UVA Health Experts Urge Athletes to Recognize Concussion Warning Signs as Fall Sports Begin

With fall sports underway, UVA Health concussion specialists are reminding athletes, parents, and coaches that a concussion does not always produce obvious symptoms — and football players are far from the only athletes at risk.

Headaches, dizziness, and nausea are among the most common symptoms, but other problems can include sensitivity to light or sound, vision changes, fatigue, and difficulty concentrating, according to specialists at the UVA Health sports concussion clinic.

Just as importantly, symptoms may not appear immediately after an injury.

Dr. Racheal Smetana

Dr. Racheal Smetana, a neuropsychologist with the clinic, said the excitement and adrenaline surrounding a game or intense practice can sometimes make symptoms less noticeable at first.

An athlete might take a hard hit or strike his or her head on the ground, get back up and initially feel normal.

Once the athlete is out of that environment, however, a headache or dizziness may become noticeable several hours later.

“In general, we tend to expect symptoms to pop up within a couple of days,” Smetana said. “Usually, it is within a few hours to a day after injury, though.”

Other problems, including difficulty concentrating and changes in sleep, can take longer to recognize. An athlete returning to school, for example, may suddenly notice that paying attention is more difficult than it was before the injury.

That is one reason UVA Health specialists are urging people around young athletes to pay attention to changes in behavior rather than depending solely on an injured player to report a problem.

“If you see something, say something,” Smetana said.

If an athlete falls, hits his or her head, gets up appearing woozy but insists on continuing to play, Smetana said that is a reason to remove the player and have the injury checked.

The same advice applies away from the playing field.

“If your child comes home from a practice and seems a little off, maybe doesn’t remember explicitly hitting their head, but something seems weird, that’s a time to just tell someone to get it checked out,” she said.

That could mean notifying a school athletic trainer or coach or contacting a pediatrician or primary care provider.

Some symptoms require more urgent attention.

Jose Hernan N Posas, III, MD

Dr. Jose Posas, a neurologist with the UVA Health sports concussion clinic, identified loss of consciousness as one of the more recognizable warning signs following a head injury.

Other red flags can be less obvious.

An athlete’s arm or both arms becoming unusually stiff after a hit can be concerning, as can slurred speech, facial drooping or weakness in an arm or leg.

An athlete who gets up and appears to be “bobbing and weaving” while trying to walk back to the bench or sideline should also be evaluated quickly.

“Those are things that need to be checked out fairly quickly for things that may be more dangerous than concussion,” Posas said.

He also emphasized that an athlete suspected of suffering a concussion should not simply return to the same game.

Football receives much of the attention when concussion discussions increase during the fall, but UVA Health specialists said the risk extends well beyond the football field.

For boys and men, Smetana said sports including ice hockey and wrestling carry concussion risks. Soccer and lacrosse present risks for both male and female athletes.

Cheerleading is another sport in which the clinic sees concussions, particularly during stunts and tumbling.

And in Central Virginia, there is another significant source of sports-related head injuries: horseback riding.

“We also see a lot of sport-related concussions with equestrian injury across the lifespan, from children to adults,” Smetana said.

The clinic uses return-to-riding protocols to help those patients safely work their way back to equestrian activities.

The UVA specialists also addressed questions about whether concussions affect male and female athletes differently.

Posas said previous thinking suggested women might take longer to recover from concussions. But research from a UVA colleague found recovery times were about the same when differences in access to athletic trainers and appropriate medical care were taken into account.

In sports played by both men and women in the region, including soccer and lacrosse, Posas said the concussion numbers seen by UVA Health appear fairly even.

Preventing every concussion may not be possible, but there are steps teams can take to reduce risk.

Keith Thomson

Keith Thomson, an athletic trainer with the UVA Health sports concussion clinic, said properly fitted equipment is one important measure.

Football and lacrosse players, for example, need helmets and pads that fit properly rather than equipment that is too large or otherwise ill-fitting.

Technique also matters.

Coaches should teach athletes how to make contact properly, including avoiding lowering the head during a football tackle.

Posas said teams can also reduce unnecessary contact during practices.

He pointed to a trend at the college level of limiting the number of contact days and suggested similar approaches could be considered for younger athletes.

Another step is eliminating drills that involve hard collisions solely to demonstrate or build “toughness,” rather than to teach a specific skill.

Posas said some drills familiar to earlier generations of football players were essentially designed for athletes to smash into teammates without a particular technical objective.

Reducing that type of unnecessary contact can reduce opportunities for head injuries while still allowing athletes to practice the skills they need.

Education across the entire team is another important tool.

Thomson said athletes sometimes do not recognize that something is wrong with them following a hit. A teammate may be the person who notices unusual behavior and brings the injured athlete to an athletic trainer or alerts a coach.

That makes concussion awareness a responsibility shared by players, coaches, trainers and parents.

UVA Health also offers preseason baseline concussion testing for some athletes.

Thomson said the clinic may recommend baseline testing for athletes with a history of concussions or other diagnoses that could make post-injury symptoms more difficult to evaluate.

Testing can include a computer-based neurocognitive assessment, balance testing, and tests involving the eyes and vestibular system, which help control balance and spatial orientation.

The purpose is to establish what is normal for that particular athlete before an injury occurs.

“Everybody’s normal is a little different,” Thomson said.

If the athlete later suffers a concussion, clinicians have additional information to help determine when the patient has returned to his or her normal level of functioning.

The UVA Health concussion clinic treats more than school and college athletes.

Thomson said the clinic sees patients ranging from elementary school children to older adults in their 70s and 80s who participate in recreational sports and suffer acute concussions.

The goal is to see patients quickly and develop an appropriate treatment plan.

Posas said the clinic currently serves patients in Charlottesville and Albemarle County, including University of Virginia students and students from local high schools. The program is also building its capacity to serve younger students and hopes to expand connections with surrounding Central Virginia communities.

For families preparing for another season of practices and games, the specialists’ message is relatively simple: Don’t ignore anything that doesn’t look right.

Young athletes can face considerable pressure to remain in a game, particularly as they reach high school and college and begin thinking about recruiting and opportunities to compete at higher levels.

That makes it even more important for the adults and teammates around them to recognize when an athlete needs to stop.

“If something feels wrong or looks wrong, it might be wrong,” Smetana said. “Get it checked out.”