Concussions: Prevention and recovery for athletes

Team sports such as soccer, lacrosse, football, and field hockey bring together all the benefits of rigorous exercise and fun with friends. However, participation also comes with the risk of injury.

Concussions, a type of traumatic brain injury, are all too common among young athletes. Helmets and mouth guards reduce players’ risk of other injuries, but are not a safeguard against concussion. So, if protective equipment can’t keep players safe, what can?

Dr. Michael O’Brien, director of the Sports Concussion Clinic at Boston Children’s Hospital, helps athletes who’ve had concussions get back in the game. He also works with athletes to prevent concussions. Preparation and clear communication, he says, can go a long way toward reducing athletes’ risk.

Train in the off season

The season for concussion prevention is year-round. “The truth is, technology and equipment have been fairly disappointing in demonstrating real concussion prevention,” says Dr. O’Brien. “However, if we focus on improving individual athletes’ body control, we can reduce their risk of awkward falls or collisions.”

The more comfortable a player is with the ball, the more likely they’ll be aware of their surroundings and at lower risk of colliding with other players.

Dr. O’Brien believes that all athletes need to take responsibility for preparing their bodies before the season starts. He suggests everything from non-contact ball-handling drills and cross-training to balance and posture exercises. The more comfortable a player is with the ball, for instance, the more likely they’ll be aware of their surroundings and at lower risk of colliding with other players as they move the ball down the field. “Learning to control the body and, by extension, the ball, may translate to fewer concussions, not to mention better performance,” Dr. O’Brien says.

Coaching to avoid concussions

Coaches have their own role to play in supporting and improving an athlete’s body and ball control. “When running practices, we want to make sure coaches are clearly demonstrating drills to athletes at low speeds first,” Dr. O’Brien explains. “Athletes need to know what it feels like to do each drill properly at low speeds so they’re more in control of their bodies at medium and high speeds.”

The motion sequences learned in practice repeat thousands of times after practice ends. This is called “motor pattering.” Even in sleep, athletes continue to absorb the motions they’ve practiced on the field. “This is actually where a lot of motor learning occurs,” says Dr. O’Brien. “That’s why it’s essential that these techniques are done properly, at slow speeds, in the beginning.”

You’d be surprised how many concussions we get from multiple balls flying around and someone getting hit inadvertently.

Additionally, coaches need to effectively organize and manage players during practice, when there are many balls and players moving around at once, often in unpredictable directions. “You’d be surprised how many concussions we get from multiple balls flying around and someone getting hit inadvertently,” says Dr. O’Brien. “That’s why it’s important for the coach to communicate clearly, so players know what they’re expected to do and when.”

When players experience headaches, nausea, dizziness, or vomiting after a head collision, communication is key. “The concussions that go unreported or unrecognized concern me the most,” explains Dr. O’Brien. “There’s a window of vulnerability when sustaining more collisions can escalate symptoms, prolong recovery, and even lead to long-term issues.”

Safe and effective recovery

Dr. O’Brien is quick to debunk the myth that concussion treatment is a matter of prolonged rest in a dark room. “It’s actually quite the opposite. Sitting in a dark room can promote irritability, trouble sleeping, and other symptoms that we’re trying to prevent.” Instead, he suggests complete rest for the first two to four days. If their symptoms are significant, the athlete may be kept out of school. This initial period should be followed by what Dr. O’Brien calls “reasonable rest,” when the athlete can be reintroduced to light or medium exercise and cognitive activity.

Helping people feel like themselves again is a big part of recovery, but we want to do that in a way that doesn’t provoke further symptoms.

After a short time out, the next step in recovery involves light cognitive activity along with stretching and “level one” exercises the athlete can perform without getting out of breath. “The goal is two-fold,” says Dr. O’Brien. “First, we want to prevent de-conditioning. Second, we want to activate the athlete’s metabolism.” He also encourages athletes to ask for help or consider temporary academic accommodations if necessary. “Helping people feel like themselves again is a big part of recovery, but we want to do that in a way that doesn’t provoke further symptoms.”

When athletes can accomplish light cognitive and physical activity without symptoms, they can move on to slightly more strenuous level two exercises. Level three and four exercises require higher-intensity physical exertion and include activities that involve change of direction and ball handling, but the exercises are still non-contact. Only after an athlete is symptom free, can tolerate all levels of exercise, and successfully completes a cognitive assessment, should they return to practices and games that involve contact.

Consider baseline testing

A baseline test can measure your child’s normal brain function and balance before any injury. In case your child is injured in the future, your child’s doctor will be able to compare the baseline results to their current state. This can help diagnose a concussion as well as track your child’s progress as they recover.

It’s the players’ responsibility to keep the lines of communication open, and up to coaches and parents to encourage players to speak up when they feel out of sorts.

“We recommend that all student athletes, especially those who play high-impact sports like ice hockey, football, rugby, and soccer, get baseline testing before the start of the season,” says Dr. O’Brien.

Dr. O’Brien understands the complexities of preventing a condition that doesn’t have an outwardly objective measure. “It often comes down to a matter of trust and communication between athlete and trainer,” he says. “It’s the players’ responsibility to keep the lines of communication open, and up to coaches and parents to encourage players to speak up when they feel out of sorts.”

Learn more about the Sports Concussion Clinic at Boston Children’s Hospital.