are competing in full force this fall, and sports neurologists say parents, coaches and players need to be reminded of the signs of concussion and how best to recover from one – actively.

“Rest is not the best anymore,” says Erik Beltran, M.D., a neurologist and a fellowship-trained sports neurologist at NorthShore Neurological Institute. “Active recovery is what’s proving to be a better treatment option.” That said, Dr. Beltran acknowledges developing a recovery plan is more of an art than science. The injury itself and the medical history of the concussed student athlete need to be taken into consideration.

Dr. Beltran says the earlier student athletes alert their coaches and/or training staff to concussion symptoms the better.

“Some athletes think if they hide the fact that they might have a concussion, they can work through it and stay in the game,” Dr. Beltran notes. “But studies have shown that early endorsement of symptoms results in a quicker return-to-play, 14 to 21 days sooner than if symptoms were not reported immediately upon onset.”

Concussion symptoms include headache, neck pain, confusion, lack of coordination, memory loss, dizziness, ringing in the ears, blurred vision, balance problems, tiredness, nausea, vomiting. Other signs of a concussion that might be noticed are sleepiness, excessive fatigue, and mood changes such as irritability, sadness or anxiety. It is important to note that these symptoms can appear immediately after impact or delayed up to 72 hours post-injury. 

Dr. Beltran advises his student athletes to tell their coach immediately if they are experiencing any of these symptoms. “If so, a coach should assess his player and when in doubt have the player sit it out. The coach needs to take the athlete out of the game immediately.”

There are three phases to recovery, Dr. Beltran explains.

1. Acute Rest Phase. For the first 72 hours (3 days), the concussed student athlete needs to relax: No sports play, sleep if feeling fatigued, and avoid screen time.
2. Relative Rest Phase. On Day 4, active recovery begins. Over the course of a few days, specialists implement protocols that involve a gradual increase in physical activity and cognitive energy, as tolerated, documenting any adverse reactions.
3. Return-to-play Phase. This is a four-to-five-day process guided by coaches. With a watchful eye on symptoms, coaches work their student athlete back into the practice routine. They start the student with light aerobic activity, then move to a more intense cardio workout, sports agility test, no contact practice, and finish with a full practice. If there are any lingering signs of a concussion, athletes are advised to see a doctor for further evaluation.

The best recovery plan involves the physician working closely with family members, coaches, and athletic trainers – all with a solid understanding of the severity of the concussion based on the initial blow to the athlete and how he or she is responding to treatment.

“There is a greater risk of a more prolonged recovery if symptoms are not endorsed immediately after the injury,” Dr. Beltran notes.

He also warns of the serious damage that could come when an athlete avoids reporting a concussion. “They can suffer from second-impact syndrome, when they experience a second head injury before fully recovering from their initial head injury, and that could result in a deadly traumatic head injury or more longstanding or chronic symptoms.”

For athletes who continue to experience symptoms two weeks after a concussion, they will likely be diagnosed with persistent post-concussion syndrome. If symptoms last more than three months, doctors will likely classify the diagnosis as post-concussion syndrome.

“Post-concussion syndrome is not a devastating diagnosis,” says Dr. Beltran, who has expertise in managing acute concussion, post-concussion syndrome and neurological conditions in athletes with a focus on long-term brain health.“No matter where an athlete is on the spectrum of symptom chronicity, active rehabilitation and gradual increases in physical and cognitive activity along with any medications and therapies that may be needed can begin the healing process.”

Despite the potential severity and lasting effects of concussion, Dr. Beltran emphasizes early reporting of symptoms to give student athletes the best chance for getting back in the game safely and as soon as possible.

Erik Beltran, MD. is a neurologist and a fellowship-trained sports neurologist with expertise in sports concussion.  You may schedule an appointment with him online or call 847.570.2570.