DEAR MAYO CLINIC: Our daughter plays field hockey, and it can get physical on the field with collisions and falls. We’re worried that we won’t know if she gets a concussion. What signs should we watch for?
ANSWER: With school team sports amping up, student-athletes are at greater risk of concussion. In addition to coaches, parents play a role in spotting signs of symptoms. A possible concussion isn’t something to brush off. It’s a form of mild traumatic brain injury.
During a concussion, the brain moves within the inner walls, sliding back and forth. This can be due to a violent blow to the head and neck or upper body, a collision, or a hard fall during practice or a game. Typical symptoms include:
- Blurry vision or hazy spots in their vision field.
- Confusion or feeling as if in a fog.
- Amnesia about what happened.
- Slowness getting up after a play.
- Changes in behavior, such as irritability and crankiness.
- Loss of balance or unsteadiness in walking.
- Ringing in the ears that doesn’t go away.
It’s important to know that no two concussions are the same. While student-athletes often compare themselves with teammates or friends who have had concussions, one athlete may experience only one symptom, and another may have several. The absence of a particular symptom doesn’t rule out a concussion; all potential symptoms should be taken seriously.
Concussion symptoms may not appear immediately. An athlete may seem fine at first but develop symptoms later. Athletes may also minimize or hide symptoms because they’re worried about being removed from a game or missing future competitions. That makes it especially important for parents, coaches and athletic trainers to pay attention not only to what an athlete says but also to changes in how they look or behave.
A concussion doesn’t require a direct blow to the head. If someone is pushed, falls backward or experiences a whiplash-type motion, that action can cause the brain to move within the skull. If parents see that type of injury or their child reports concussion-like symptoms afterward, they should be alert for changes. For younger athletes, it may be difficult to explain exactly what they’re feeling. Parents know what’s typical for their child, so recognizing that something seems “off” can be important.
Today’s school sports concussion protocols require that if a student-athlete has possible concussion symptoms, they shouldn’t return to play that day and not return until cleared by a healthcare professional.
At home, parents should continue monitoring symptoms. If their child’s symptoms get worse, they should receive medical attention right away. Parents also should watch how symptoms change in the following days. Symptoms often begin to improve within the first several days, with recovery typically progressing over about 7 to 14 days. If symptoms aren’t resolving after about two weeks, more evaluation may be needed. This could include referral for physical therapy and therapies that address lingering problems, such as problems with balance and dizziness.
Recovery also involves more than getting an athlete back onto the field. Returning to school should come before returning to sport. If a student can’t tolerate a full school day, they shouldn’t be participating fully in athletics. Some students may need temporary academic adjustments, such as additional time for tests, help with note-taking, or reduced exposure to screens if computers or projected displays make symptoms worse.
Concussions can be challenging because there’s often no outward sign of injury, such as a cast or crutches, that shows others something is wrong. That can make it tempting for an athlete — or the people around them — to underestimate the injury. Protecting the brain and giving it adequate time to recover needs to be the priority. For young people, that means remembering they are students first and athletes second.
Kimberly Penkert, Sports Medicine, Mayo Clinic Health System, Mankato and New Prague, Minnesota
