How Many Concussions Are Too Many?
By Trina Lisko, DO, Virtua Sports Medicine Physician
A concussion is a mild traumatic brain injury caused by a sudden blow to the head (or to the body without direct contact with the head). While concussions are most common for athletes who play football, soccer or ice hockey, they’re not limited to people who play contact sports. Although more athletes are seeking proper medical treatment for concussions now, determining when and if an athlete can safely return to sport is a personal and medical decision that’s based on a combination of factors.
Individualized concussion management
To assess the severity of concussions years ago, doctors relied on a grading system that’s now obsolete. At that time, each concussion was graded on a scale of 1 to 3 based on symptoms—grade 1 was considered mild and grade 3 was considered severe. Guidance for returning to activity was based on the number and grade of concussions an athlete had experienced.
Now, new research has shown that individualized concussion management is necessary to help patients make a complete recovery and prevent long-term complications. And that means that there is no one-size-fits-all, easy answer when it comes to returning to sports.
Things to consider
If you think your athlete may have a concussion, the most important thing you can do is immediately remove him or her from the game. Next, get assessed by a sports medicine specialist as soon as possible.
Your sports medicine specialist will evaluate physical, cognitive and emotional symptoms, as well as sleep/eating habits. You specialist also will ask about any history of previous concussions. Based on that assessment, your doctor will suggest a treatment plan and closely monitor your child’s progress.
When it’s time to discuss returning to athletic activities, your sports medicine specialist will consider several factors, including:
- The number of concussions you’ve had. Because the brain is more vulnerable to injury after sustaining a concussion, it may take significantly less force to cause a future concussion. Also, future concussions may result in more severe and longer-lasting symptoms.
- The length of your recovery after each concussion. Each subsequent concussion usually results in a longer recovery period. Although you may feel better quickly, cognitive problems such as balance issues and trouble focusing can last for a long time.
- The type of symptoms and when they started. The severity of your symptoms (such as dizziness, drowsiness, headache and memory problems) does NOT indicate the level of damage that was done to the brain. Generally, worse symptoms require a longer recovery time and may make your doctor more likely to recommend discontinuing your sport.
- The time elapsed since your last concussion. Multiple concussions within a short timeframe can leave your brain more vulnerable to injury. If you’re still experiencing symptoms of a previous concussion and then sustain another concussion, you could be at risk of a rare but fatal condition called second-impact syndrome that causes swelling in the brain.
- What kind of force caused each concussion. The force required to cause a concussion varies from person to person. However, a history of previous concussions can make you more likely to suffer another concussion after a relatively minor blow to the head.
In some cases, one severe concussion might be enough to sideline an athlete for good. In other cases, it may take several minor concussions to render an athlete unable to play.
Multiple concussion risks
The risks of sustaining multiple concussions are serious. Research has shown that people who have multiple concussions are at an increased risk of long-term impairment, such as forgetfulness, “foggy” thinking, difficulty concentrating, balance issues, difficulty focusing and trouble with eyesight. And, multiple concussions also have been associated with mood disorders such as depression and anxiety.
Getting the right treatment
Your sports medicine specialist will work closely with you throughout your recovery to assess your progress and determine if, and when, you can safely return to your sport. Because your brain is more susceptible to injury following a concussion, returning to the game before all your symptoms are fully resolved can put you at a higher risk of sustaining another concussion or suffering from second-impact syndrome.
Ultimately, the decision to return to your sport after a concussion is an individual one. It’s important to follow your doctor’s recommendations to ensure your safety. For more information about concussion diagnosis and treatment, visit Virtua Sports Medicine.
Updated September 6, 2017