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The Early Concussion Management: How to Head in the Right Direction

By Nate Hadley DPT


The 2015-2016 NFL season was a season marked by change, especially in rules affecting player safety. One of the most significant changes made to the game can be seen through the NFL’s evolving management of concussions. No longer written off as “getting your bell rung” or “seeing stars”, professional football teams now employ myriad health care practitioners to recognize, diagnose, and treat concussions. Changes in concussion management are not exclusive to the NFL. Emerging concussion research has improved our understanding of the mechanisms behind these brain injuries and has provided hope for more efficient treatment options in athletic, military, and civilian populations.

Concussions, also referred to as mild traumatic brain injuries (mTBI), occur at a rate of 1.6 to 3.8 million cases annually. They are caused by a bump, blow, or jolt to the head or to the body. People do not have to lose consciousness to experience a concussion. Impact to the head or body can cause the brain to bounce or twist within the skull and damage neuronal axons. This damage then leads to disruptions in baseline chemical and metabolic activity within the brain and makes it difficult for neurons to communicate with one another. In some situations, symptoms can come on almost immediately while other times it will take hours for symptoms to develop. This can make the identification and management of concussions a difficult process. The symptoms of a concussion are variable and can include dizziness, nausea, vomiting, headaches, blurred or double vision, mood changes, sleep disruptions, or cognitive difficulties.

Given the appropriate rest, neurons have the ability to recover and return to normal function over time. Most people will recover spontaneously and without long-term effects. However, there is no specific timeframe for this recovery process. Current treatment usually involves rest and minimizing exposure to certain stimuli, like bright light or excessive noise. Unfortunately, this rest often comes with the expense of time away from school, work, and sport.

Here is where early symptom identification and multi-disciplinary care becomes important. Whereas previous treatment has been focused mostly on rest, health care providers are finding that certain clusters of symptoms actually respond better to different treatment protocols. For example, some types of post-concussive symptoms will present as cognitive fatigue during the work or school day. An individual experiencing these symptoms may benefit from intermittent rest breaks throughout the day or perhaps from minimizing bright lights or loud noises in their learning or work environment. Other individuals may experience visual difficulties after a concussion. These people may experience double vision, headaches after long periods of screen time, or may have difficulty focusing their eyes while reading. This cluster of symptoms may actually respond well to a graded exercise program.

While the symptoms of a concussion can be vague and difficult to identify, potential head injuries should be taken seriously. Changes in rules to minimize impact to the head in all sports will no doubt be beneficial to improving player safety. When concussions do occur, early recognition and treatment by a multi-disciplinary team may be the key in minimizing the wide variety of effects this injury can have on a person’s life.

For more information on concussions, please refer to the Brain Injury Association of America: