I love fall – it’s (ideally!) less humid, leaves are starting to change color, my electric bills start to return to reasonable levels, and the monthly-major-holiday season is underway.
It’s also football season, when I feel compelled to draft and publish another common-sense guide to sports-related concussions. While I truly appreciate the many ways we continue to improve player safety, there are still some surprisingly easy opportunities to go further, along with outdated practices and misinformation sometimes promoted by people with the very best of intentions.
An example? Pre-season computerized neurocognitive testing. Some schools still devote considerable, well-intended time and resources to baseline testing of youth athletes, even though it is no longer recommended as best practice. Imagine devoting that same time and energy to helping athletes, parents, coaches, and educators better understand concussions and recovery instead.
Don’t get me wrong – baseline testing has its place for some athletes, and I’m not knocking the critical roles of Athletic Trainers, or physicians, coaches, and educators. But not even the most gifted can effectively play every position. As a Developmental and Sports Neuropsychologist, concussions happen to be mine.
So, with football season underway, why not put what I know into play, starting with education?
Any athlete at the high-school level or above has had some education about concussions. Same for their parents and coaches. Yet, I still very rarely meet a youth, elite, or professional athlete in my office who truly understands what a concussion actually is, and how differently we manage concussions compared to other injuries.
The Concussions page of my website provides that definition, highlighting that concussions are metabolic injuries that disrupt the brain’s energy sources. When brains are fuel-starved and we continue to engage in energy-demanding activities, symptoms can feel worse instead of better. So, the common wisdom has been – and continues to be – REST.
What “REST” is interpreted to mean is the problem, however. It’s definitely not all those “No’s.”
We now know total and/or prolonged rest doesn’t help recovery. Common sense probably should have told us that too; shut down any active person, especially an athlete, and take away their friends, screens, school, and the sport they love, and they are NOT going to feel better! And, watching six missed tests and three projects pile up is not optimal stress reduction, either.
That’s where a sports neuropsychologist comes in as part of an athlete’s team – our expertise is understanding how the brain functions and affects us. In collaboration with the (sports) medicine team, we identify symptom profiles along with risk factors and contextual demands, helping athletes remain engaged in life without energy overload.
Concussions are treatable! If managed appropriately, recovery should take days or weeks, not months. But when symptoms don’t improve significantly after a week, or recovery drags on for weeks or months, we need to be asking why, not simply waiting longer. And the sooner we can step in, the more we can do to promote and expedite recovery.
Otherwise, athletes may minimize or underreport symptoms just to get their lives back, presuming they’ve admitted to the injury in the first place, while prolonged recovery can trigger a cascade of secondary issues, from social withdrawal to depressed mood, irritability or “attention problems,” and worsened sleep.
Persistent symptoms are definitely not a cue to pull out a bigger test kit! We neuropsychologists love our tests, but sports neuropsychology is a highly specialized area of expertise, and concussive injuries are evaluated and managed differently than other brain injuries.
The goal is not necessarily quantifying what athletes are already telling us. It’s to figure out what is getting in the way of recovery and what to do about it.
No one specialty can manage every aspect of a concussion – I have another blog that discusses the key players on concussion management teams. Athletic Trainers and Team Physicians are on the front lines and sports neuropsychologists don’t need to see everyone. BUT if symptoms are severe, risk factors are present, and/or there’s not significant improvement after the first week, REACH OUT – I will make every effort to see acute injuries within a few days to identify what may be interfering with recovery, the other providers needed, and the individualized recommendations to help the student-athlete to return to learn and play.
As the Charlotte Observer, local schools, and mental health professionals all continue to focus on mental health among high school students, education around concussive injuries deserves a place in that conversation, too.
Teen depression and suicide are extraordinarily complex, and it would be inaccurate and irresponsible to attribute either to a single injury or event. But that doesn’t mean we should ignore factors we have the ability to change. Returning an athlete to play before recovery, allowing symptoms to linger without appropriate intervention, or treating significant post-concussion changes in mood, sleep, behavior, or functioning as something to simply wait out can have consequences well beyond the playing field.
We cannot prevent every tragedy or eliminate every threat to youth mental health. But better pre-injury concussion education, earlier identification, and evidence-based management are concrete things we can do. When the stakes include not only an athlete’s recovery, but potentially their emotional well-being, that seems like a pretty small ask.
That should be a no-brainer.
