Concussion in Athletes

Concussions in athletes are extremely common. In fact, about 3.8 million concussions occur each year in the U.S. from sports-related injuries. The Center for Disease Control estimates that 5-10% of athletes will experience a concussion in any given sports season. Many of these injuries go unreported and undiagnosed, leading to mismanagement and premature return to activity. The mismanagement of concussion can lead to prolonged symptoms and long-term consequences. To learn about myths related to concussion see Concussion Myths below.

NeuroSport: Dedicated to Concussion in Athletes

The University of Michigan is one of only a handful of comprehensive programs in the country dedicated to the neurological concerns of athletes through its multidisciplinary NeuroSport program. The mission of U-M NeuroSport is to provide individualized care for athletes of all levels with an emphasis on acute concussion care and potential long-term consequences of mild head trauma. Visit the NeuroSport page to learn more about NeuroSport services and the Sports Neurology Fellowship and research.

For information about the Understanding Sport Related Concussion Teach-Out or the Michigan Concussion Training Certification (MOOC) offered in affiliation with the Michigan Concussion Center and NeuroSport, visit our Concussion Education page. You may also read the news release about the two programs on the University of Michigan News website.

For Athletes: What to Do if You Suspect a Concussion

It is important to be evaluated by a health care professional trained in the diagnosis and management of concussion. Do not try to judge the seriousness of the injury yourself. If an athlete is participating in sports at the time of the injury they should be removed from their game or practice and should be seen by a health care provider who is trained in the care of concussion. They should avoid any activities that would put them at risk of another head injury.

Before a youth athlete can return to sports they must be symptom-free and cleared by a healthcare provider as required by Michigan law. Learn more about Michigan Sports Concussion Law.

If you suspect a concussion, please contact NeuroSport at 734-930-7400 to be evaluated.

When to Go to the Emergency Room

Seek immediate medical attention or call 911 if you experience or witness any of the following symptoms:

  • Look drowsy or cannot be woken up
  • Headaches that severely worsen
  • Seizures
  • Slurred speech
  • Increasing confusion
  • Difficulty recognizing people or places
  • Loss of consciousness
  • Weakness or numbness
  • Persistent vomiting
  • Unusual behavior changes

Concussion Treatment and Recovery for Athletes

Recovery from concussion is a complex and dynamic process and includes three phases:

  1. Acute symptomatic phase
  2. Recovery phase
  3. Recovered

If recovery is not properly managed it can lead to unnecessarily prolonged recovery. Management of recovery should be individualized and directed by a healthcare provider with expertise in concussion care who has ready access to treatment resources. For more detailed information about these phases and concussion recovery management, visit our Concussion Treatment and Recovery page.

Return-to-Play for Sport-Related Concussion

Return to physical activity and sports play should be gradual and determined by your doctor.

Once you are symptom-free without medications, you can start a Return-to-Play process (see below).A Return-to-Play evaluation should be completed before a full return to your sport. Making Return-to-Play decisions can be complex; therefore, it is essential to understand the sport in question as well as the risks it carries.

This progression should only be started with the guidance of a health care provider trained in the evaluation and management of concussion. The purpose of the process is to gradually place more difficult demands on the brain to help determine if you are ready to return to sport. Each stage of the Return-To-Play process must be completed without symptoms before moving to the next stage.

Graduated Return-to-Play Process by Stage

  1. Relative Rest
    • Activity: Symptom-limited activities of daily living; light walking
    • Goal: Gradual reintroduction of activities involved with daily living and school or work
  2. Cardiovascular Activity
    • Activity: Light to moderate aerobic exercise without resistance training on stationary bike or walking (treadmill)
    • Goal: Increase blood flow to the brain and heart rate
  3. Sport-Specific Non-Contact Exercise
    • Activity: Progressive aerobic exercise with sports-specific activity (drills) without head impact. May start progressive resistance training.
    • Goal: Interval training by adding fluctuations in heart rate and adding cognitive activity while increasing movement
  4. Non-Contact Training Practice
    • Activity: Complex training drills, conditioning drills (can add limited controlled contact drills, e.g. pushing or hitting sleds or dummies)
    • Goal: Increase cognitive demand and access processing speed and coordination. Assess for recurrence of symptoms after adding limited controlled magnitude of force
  5. Unrestricted Training
    • Activity: Full participation in training activity only after medical clearance
    • Goal: Assess for recurrence of symptoms. Assess functional skills by coaching staff. Ensure self-confidence and readiness to play.
  6. Full Return to Play
    • Activity: Participation in full activity without restrictions
    • Goal: Full game day participation

Note: An initial period of 24-48 hours of both relative physical rest and cognitive (thinking) rest is recommended before beginning the Return-to-Sport process. There should be at least 24 hours (or longer) for each step of the progression. If any symptoms get worse during exercise, you should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (10-14 days in adults or more than one month in children), you should go to a health care professional who is an expert in the management of concussion.

What Kind of Exercise Counts As Return-to-Play Activity?

Exercise performed while you are still experiencing symptoms from concussion should not be considered part of the Return-to-Play process. However, exercise you have performed without experiencing any symptoms can be used as a guide as to where to begin the Return-to-Play protocol. This should be determined by your doctor. Your ability to perform intense, supervised, sport-specific activities without symptoms can be used:

  • To help determine your progress in recovering from concussion
  • For guidance in the Return-to-Play protocol

Prolonged Recovery

About 10% to 30% of individuals have a recovery period that is considered a longer than normal (prolonged recovery). Many factors likely play a role in the development of prolonged recovery. One main factor may be the lack of recognition and treatment of causes of symptoms. In those suffering from prolonged recovery, it is critical to identify the factors causing symptoms and begin treatment for them.

Long-Term Complications of Repeated Mild Brain Trauma

There is a growing concern that concussions, or sub-concussive blows (repeated head impacts not severe enough to cause concussion), may cause or be a risk factor for developing complications later in life. It is clear, primarily from studies of retired boxers, that some people seem to have developed neurological problems secondary to repetitive mild head trauma in their athletic careers.

Researchers have also discovered microscopic brain changes in people exposed to repetitive mild head trauma. This condition is called CTE, or chronic traumatic  encephalopathy. CTE is a pathologic diagnosis, meaning it can only be diagnosed after someone dies and their brain has been examined. The consequences of CTE in a person's life are unknown.

The Risk to Children Who Participate in Contact Sports

Studies have been done that have looked at the risk of long-term consequences in children who participate in contact and collision sports, but no long-term neurologic or psychiatric consequences have yet been identified.

Make an Appointment

To request an appointment or to get more information about Michigan NeuroSport, please call 734-930-7400 or send an email request to [email protected], with your name and phone number, and a team member will get back to you within two business days to schedule an appointment for evaluation and treatment of your athlete.

Concussion Myths

Myth: You must be hit on the head to have a concussion.
Fact: Any force to the body which is transmitted to the head can cause a concussion. One example would be a whiplash injury of the neck.

Myth: You have to lose consciousness to have a concussion.
Fact: Over 90% of people who sustain a concussion do not lose consciousness.

Myth: You must have imaging of your brain after having a concussion.
Fact: Your doctor will determine if imaging is needed. CT scans and MRIs will not show evidence of a concussion.

Myth: Wearing a helmet will prevent concussion.
Fact: Wearing helmets and other protective equipment may protect you from more serious injuries, however, no equipment can eliminate the risk of concussion.

Myth: The symptoms of a concussion begin right away.
Fact: Not all concussion symptoms will develop in the minutes immediately following an injury. Many will develop over the hours after a concussion. This is why it is important to remove an athlete from play and have them evaluated by a healthcare professional if there is any concern they may have suffered a concussion.

Myth: Once an athlete’s headache is gone they can return to their sport.
Fact: Headaches are one of many symptoms of a concussion. There are other symptoms that can persist once a headache has resolved. An athlete should only be cleared to return to sport by a healthcare professional who is familiar with concussion and its many signs and symptoms.

Remember that healing takes time and that it is important to get adequate sleep, eat healthy, and drink plenty of water during your recovery. After a period of rest for 24-48 hours patients can gradually become more active, however, this should be directed by your physician.