By Dr. Kenton Fibel
March 18, 2015

In this week’s installment of Ask the Expert, Dr. Kenton Fibel, Sports Medicine Physician, answers questions on concussions in honor of Brain Injury Awareness Month.

Q1. What is a concussion?
The term concussion comes from the Latin word concutere, which means to shake violently. Based on our current understanding, a concussion is defined as a complex pathophysiological process affecting the brain and largely reflects a functional disturbance, which is generally self-limited. It can be caused by either a direct blow to the head or by an indirect force to another part of the body that is transmitted up to the head.

Q2. What are the symptoms of a concussion?
There are many symptoms that can occur with a concussion and each one can present differently, which is why it is important to increase concussion education and awareness among players, parents, coaches, and other medical professionals. Headache is the most common symptom reported with dizziness being the second most common. It is important to recognize that loss of consciousness only occurs in about 10% of concussions, which means that loss of consciousness will not occur with most concussions. Many other symptoms including nausea, vomiting, visual disturbances, feeling in a fog, or change in behavior should raise suspicion for a concussion and should prompt medical evaluation.

Q3. What should be done when someone suffers a concussion?
If someone suffers a concussion while playing sports, the athlete should be immediately removed from play without the ability to return even if symptoms appear to resolve shortly afterwards. They should then be evaluated by a medical provider who is knowledgeable in concussions in order to determine if the athlete needs to undergo further evaluation in the emergency room or if they can safely return home with specific instructions and precautions discussed with the parent or person that will be caring for them over the next several hours. Prior to returning to play, the athlete should be evaluated by a physician who is experienced in the treatment of concussions. They will help to determine when the athlete is safe to begin a graded return-to-play protocol. Return to full, unrestricted play should only occur if there is no recurrence of any symptoms while increasing both mental and physical activities.

Q4. How long do concussions usually last?
Most concussions are self-limited and will resolve within 7-10 days. It should be noted that several studies have suggested that females may experience a longer duration of symptoms prior to recovery when compared to their male counterparts as well as younger athletes may also have a more prolonged recovery when comparing them to adults. For this reason, it is important to recognize that every concussion can present differently and recovery can also vary from individual to individual and from concussion to concussion. Following a concussion, the athlete should continue to work with their health care provider to develop an individualized treatment plan in order to achieve full resolution of symptoms and return to their previous level of activities.

Q5. How many concussions can someone have before they should stop playing sports?
There is no specific number of concussions that determines when someone should stop playing sports. However, concerning signs may include if concussions are appearing to be sustained more easily (lowering of threshold), occurring more frequently, or having a longer duration of symptoms and prolonged recovery with each subsequent concussion. Each case should be treated on an individual basis and it is encouraged to discuss any of these concerns with your healthcare provider.

Dr. Kenton Fibel is a Sports Medicine Physician at Hospital for Special Surgery. He is board certified in Family Medicine with a specialization in Sports Medicine and currently serves as a Team Physician for the New York Rangers. Dr. Fibel has an interest in caring for athletes who play a variety of sports and has an appreciation for the demands of higher level athletics. His expertise lies in his conservative, non-surgical approach to sports-related injuries including those that are acute, chronic, or from overuse.