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Core Knowledge


Concussions: What You Need to Know


A concussion is an injury to the brain caused by a blow to the head. It is not a life-threatening condition, but it can cause serious short and long-term problems. Because concussions are very complex physiological events, there is no single protocol that applies to each case. Each one has to be managed on an individual basis.  

Matt King / Getty Images

How it Happens

Concussions happen when a person’s head comes into contact with a stationary or moving object. If the collision causes the brain to move within the skull, the person can become unconscious. Bleeding into the brain is also a possibility, which is why the person who has been injured should be closely monitored. How long he or she remains unconscious is related to the severity of the concussion, although some concussions do not result in unconsciousness.

By the Numbers

Number of concussions per year in the U.S.

Percentage of people who suffer postconcussive syndrome (persistent headaches, dizziness, poor concentration, nausea and/or vomiting)

Number of weeks up to several months that post-concussive syndrome can last

Who’s At Risk

Concussions are most likely to occur in contact sports such as football, hockey, soccer, boxing, martial arts and rugby, but can happen in other sports as well, including baseball (when hit by a pitch), cycling (on crashes and falls), rollerblading, surfing and skateboarding.


Symptoms Observed by a Coach, Trainer, Physician or Other Person

  • Dazed or stunned appearance
  • Confusion about assignments (in sports)
  • Forgets plays or events prior to plays
  • Unsure about the game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness, but not in every case
  • Exhibits behavior or personality changes
  • Forgets events after being hit
  • Unequal size of pupils
  • Unusual eye movement

Symptoms Reported by the Person Injured

  • Headache
  • Nausea
  • Dizziness, problem maintaining balance
  • Double/fuzzy/blurred vision
  • Feeling of sluggishness or fatigue
  • Problem with concentration or memory
  • Change in sleep pattern

Initial Treatment

Managing a person’s concussion involves 1) education about the condition, 2) identifying the concussion early and 3) prohibiting the athlete or exerciser from returning to play or practice until there are no symptoms at rest and during exertion, as well as a complete return to the way the person felt and acted prior to the injury. Here are specific guidelines from the University of Pittsburgh Sports Medicine Concussion Program:

An athlete demonstrating or reporting any symptoms of the injury should be removed from play and not allowed to return.

The person’s mental status and symptoms should be regularly monitored in case symptoms get worse, and a physician should evaluate the person’s condition as soon as possible.

Get the person to an emergency room in these cases:

  • Severe head trauma, headache
  • Unconsciousness that lasts longer than two minutes
  • Delayed loss of consciousness
  • Vomiting more than once
  • Confusion that persists
  • Extreme drowsiness, weakness, or inability to walk
  • Repeating the same thing over and over (perseverating)

Comeback Strategy

Return to play should follow a supervised and graduated process.

The injured person should be required to advance through these three levels:

  1. No activity that requires exertion during the period while symptoms are present when at rest.
  2. Once the symptoms have disappeared, the person should be tested to see if symptoms reoccur during light, aerobic activity (walking, stationary cycling), during moderate sport-specific training (running, skating), and then during heavy exertion/non-contact training drill.
  3. Return to contact sport participation only after completing heavy exertion with no symptoms.

Individuals who have had a concussion are more likely to have another one, and the effects of multiple concussions are cumulative.

How to Avoid This Injury

For athletes and exercisers, the risk of injury comes with the territory, but you can reduce the likelihood of concussions by following these rules:

  • Learn to recognize the signs of a concussion.
  • Wear helmets/headgear during activities where contact is common or even possible (See “Who’s at Risk” above).
  • Wear mouthguards while playing contact sports (some concussions are related to blows to the jaw).

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.

Tags: Injury, Rehabilitation, Pain, Injury Prevention


  1. Athletes’ Performance
  2. MayoClinic.com
  3. National Institutes of Health (Medline Plus)
  4. Sports Health Competitive Edge (Cleveland Clinic)
  5. University of Pittsburgh Sports Medicine Concussion Program