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Dr. Williams Shares with Max Sports & Fitness What You Need to Know about Concussions



By: Linda Hepler, BSN, RN

Many people who’ve played high school or college contact sports like football, soccer or hockey remember an incident of getting “knocked out,” “dinged up” or getting their “bell rung.” These names refer to a mild traumatic brain injury, or a concussion. But you don’t have to be a college athlete – or even play contact sports – to experience a concussion, said Vernon Williams, MD, a sports neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine in Los Angeles, California. “You can suffer a concussion in any activity where you’re moving at high velocity – skiing, snowboarding, running, cycling or skateboarding, for example,” he explained.

According to the Centers for Disease Control and Prevention, there are an estimated 3.8 million sports and recreation related concussions in the United States each year. This condition is caused by a blow to the head or the body, a fall or an injury that shakes the brain inside of the skull. And while the overwhelming majority of concussions heal within a week to 10 days, said Dr. Williams, a small percentage of people – about 10-15 percent – have a “post-concussive syndrome,” or symptoms that last longer, up to three months or even longer. Risk factors for a prolonged recovery are having had a previous concussion, having a learning disability such as ADHD or having chronic migraines or a pre-existing mental health condition such as depression or anxiety.

Richard Hamilton, PhD, brain injury specialist and clinical director of the Brain Injury and Concussion Rehabilitation programs at Baptist Hospital in Miami, Florida, said a recurrent head injury while still recovering from a concussion can cause severe problems – or in rare cases, even death. “A concussion is a dysfunction of the brain that temporarily alters your metabolic function,” he explained. “You’re four times more likely to get another concussion within the two weeks following a first one.” This “second impact syndrome,” or a second blow to the head before the symptoms of a first concussion fully clear up, is rare but has devastating results, said Dr. Hamilton. “About 50 percent of these people die, and those who don’t, have permanent brain damage.”

This can wreak havoc, with lingering physical, cognitive and mental symptoms that can spell the end of a college or professional athletic career and cause difficulties holding down jobs or maintaining relationships.

How do you know if the blow you took to the head is a concussion? According to Dr. Hamilton, many people think that a concussion is when you lose consciousness, but this isn’t always the case. You may experience problems with thinking and remembering (inability to concentrate, feeling foggy) or have physical complaints like headache, blurred vision, nausea, balance problems, fatigue and sleep disturbances. People who have concussions may also have emotional or mood issues such as irritability, anxiety or even depression. If you have any of these symptoms following a blow to the head or a fall, it’s important to get checked out by a medical professional with expertise in concussion management, he added.

While a promising recent Swedish study suggests that there is a rise in blood levels of a protein called “total-tau” following a concussion, there is no testing at present to diagnose the condition, said Mark Herceg, PhD, director of Rehabilitation Psychology and Neuropsychology at Burke Rehabilitation Hospital in New York. “You won’t see a concussion on a CT scan or a MRI,” he explained.

Instead, said Dr. Herceg, the doctor will “clinically” diagnose a concussion based upon the symptoms you’re experiencing following a blow to the head or another injury that may have caused it. Early diagnosis, according to Dr. Herceg, is crucial.

Proper concussion management is crucial, too, said Dr. Hamilton. “Athletes with concussion should have both physical and cognitive rest until symptoms clear. The brain is trying to go back into balance, to heal itself from the injury. It needs glucose from blood flow. So that means no physical activity and no mental activities, like computer work, school work, TV, texting and computer games.”

Those with lingering symptoms need to be referred to the right expert for help, said Dr. Williams. If you have balance problems, there’s vestibular therapy. Cognitive problems can be helped with an occupational therapist or speech therapist, and psychotherapy can help with emotional issues. “Concussion is a significant injury, but it doesn’t have to be serious if handled properly,” he said.



Even at the point that your concussion symptoms clear, you need to gradually return to contact sports or high-risk recreational activities. Most high school and professional athletic teams use a protocol for gradual return to play. Each phase should be followed for 24 hours, and if concussion symptoms return, the athlete goes to the previous phase for 24 hours:

Phase 1: No activity – Physical rest (no running, jumping, sports) and cognitive rest (no schoolwork, computer work, texting, TV or computer games.

Phase 2: Light exercise – Walking, swimming or stationary cycling at less than 70 percent of maximum heart rate for age. No resistance training.

Phase 3: Sport specific exercise – Such as skating if you play hockey or running if you play soccer.

Phase 4: Non-contact training – Progression to more complex training, such as passing in ice hockey. May start progressive resistance training.

Phase 5: Full-contact practice – After the go-ahead from your doctor, participation in normal training activities.

Phase 6: Return to play – Normal game play



Every athlete should recognize the signs and symptoms of a concussion and know when to seek medical help for a head injury, said Vernon Williams, MD, a sports neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine in Los Angeles, California. “Even better,” he added, “is taking steps to prevent concussions in the first place. This will assure a healthy brain, and with a healthy brain, you’re a better athlete.”

Here are five tips from Dr. Williams to help prevent concussion:

1). Use all recommended protective equipment for contact sports and check for proper fit.

2). Make sure you’re using proper technique while engaging in sports to prevent head and neck injuries.

3). Stay hydrated. When you’re dehydrated, your neurological function and balance are impaired, which could lead to falls.

4). Strengthen your neck with exercises (ask a personal trainer or sports medicine professional for help). A strong neck greatly reduces the risk of whiplash-type injuries that may lead to concussion.

5). Take steps to improve your balance with a stability ball or simple balance board. You can also do exercises without equipment; for suggestions, see



Less than two months ago, the NCAA settled a federal class-action lawsuit involving a number of former athletes who said they suffered brain damage from improper management of concussions sustained while playing contact sports in college. The settlement included a $70 million fund set aside for medical screening of thousands of current and former NCAA athletes to determine the extent of neurological injuries they incurred while playing contact sports like football, hockey, lacrosse and soccer – a step which may establish grounds for individual lawsuits for damages. Part of the fund will also go toward concussion research.

In addition to medical testing and research, the college sport’s governing body also agreed to implement a single return-to-play policy for treatment of players who’ve suffered head blows, rather than allowing individual schools to use their own discretion about when athletes can go back into games (former requirements only said that schools must have concussion management plans but did not outline what should be in those plans). Other mandates for NCAA member schools include preseason baseline cognitive testing for all athletes (concussion testing assesses your brain and thinking function both before and after a head trauma) to aid in the determination whether a concussion has healed, and a requirement that medical personnel trained in the diagnosis, treatment and management of concussions be present for all games and available for practices for all contact sports. MS&F