National Federation of State High School Associations (NFHS)
Sports Medicine Advisory Committee (SMAC)

A concussion is a brain injury which results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull, typically from a blow to the head or body. An athlete does not need to lose consciousness (be “knocked-out”) to suffer a concussion, and in fact, less than ten percent of concussed athletes suffer loss of consciousness.

What should I do if I think my child has had a concussion?

If an athlete is suspected of having a concussion, he or she must be immediately removed from that activity. Continuing to play or work out when experiencing concussion symptoms can lead to worsening of symptoms, increased risk for further injury and possibly death. Parents and coaches are not expected to be able to make the diagnosis of a concussion. A medical professional trained in the diagnosis and management of concussions will determine the diagnosis. However, you must be aware f the signs and symptoms of a concussion. If you are suspicious your child has suffered a concussion, he or she must stop activity right away and be evaluated:

When in doubt, sit them out!

All student-athletes who sustain a concussion need to be evaluated by a health care professional who is experienced in concussion management. You should call your child’s physician and explain what has happened and follow your physician’s instructions. If your child is vomiting, has a severe headache, is having difficulty staying awake or answering simple questions, he or she should be immediately taken to the emergency department.

When can an athlete return to play following a concussion?

After suffering a concussion, no athlete should return to play or practice on that same day. Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury. Studies have shown that the young brain does not recover quickly enough for an athlete to safely return to activity in such a short time.

Concerns over athletes returning to play too quickly have led state lawmakers in almost all states to pass laws stating that no player shall return to play that day following a concussion, and the athlete must be cleared by an appropriate health-care professional before he or she is allowed to return to play in games or practices.

The laws typically also mandate that players, parents and coaches receive education on the dangers and recognizing the signs and symptoms of concussion.

Once an athlete no longer has symptoms of a concussion and is cleared for return to play, he or she should proceed with activity in a step-wise fashion to allow the brain to re-adjust to exertion. On average, the athlete will complete a new step each day. An example of a typical return-to-play schedule is shown below:

• Day 1: Light exercise, including walking or riding an exercise bike. No weight-lifting.
• Day 2: Running in the gym or on the field. No helmet or other equipment.
• Day 3: Non-contact training drills in full equipment. Weight-training can begin.
• Day 4: Full contact practice or training.
• Day 5: Game play.

If symptoms occur at any step, the athlete should cease activity and be re-evaluated by their health care provider.

How can a concussion affect schoolwork?

Following a concussion, many student-athletes will have difficulty in school. These problems may last from days to months and often involve difficulties with short- and long-term memory, concentration and organization.

In many cases after the injury, it is best to decrease the athlete’s class load early in the recovery phase. This may include staying home from school for a few days, followed by academic accommodations (such as a reduced class schedule), until the athlete has fully recovered. Decreasing the stress on the brain and not allowing the athlete to push through symptoms will shorten the recovery time.

What can I do?

• Both you and your child should learn to recognize the “Signs and Symptoms” of concussion as listed above.
• Teach your child to tell the coaching staff if he or she experiences such symptoms.
• Emphasize to administrators, coaches, teachers and other parents your concerns and expectations about concussion and safe play.
• Teach your child to tell the coaching staff if he or she suspects that a teammate has suffered a concussion.
• Ask teachers to monitor any decrease in grades or changes in behavior that could indicate a concussion.
• Report concussions that occurred during the school year to appropriate school staff. This will help in monitoring injured athletes as they move to the next season’s sports.

Why is it so important that athletes not return to play until they have completely recovered from a concussion?

Student-athletes that return to any activity too soon (school work, social activity or sports activity), can cause the recovery time to take longer. They also risk recurrent, cumulative or even catastrophic consequences, if they suffer another concussion. Such risk and difficulties are prevented if each athlete is allowed time to recover from his or her concussion and the return-to-play decisions are carefully and individually made. No athlete should return to sport or other at-risk activity when signs or symptoms of concussion are present and recovery is ongoing.

Is a “CAT scan” or MRI needed to diagnose a concussion?

Diagnostic testing, which includes CT (“CAT”) and MRI scans, are rarely needed following a concussion. While these are helpful in identifying life-threatening head and brain injuries (skull fractures, bleeding or swelling), they are currently insensitive to concussive injuries and do not aid in the diagnosis of concussion. Concussion diagnosis is based upon the athlete’s story of the injury and a health care provider’s physical examination and testing.

What is the best treatment to help my child recover quickly from a concussion?

The best treatment for a concussion is rest. There are no medications that can help speed the recovery. Exposure to loud noises, bright lights, computers, video games, television and phones (including text messaging) may worsen the symptoms of a concussion. You should allow your child to rest as much as possible in the days following a concussion. As the symptoms lessen, you can allow increased use of computers, phone, video games, etc., but the access must be lessened or eliminated, if symptoms worsen.

How long do the symptoms of a concussion usually last?

The symptoms of a concussion will usually go away within 2–3 weeks of the initial injury. You should anticipate that your child will likely be out full participation in sports for about 3-4 weeks following a concussion. However, in some cases symptoms may last for many more weeks or even several months. Symptoms such as headache, memory problems, poor concentration, difficulty sleeping and mood changes can interfere with school, work, and social interactions. The potential for such long-term symptoms indicates the need for careful management of all concussions.

How many concussions can an athlete have before he or she should stop playing sports?

There is no “magic number” of concussions that determine when an athlete should give up playing contact or collision sports. The circumstances that surround each individual injury, such as how the injury occurred and the duration of symptoms following the concussion, are very important and must be individually considered when assessing an athlete’s risk for and potential long-term consequences from incurring further and potentially more serious concussions. The decision to “retire” from sports is a decision best reached after a complete evaluation by your child’s primary care provider and consultation with a physician or neuropsychologist who specializes in treating sports concussions.

I’ve read recently that concussions may cause long-term brain damage in professional football players. Is this a risk for high school athletes who have had a concussion?

The issue of “chronic traumatic encephalopathy (CTE)” in former professional players has received a great deal of media attention lately. Very little is known about what may be causing these dramatic abnormalities in the brains of these unfortunate players. At this time we do not know the long-term effects of concussions (or even the frequent sub-concussive impacts) which happen during high school athletics. In light of this, it is important to carefully manage every concussion and all concussion-like signs and symptoms on an individual basis.

Some of this information has been adapted from the CDC’s “Heads Up: Concussion in High School Sports” materials by the NFHS’s Sports Medicine Advisory Committee. Please click here for more information.

• A concussion is a type of traumatic brain injury. The result is a more obvious functional problem than a clear structural injury, causing it to be invisible to standard medical imagining (CT and MRI scans).
•  It is estimated that over 140,000 high school athletes across the United States suffer a concussion each year. (Data from NFHS Injury Surveillance System)
• Concussions occur most frequently in football, but boys’ ice hockey, boys’ lacrosse, girls’ soccer, girls’ lacrosse and girls’ basketball follow closely behind. All athletes are at risk.
•  A concussion may cause multiple symptoms. Many symptoms appear immediately after the injury, while others may develop over the next several days or weeks. The symptoms may be subtle and are often difficult to fully recognize.
• Concussions can cause symptoms which interfere with school, work, and social life.
• Concussion symptoms may last from a few days to several months.
• An athlete should not return to sports or physical activity like physical education or working-out while still having symptoms from a concussion. To do so puts them at risk for prolonging symptoms and further injury.

SIGNS OBSERVED BY PARENTS, FRIENDS, TEACHERS OR COACHES

• Appears dazed or stunned
• Is confused about what to do
• Forgets plays
• Is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness
• Shows behavior or personality changes
• Can’t recall events prior to hit
• Can’t recall events after hit

SYMPTOMS REPORTED BY ATHLETE

•  Headache
• Nausea
• Balance problems or dizziness
•  Double or fuzzy vision
•  Sensitivity to light or noise
• Feeling sluggish
• Feeling foggy or groggy
• Concentration or memory problems
• Confusion

The NFHS regularly distributes position statements and guidelines to promote public awareness of certain health and safety-related issues. Such information is neither exhaustive nor necessarily applicable to all circumstances or individuals, and is no substitute for consultation with appropriate health-care professionals. Statutes, codes or environmental conditions may be relevant. NFHS position statements or guidelines should be considered in conjunction with other pertinent materials when taking action or planning care. The NFHS reserves the right to rescind or modify any such document at any time.

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