Concussions

And what the research really says about returning to school and play

Anyone who knows me knows that I am not a sports fan. I love being active—long distance running, for instance, helps me meditate and to push myself to my limits—but, frankly, I find most team sports to be needlessly aggressive. Most people think I’m crazy and try to convince me of the myriad benefits of sports, but when, time and again, kids come into my office complaining about head injuries, I feel like my concerns are warranted.

Let’s take a second to talk about traumatic brain injuries. All traumatic brain injuries, or TBIs, involve changes in normal brain function after a blow to the head. Some TBIs are very severe: those include significant memory loss and loss of consciousness for several minutes or longer, and they can impair functioning long term. Fortunately, those sorts of TBIs are rare among high school athletes. Other TBIs, known as concussions, are relatively mild, and those are much more common. Most kids who suffer concussions during sports never lose consciousness and have very mild, if any, memory loss. But they may still have vision changes, drowsiness, headaches, nausea, and more for up to two weeks following the injury, and those symptoms can be really upsetting.

For a long time, we thought that it was important for kids who had concussions to rest, both physically and cognitively. For days after injuries, kids were told to stay home from school and do essentially nothing until their symptoms resolved. But recent research actually suggests that missed school is associated with reduced recovery, and, instead, kids recover more quickly and more completely when they re-integrate into school as quickly as possible.

Two caveats: First, post-concussion symptoms are real, and teachers need to understand that students may not be functioning normally in the days after a concussion. Academic accommodations, such as flexible deadlines, reduced workloads, and preferential seating in the classroom, may be necessary for a week or two, until symptoms fully resolve, to support an injured student’s return to school.

Second, a return to school does not include a return to sports. Increased caution in sports is important because repeated concussions may lead to worse symptoms and, in some cases, long-lasting brain damage. Kids really need to wait until their symptoms have fully resolved to begin playing again. They should feel a complete resolution of pain without medication, their cognitive functioning should be totally back to normal, and they shouldn’t notice any symptoms even while doing light physical activity, like jogging or doing a few push ups. Some schools do baseline cognitive testing before the sports season begins, and then they repeat testing after a concussion to make sure functioning is back to baseline before letting kids go back to sports; I think this is a sound protocol and highly recommend it.

So, basically, my advice to teenagers with concussions is to return to school even before they feel better but wait to return to sports until they feel completely better. Unfortunately, none of this is winning me any popularity points.

***

I watched the Emmys last night, and I loved seeing Meghann Fahy. She was awesome in White Lotus, right? So here’s your weekly reminder that all the best people got their start on Broadway!