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Athletes should never try to “tough out” a concussion. Teammates, parents/guardians, and coaches should
never encourage an athlete to “play through” the symptoms of a concussion. In addition, there should never
be an attribution of bravery or courage to athletes who play despite having concussion signs and/or
symptoms. The risks of such behavior must be emphasized to all members of the team, as well as coaches and
parents.
If an athlete returns to activity before being fully healed from an initial concussion, their reaction time and
reflexes may be compromised, placing the athlete at greater risk for sustaining another head injury. A second
injury that occurs before the brain has a chance to recover from the initial concussion will delay recovery and
increase the chance for long-term problems. In rare cases, a repeat head injury can result in severe swelling
and bleeding in the brain that can be fatal.
What Are Some Danger Signs to Look Out For?
In rare cases, a dangerous collection of blood (hematoma) may form between the brain and skull after a
bump, blow, or jolt to the head or body. The pressure from this blood can squeeze the brain within the skull.
Call 9-1-1 for any athlete that demonstrates any of the following signs or symptoms after a bump, blow, or jolt
to the head or body for transport to the emergency department:
• One pupil larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea
• Convulsions or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken
seriously.
Management Until Recovery
Rest
The first step in recovering from a concussion is rest. Rest is essential to help the brain heal. Athletes with a
concussion need rest from physical and mental activities that require concentration and attention as these
activities may worsen symptoms and delay recovery. Exposure to loud noises, bright lights, computers, video
games, television and phones (including texting) all may worsen the symptoms of concussion. Athletes
typically require 24-48 hours of rest, though some may require a longer period of time.
Return to Learn
Following a concussion, many athletes will have difficulty in school. These problems may last from days to
weeks and often involve difficulties with short- and long-term memory, concentration, and organization. In
many cases, it is best to lessen the student’s class load early on after the injury. This may include staying
home from school during the short period of rest (typically no more than 1-2 days) followed by a lighter school
schedule for a few days, or longer, if necessary. Decreasing the stress to the brain in the early phase after a
concussion may lessen symptoms and shorten the recovery time. Additional academic adjustments may
include decreasing homework, allowing extra time for assignments/tests, and taking breaks during class. Such
academic adjustments are best made using a team approach collaborating with teachers, counselors, and
school nurses.