Physical activity, sports, and head injuries

Sarah Romano

Updated 2015

If you or a family member is involved in a contact sport like football, soccer, wrestling, or basketball, chances are you know something about concussions. Maybe you know someone who has had one, or maybe you’ve had one yourself. But, did you know that even one concussion may have serious, long-term consequences for your brain and can increase the chances that you will have another concussion in the future?

Concussions are defined as a brain injury that causes a change in mental functioning.  It’s more than “being dazed” and less than a coma. Sports and bicycle accidents account for most concussions in children between 5 and 14.[end Ropper AH, Gorson KC. Concussion. The New England Journal of Medicine. 2007;356:166-172] A concussion does not necessarily cause loss of consciousness, but if it does, unconsciousness may last only a few seconds and not be noticed. Other symptoms, which may not be noticed right away, are:

  • Vacant stare (dazed, befuddled facial expression)
  • Delayed responses (slow to answer questions or follow instructions)
  • Inattention (easily distracted or unable to follow conversations)
  • Disorientation (walking in the wrong direction, unaware of time, date, place)
  • Slurred or incoherent speech (making disjointed or incomprehensible statements)
  • Lack of coordination (stumbling, inability to walk a straight line)
  • Inappropriate emotionality (appearing distraught, crying for no apparent reason)
  • Memory problems (repeatedly asking a question that has already been answered or showing memory deficits on formal tests of mental status)
  • Loss of consciousness (paralytic coma, unresponsiveness to stimuli)[end Is Soccer Bad for Children’s Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Institute of Medicine. National Academy Press. Washington D.C. 2002]

A person who suffers a concussion may not even realize that his or her brain has been injured, especially after a mild concussion. Still, just one concussion puts the child or adult at a greater risk for a second. For instance, one study of high school and college football players found that students who suffered a concussionwere almost six times more likely to suffer a second concussion in the five years after the initial injury.[end Zemper ED. Two-year prospective study of relative risk of second concussion. American Journal of  Physical Medicine and Rehabilitation. 2003;82:653-659.] The second concussion will probably come with symptoms that last longer than the first.[end Bruce JM, Echemendia RJ. Concussion history predicts self-reported symptoms before and following a concussive event. Neurology. 2004;63:1516-1518.] It is always important to wait until all concussion symptoms are gone before resuming sports or doing anything physically demanding. The National Institutes of Health (NIH) recommends that children with concussion symptoms should “avoid sports, hard play at recess, being overly active, and physical education class.” [end Medline Plus. National Library of Medicine and the National Institutes of Health: Concussion-Child-Discharge.]

Certain concussion symptoms indicate that the person will need more time to recover. Anyone who has more than 4 separate symptoms, a prolonged headache, or the presence of fatigue or “fogginess” should take a few extra days after symptoms go away before they return to play after their concussion.[end Brunker P, Darby D, Makdissi M, Maruff P, McCrory PR, Ugoni A. Natural History of Concussion in Sport: Markers of Severity and Implications for Management. American Journal of  Sports Medicine 2010 38:464-471.]

What if someone suffers a concussion but doesn’t realize it? At this point it’s important for adults to ask the right questions. Children and teens who have suffered a blow to the head are much more likely to report concussion when asked about symptoms in everyday language rather than complicated, medical terms that they may not understand completely.[end Bay, RC, Heil J, McVeigh SD Valovich TC. Identification of Sport and Recreational Activity Concussion History Through the Preparticipation Screening and a Symptom Survey in Young Athletes. Clinical Journal of Sports Medicine. 2008;18:235-240]

Are there long-term effects from getting a concussion? In one study a group of male college athletes who had suffered a concussion more than six months before the start of the study did not differ significantly in neurological tests compared to college athletes who had never had a concussion.[end  Bruce JM, Echemendia RJ. History of multiple self-reported concussions is not associated with reduced cognitive abilities. Neurosurgery. 2009;64:100-106.] However, a study of retired professional football players suggested that those players who suffered more than three separate concussions during their career were at a significantly greater risk of having depressive episodes later in life than retired players with no history of concussion.[end Guskiewitz KM, Marshall SW, Bailes J, McCrea M, Harding HP, Matthews A, Mihalik JR, Cantu R. Recurrent concussion and risk of depression in retired professional football players. Medicine & Science in Sports and Exercise. 2007;39:903-909.] And, another study of retired NFL players found that players who had suffered more than three concussions during their careers were at greater risk of developing early Alzheimer’s Disease.[end Guskeiwitz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C, Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005: 57; 719-726.]

Ultimately the decision about how long to wait after a concussion before resuming practice and playing in games should be made in consultation with a medical professional. Every injury and every player is different. A 2015 study in the journal of Pediatrics found that adolescents who rested 5 days after having a concussion reported more daily symptoms and slower recovery than those who rested the usual 1-2 days. The researchers advised resting for 1-2 days and then gradually starting to resume physical activity.[end Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics. 2015; 135(2).]

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.