Female Athletes and Sports Injuries

Beth Shubin Stein, MD, discusses the most common types of injuries among female athletes and how they can advocate for better treatment

Field and court sports provide the highest risk for injury in female athletes, says Dr. Beth Shubin Stein, Associate Professor of Orthopedic Surgery and Sports Medicine at the Hospital for Special Surgery in New York. When it comes to the type of injury, Dr. Shubin Stein says female athletes are most susceptible to knee and shoulder injuries—and even have an increased risk for some of these injuries compared to male athletes. While prevention programs aimed at educating female athletes about the prevalence of these injuries and how to best train to reduce their risk have popped up in recent years, there is still work to do.

Dr. Shubin Stein recently spoke with us about the differences in treatment between male and female athletes, the most common type of injury female athletes face and the role concussion plays in women’s athletics.

Equal Care for Female Athletes

Treatment of female athletes has improved significantly in the past couple of decades, Dr. Shubin Stein says. “In the last 15 to 20 years, we’ve seen a huge shift toward more aggressive care for the female athlete,” she says. “That’s because, in this generation, we have seen nearly equal sports participation amongst women and men as they grow up.”

Dr. Shubin Stein says she always advises her female patients to speak up if something doesn’t seem right when they are being treated for an injury. “Women need to be their own best advocates,” she says. “If what they’re told on the sidelines or even in the doctor’s office does not make sense, or they’re told that it’s time to return to sport and something doesn’t fit, they should say, ‘I’m not comfortable. Something is off.”

The Prevalence of Knee Injuries in Female Athletes

When comparing women’s soccer, tennis and basketball players to men’s soccer, tennis and basketball players, the risk to the female knee is four to nine times greater than it is to the male knee, Dr. Shubin Stein says.

The anatomy of the female knee and the way in which women land, cut, pivot and jump contribute to this increased risk of knee injury. More specifically, female athletes have a higher incidence of ACL injuries than male athletes in the same sports, according to a 2012 study published in Research In Sports Medicine.

Dr. Shubin Stein says prevention programs have been created to mitigate the risk female athletes face regarding knee injury. This is an area experts have tried to create more awareness about, especially in youth athletics. But incorporating these risk prevention programs in youth athletics is still a challenge. “Unfortunately, most of the schools that would benefit from it don’t have the finances to get the athletic trainers who could actually help them,” Dr. Shubin Stein says. “But the awareness is there.”

Concussion Risk in Female Athletes

For female athletes, the greatest risk for concussion occurs in soccer and lacrosse, Dr. Shubin Stein says. This year, female lacrosse players have the option to wear helmets for the first time. Previously, there were no protective helmets for women, Dr. Shubin Stein says. Men, on the other hand, have always worn protective helmets during lacrosse.

Dr. Shubin Stein says she believes newer and stricter policies that came out regarding concussion in the past few years have created more awareness for concussion not only in athletes but health care providers, as well.

“When my patients and I speak, and we talk about the injury at hand, if it had anything to do with their head, I make sure that they’ve either seen a neurologist or have an appointment to see a neurologist to be evaluated,” she says.

Dr. Shubin Stein believes this increased awareness about concussion will make treatment of it gender-neutral in the future. “I think we will see that concussion is treated aggressively both between men and women. The focus now is more equal in terms of how we treat our young athletes,” she says. “I don’t think that was true 25 years ago, but it has become true within the last decade.”


Beth Shubin Stein, MD, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org  is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

8 Tips for Coping with Post-Traumatic Headache Over the Holidays

Loud music and bright lights can pose a risk for people with PTH. Here’s how to navigate the holiday season

The holidays can be a fun, busy time filled with parties, big meals and endless opportunities to deck the halls. But with those events comes loud music, bright lights, rich food and other triggers that can pose a risk for people with post-traumatic headache (PTH).

From high-school cheerleaders to firefighters, nearly anyone can experience PTH. PTH is a headache that occurs within seven days after someone has experienced a concussion. Symptoms of PTH include everything from dizziness and trouble sleeping to sensitivity and noise and mood changes. In addition to medication, treatment for PTH includes physical therapy and relaxation therapy. Emotional and psychological problems can trigger a headache, so relaxation during PTH recovery is crucial.

For someone experiencing PTH, the holidays can often be chaotic and problematic. Everything from bright holiday lights and loud parties to sugary food and alcohol can trigger PTH. Here’s everything you need to know about navigating the holidays with PTH:

1. Take the Time to Rest

Rest is one of the most important things to keep in mind when recovering from PTH. Although you might be tempted to RSVP yes to every invitation you receive, consider sitting some events out if you know they’ll be overwhelming or will cut into your sleep time. Strive to get the recommended seven to nine hours of sleep per night, as lack of sleep can exacerbate the symptoms of PTH.

2. Avoid Crowded Stores

Sensitivity to light and sound are two symptoms of PTH. Avoid crowded stores during the holiday season to alleviate these symptoms. If you must go shopping, try to find a quiet, isolated place upon arriving where you can relax if needed.

3. Wear Noise-Reducing Headphones

Hypersensitivity to noise is a common PTH symptom, and unfortunately, the holiday season is filled with noise: music at parties, people talking loudly at stores and family members debating at dinner. Carry noise-canceling headphones with you in case your environment becomes overwhelming.

4. Keep Sunglasses on Hand

In addition to noise sensitivity, light sensitivity is a hallmark symptom of PTH. Keep a pair of sunglasses or a hat on hand to avoid bright, twinkling holiday lights.

5. Go Easy on Holiday Treats

Nearly everywhere you turn during the holiday season, there’s a sugary treat waiting for you: donuts at the office, hot chocolate at happy hour and Christmas cookies at a family party. But sugar can exacerbate the symptoms of PTH. Limit your intake of sweet treats during the holidays if you’re recovering from PTH.

6. Skip the Alcohol

Although spiked apple cider and eggnog might be tempting, it’s best to avoid alcohol if you’re recovering from PTH, as drinking it can lengthen recovery time and further damage the brain.

7. Wear Proper Winter Attire

Wear shoes with good tread, which can prevent a slip or a fall that might lead to another concussion. Experiencing another concussion while still recovering from the initial one can lead to a series of complications, such as second-impact syndrome.

8. Ask for Help

Overexerting yourself will only make it more difficult to recover from PTH quickly, as anxiety, stress and other emotional problems can worsen symptoms. If you need help hosting a holiday party or decorating your home, don’t be afraid to ask a family member or friend for help.

The Impact Report with Thomas Bottiglieri

Thomas Bottiglieri, DO, aims to fight concussion so current and future athletes can keep playing the sports they love, safely

Dr. Thomas Bottiglieri found his passion for treating concussion through his own personal experiences. During his high school and college career as a linebacker, he suffered from concussion symptoms, but did not have the resources needed to adequately return to play. “In the days that I played football,” Dr. Bottiglieri said, “almost nothing was known, or at least said out loud, about the dangers of brain injury in sport.” Due to the lack of knowledge surrounding concussions, he chose to retire from his sport to focus on his recovery. This experience led to his decision to specialize in sports medicine and concussion. Today, he is Associate Professor of Sports Medicine at New York-Presbyterian/Columbia University Medical Center, where he works to better understand the disease in order to best evaluate, treat and protect patients. As a member of the International Concussion Society’s Scientific Advisory Board, Dr. Bottiglieri elaborates on the future of the field.

What does the word concussion mean to you?
A concussion is a syndrome including a constellation of injuries impacting brain function after trauma. My interested has always revolved around sport related concussions. When specifically working with athletes, there is a unique character of the pathology involved, given the known signs and symptoms as well as the more opaque sub concussive blows in collision sports.

How have concussions impacted your life or career?
Having participated in high school and collegiate football, as a linebacker, I am personally familiar with the nature of concussion. I have a love-hate relationship with football given the character-building nature of the sport. However, there is obviously a detrimental impact, which I have experienced both personally and professionally.

Due to my experiences, I hope that furthering the science to better understand the pathophysiology, biomarkers, and appropriate treatment for brain injury in sport will help to both protect athletes and save the game.

Have you ever experienced a concussion personally?
There are several stories I could tell of times when my brain was injured during sports participation. The most important, though, is my last concussion. It was one that occurred after never having reported a single injury, despite many. When in college, after several weeks of ignoring concussion symptoms, and multiple undiagnosed concussions, a final hit caused me to lose consciousness while participating in an Oklahoma drill, during practice. This was followed by subsequent post-concussion syndrome that lasted years.

It is my belief, that had I known the impact of each injury and had appropriate medical treatment, I might have been able to recover and have success with college football.

In your opinion, why is it so important to educate your field about concussions?
The term concussion is still an ill-defined entity and overall lacks research. There is a need for further studies to better characterize the various subtypes of concussion and understand the pathophysiologic mechanisms involved. For the athletic population, it is important that they are educated on the implications of each injury in the short and long term, appropriate time for return to play, and the time at which they are no longer safe to participate.

There are many studies happening. However, it is important to be able to apply the science for clinical practice, while pushing the field to undertake studies needed to fill gaps of current clinical knowledge.

If you could share one piece of information about concussion, what would it be?
The most important marker of injury is honest symptom reporting, which makes building trust with your athletes vital in their care. Athletes, organizations, physicians, and athletic trainers need to have a mutual understanding that the ultimate outcome of the game is the health of an athlete.


Thomas Bottiglieri, DO, is a member of the Scientific Advisory Board of the International Concussion Society. The International Concussion Society sponsored website Concussion.org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

The Impact Report with Jennifer Wethe

Jennifer Wethe, PhD, ABPP-CN, takes a balanced approach to concussion awareness, treatment and management

Concussion is not just an organized sports problem, says Dr. Jennifer Wethe, Co-Director of the Sports Neurology and Concussion Program at Mayo Clinic Arizona and founding member of the International Concussion Society’s Scientific Advisory Board. As a mother to a son who has experienced concussions in his day-to-day life, unrelated to organized sports, Dr. Wethe wants to change the perception of mild traumatic brain injury and educate people about treatment and prevention options. She recently spoke with us about her personal experience with concussion. Read on.

How did you become interested in studying concussion?
I’ve worked with individuals with acquired brain injury throughout my career. Earlier in my career, most of my time was spent with individuals who had sustained a moderate or severe brain injury. In addition to assessing injury-related changes in functioning, I worked closely with the individuals and their families to help them understand the injury, the course of recovery, and what they could do to improve functioning and enhance daily performance.

Over time, I developed a growing recognition of the need to provide related services tailored to individuals with milder forms of traumatic brain injury. Even though these individuals do not require lengthy hospitalizations, they still require a timely evaluation of injury-related changes in functioning, appropriate concussion education, guidance on managing symptoms and returning to normal activities, and interventions for their symptoms. Eventually, the Mayo Clinic hired me specifically to help develop their concussion program.

Have you or anyone you’re close to experienced concussion?
My children have. Oddly enough, I was specializing in concussion before they came along. My son, in particular, has had a few concussions. His have occurred not through organized sports, but by virtue of being an active kid. One happened when he was out sledding. Another happened during recess. He was knocked into a playground structure then hit the ground and likely had a brief loss of consciousness. He was only in second grade at the time and neither he nor the school recognized or reported the injury. In both cases, I did not know about the injury until later in the day when I recognized that something was off and then got the full story.

Have your son’s experiences changed your perception of concussion or the way you go about treating it?
My son’s experiences really highlight that concussion is not just an organized sports problem. All of my son’s injuries happened over the course of his day-to-day life. Most of them probably wouldn’t have been recognized if he didn’t have a concussion specialist for a mom. I want to build awareness that concussion is not just a sports issue. It can happen almost anywhere, anytime. Appropriate concussion education, identification and management, as well as prevention of repeat injury are crucial. At the same time, it is important to take a balanced approach. Concussion is not the end of the world. Most individuals experience a full recovery from concussion, especially if it is promptly identified and appropriately managed. Physical activity, sports and opportunities for kids to be kids are very important. We certainly don’t want to take that away.

Why do you believe that it’s important to educate your field about concussion?
Concussion is often missed or misdiagnosed. I’ve seen cases in which a student has taken a hard hit to the head and experienced enough symptoms that they went to the school nurse, but they were told that there was no concussion or need for further evaluation because there was no visible bump on the head and the student’s eyes looked normal. At the same time, I have seen new symptoms misattributed to a prior concussion, months after the concussion had fully resolved. Both situations are problematic. Our approach to concussion identification and management has changed dramatically in the last decade. There is a lot of misinformation and misunderstanding out there. Concussion should not be ignored, but it should not be disproportionately feared either. It is important to recognize it when it does occur.  We need current, accurate concussion education provided to health care professionals as well as the public so that concussion is recognized as an injury to be taken seriously, but also an injury that can be treated.

What do you believe fuels the misinformation about concussion?
It’s hard to say. I think some of it is the old-school belief that there is no concussion unless there is a loss of consciousness. In reality, less than 10 percent of concussions are associated with a loss of consciousness. We also have to change the “tough guy” mentality of ignoring symptoms of a real injury. On the other side, I think the risks of concussion have been sensationalized by the media.  We always hear the news reports about the big, bad, scary cases, so it makes it hard for folks to maintain a balanced, accurate perception of what is typical.


Jennifer Wethe, PhD, ABPP-CN, is a Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

CDC Releases Guideline for Youth Concussion

This is the first evidence-based guidance for treating concussion in children

In September 2018, the Centers for Disease Control and Prevention released clinical recommendations for health care providers treating children with concussion. The CDC Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children was published in JAMA Pediatrics, and is based on a comprehensive review of pediatric mTBI.

The guideline, which includes 19 sets of recommendations on the diagnosis, treatment and management of mTBI, is the first of its kind and seeks to improve the way parents, coaches and doctors care for a vulnerable population. According to CDC Director Deb Houry, MD, MPH, more than 800,000 children seek treatment for TBI every year. The CDC developed the new guideline in response to health care providers’ need for consistent, evidence-based guidance for diagnosing and managing mTBI in their young patients.

“The guideline couldn’t have come sooner,” said International Concussion Society President John Leddy, MD, FACSM, FACP. “The concussion community is looking forward to seeing how it will inform diagnosis and treatment, as well as help children get back to their normal lives.”

The CDC guideline featured several practice-changing recommendations. Most notably, it recommends against routine imaging tests to diagnose concussion. X-rays and CT scans are not effective for determining youth concussions, and children should not be unnecessarily exposed to radiation. The guideline also encourages health care providers to “use validated, age-appropriate symptom scales to diagnose mTBI.”

The CDC guidelines include some practice-changing recommendations related to post-concussion care as well. Within the first few days after a concussion diagnosis, children should refrain from physical and mental activities, including school and sports, before gradually returning to their regular activities. Rest is recommended for only the first three days because inactivity beyond that may worsen symptoms. The CDC reassures parents that most children’s symptoms clear up within one to three months of injury.

In cases where a patient’s recovery is prolonged, the guideline also outlines symptoms that warrant further medical attention. These include changes in personal characteristics, such as learning difficulties, as well as severe physical symptoms like worsening headaches, dizziness, sensitivity to light or noise, and sleep problems.

To help health care providers implement the recommendations, the CDC developed supporting tools and materials. The resources can be downloaded on the CDC website and include screening forms to assess young patients, discharge instructions and recovery tips for parents.

The International Concussion Society is optimistic that these guidelines will inform and support health care providers, parents and coaches looking to keep children safe and healthy.

How to Prepare Your Children for Athletics

Follow these best practices to reduce the risk of injury

Youth sports can be an excellent way for children to learn about teamwork, remain in optimal health and foster strong, long-lasting relationships with their peers. More competitive team sports, such as football and basketball, can also inspire a healthy dose of competition in young children and even encourage them to be leaders one day.

Before entering your child in athletics, it’s always wise to make sure you follow certain safety best practices to prevent injury. Consult the following guide before enrolling your child in an athletic activity.

Talk to Your Child About Safety

Some children might not be aware of the signs and symptoms associated with specific injuries. For example, studies have shown that children often don’t report symptoms of a concussion because they don’t know what they feel like, according to the Sports Concussion Institute.

Teach your children not only about the signs and symptoms of more serious injuries, like a concussion, but also let them know the importance of speaking up about these symptoms. Because children might be nervous about appearing weak or will want to continue playing, they might not tell their parents or coach about symptoms they’re experiencing.

Purchase the Appropriate Protective Equipment

One way to ensure children enter athletics safely is by making sure they have the appropriate equipment, and that what they will be using—from wrist pads and elbow pads to helmets and mouthguards—meets the highest safety standards.

The Centers for Disease Control and Prevention recommends not only making sure the equipment is in good condition, but also that it fits appropriately and is worn correctly by children at all times. Poorly fitting equipment can increase the likelihood of injury.

Keep Your Children Active During the Off-Season

According to the University of Michigan, one cause of injuries in youth sports can be not enough pre-season conditioning. You can lower risk of injury by keeping your children active during the off-season.

Get a Physical

According to the National Council of Youth Sports (NCYS), getting a routine physical is one of the most important steps you can take to prepare your child for his or her first game. Though it’s likely your child will be perfectly healthy and ready to hit the field, it’s always wise to rule out any underlying conditions that could increase the risk for an injury. (Many youth sports programs conducted through schools will require a physical before children can enter play.)

Watch for Signs of a Concussion

In addition to teaching your children about the symptoms of more serious injuries like concussions, you as a parent should know these signs so you can be on the lookout for them. Confusion, clumsiness and memory loss are early observable signs of a concussion.

Create an Action Plan

Work with your child’s coach to have an action plan in place if your child is injured. The NCYS notes that most programs will have an emergency plan in place that has already been reviewed by an athletic trainer or emergency medical service. But it can’t hurt to make sure the plan in place meets top safety standards.

By following the above steps, you can rest assured your child will be as safe as possible before his or her first game.

Post-Traumatic Headache and Concussion

Trent Anderson, PhD, expands on what treatment options are currently available, and innovative research that may lead to new therapies

Every year, at least 1.7 million people in the U.S. experience a traumatic brain injury. The majority of these traumatic brain injuries are concussions, which can present as a headache and symptoms from confusion and blurry vision to difficulty sleeping and agitation. However, if the headache and symptoms that last days after the traumatic injury, the patient should seek treatment for post-traumatic headache from their health care provider.

Dr. Trent Anderson, a neuroscientist and associate professor at the University of Arizona’s College of Medicine in Phoenix and a member of the International Concussion Society’s Scientific Advisory, has spent years studying post-traumatic headache to better understand the underlying mechanisms behind it. “Research into concussion from my own laboratory focuses on understanding and examining new therapies for treating the headaches that often develop and persist following concussion,” he says.

Dr. Anderson spoke with us about what post-traumatic headache is, what treatments are currently available for it, and what research is being done on the condition.

What is post-traumatic headache?

Post-traumatic headache is a headache that starts within seven days of a traumatic brain injury. “Post-traumatic headache may occur after any traumatic brain injury, but is most common after a mild post-traumatic brain injury, which includes concussion,” Dr. Anderson says, adding that the prevalence of post-traumatic headache following a concussion is between 47 and 95 percent.

The symptoms of post-traumatic headache most closely resemble a migraine or tension headache. If the headache persists for more than three months after the initial concussion, Dr. Anderson says it becomes a condition referred to as persistent post-traumatic headache, or chronic post-traumatic headache.

How to treat post-traumatic headache

Post-traumatic headache can be difficult to treat, especially once it has transitioned into a persistent stage. No medications exist specifically for treating post-traumatic headache, at this time.

“As post-traumatic headache most often resembles migraine and tension headaches, the best current treatment strategies often use medications approved for these other types of headaches,” Dr. Anderson says.

However, these treatments aren’t necessarily effective in post-traumatic headache patients, he says. “And how these medications alter the brain’s recovery process from a traumatic brain injury remains unknown.”

Promising research on the horizon

Although post-traumatic headache resembles migraine, Dr. Anderson says it may develop in the brain differently and respond to treatment differently. “We believe this may be due to the complexity of having multiple ongoing injury and repair processes from the mild post-traumatic brain injury that may act to promote, resist or work alongside the development of headache,” he says.

Dr. Anderson and his research team at the University of Arizona have been conducting research in order to properly understand the mechanisms behind post-traumatic headache. They began their research by studying the physiological differences between migraine and post-traumatic headache.

Then, the team created animal models of post-traumatic headache to research how traumatic brain injury sensitizes the brain to headache. They are also studying biomarkers that might be able to predict who is more likely to develop post-traumatic headache following concussion.

“As basic scientists and clinicians, we have a lot of work to do to improve our understanding [of post-traumatic headache] and identifying who is at risk for developing it,” Dr. Anderson says. He hopes his lab’s research on post-traumatic headache using animal models will help lead to the development of therapies that could help treat the condition.

“The development of post-traumatic headache in patients can be devastating, but it provides a unique opportunity to understand how a traumatic brain injury, like concussion, can induce headaches in an otherwise healthy person and brain,” Dr. Anderson says.

Raising awareness for post-traumatic headache

There has been significant increased awareness about the potential complications and risks related to concussion in the last few years. But Dr. Anderson still sees room for growth when it comes to educating people on post-traumatic headache.

“We need to continue on this avenue to ensure patients, parents, physicians, coaches and the general public have the best available information to make informed decisions and help recognize the signs and symptoms of a concussion,” he says. “As part of this effort, I believe we still have significant work to do to raise awareness, particularly of post-traumatic headache.”


Trent Anderson, PhD, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org  is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

Concussion Myths Debunked

Five common misconceptions of concussion

Popular culture has perpetuated several myths about concussions. This misinformation can be dangerous, as it can lead to improper protocol and treatment of concussions.

We’ve debunked five of the most common concussion myths so you can keep yourself, your family and your friends safe the next time someone experiences a head injury.

Myth 1: You Need to Lose Consciousness to Have a Concussion

This is one of the most pervasive myths about concussions, and it’s propagated by TV and films. This myth is particularly dangerous, as it can lead people to think they haven’t suffered a concussion because they never lost consciousness.

In reality, only around 10% of concussions include loss of consciousness, according to the University of Pittsburgh Medical Center (UPMC).

In addition, loss of consciousness doesn’t necessarily mean the concussion was more severe. A research study conducted by UPMC followed those who suffered from a concussion, including people who did and didn’t lose consciousness. Their research found that loss of consciousness did not mean the injury was more severe or that the person would have a longer recovery time.

Myth 2: You Have to Hit Your Head to Get a Concussion

Because football-related concussions are covered so frequently by the media, people might believe that concussions only occur from intense blows to the head during athletic activities.

Although concussions can be the result of a direct blow to the head in contact sports, they can also occur in non-contact sports and everyday activities. For example, concussions can be caused by an abrupt bump or jolt to the body that shakes the head, like whiplash in a car crash or a fall down the stairs.

Myth 3: You Have to Keep Someone with a Concussion Awake

People have long believed that it’s dangerous to let people with concussions sleep, for fear they’ll fall into a coma or lose consciousness without anyone knowing. Many believe that it’s important to monitor people with concussions and wake them up often to prevent this from happening. This misinformation, the BBC notes, comes from the thought that if a person is suffering from a brain bleed, or a hematoma, sleeping could lead to a rare, potentially fatal complication called a lucid interval.

However, internal bleeding in the brain is rarely associated with concussions, and if a person with a concussion has been cleared by a medical professional, it is safe for him or her to sleep.

In reality, sleep is beneficial for those who have suffered concussions. One of the best ways to treat concussion is through mental rest, and sleep is the perfect way to give the brain the cognitive rest it needs, according to the Cleveland Clinic. Everyday activities can be more tiring when recovering from a concussion, which is why sleep is so important.

Myth 4: If You Don’t Have Symptoms Immediately, You Don’t Have a Concussion

In some cases, concussion symptoms won’t show up for hours, days or even a week after an injury. In addition to early symptoms such as confusion, headache, dizziness and memory loss, more delayed signs and symptoms might include sensitivity to light and noise, irritability, difficulty sleeping, fatigue and depression, according to the Washington Post.

Myth 5: You Can Return to Play as Soon as You Feel OK

Because it can take up to a week for the symptoms of a concussion to appear, it’s wise for someone to wait to return to play until he or she has been cleared by a medical professional. Even though someone might feel physically ready to play, he or she needs to make sure they have had enough mental rest, too.

Entering play too soon can lead to dangerous and potentially fatal complications, such as post-traumatic headache—a headache that can persist for months—or second-impact syndrome, in which someone suffers a second concussion before he or she has healed from the first one.

Exercise in the Management of Post-Concussion Symptoms

Robert Scales, PhD, explains how concussion victims can exercise their way to better brain health

Cardiovascular health is directly related to brain health. “There’s a lot of people out there suffering from medical conditions where cardiology-based exercise physiology can help—and post-concussion syndrome happens to be one of them,” says Dr. Robert Scales, Director of Cardiac Rehabilitation and Wellness at the Mayo Clinic in Scottsdale, Arizona.

The phrase “Use it or lose it” applies both to cardiac and brain health, but, Dr. Scales says, with the right frequency, intensity, time and type (FITT) of exercise, “You can get it back quickly.”

This perspective dates back to a 1968 landmark bed rest study, where researcher Dr. Bengt Saltin recruited young men from the University of Texas Southwestern Medical Center to rest in bed for three weeks, measuring their heart function and fitness performance. This coincided with a dramatic decline in fitness, heart function and other metrics, including blood volume, says Dr. Scales. “Within 10 days of resuming exercise, blood volume returned to normal along with cardiovascular fitness and heart function. All of these measures continued to improve with consistent exercise training over a two-month period.”

The benefits of becoming active

The symptoms of a head injury include headache, dizziness, fatigue, insomnia, difficulty concentrating, memory lapses and a disturbed autonomic nervous system, which can throw off heart rate and blood pressure. Appropriately monitored cardiovascular exercise, however, can help improve the way the heart and blood vessels respond, which results in a slower stronger heartbeat. “Control of the blood flow to the brain normalizes and therefore, the symptoms can improve,” Dr. Scales says. “So, aerobic continuous exercise can work on some of the disturbances that happen when you get hit on the head, and start to help bring it back to what it should be.”

At the Mayo Clinic’s Heart Health and Performance Program, Dr. Scales manages a gym within a cardiology clinic and often works with patients with post-concussion syndrome—persistent symptoms beyond three months post injury. “My role is to help people become more active again from a cardiovascular standpoint, which prevents deconditioning and helps normalize some of the symptoms that these people may be having,” says Dr. Scales.

Based on research from John Leddy, MD, FACSM, FACP, Dr. Scales uses a scaling system for patients to identify their symptoms while they exercise so that they can exercise below the exertion threshold that exacerbates concussion symptoms like headache or dizziness. “A conservative but progressive plan improves exercise tolerance,” Dr. Scales says, eventually normalizing post-concussion symptoms.

There are strategic forms of activity for concussion recovery: recumbent stationary biking puts less gravitational pull on the bloodstream pumping to the heart; in aqua aerobics or deep water running with a flotation belt, the hydrostatic pressure of the water facilitates blood flow and improves cardiovascular efficiency in the body. With improved symptom management, athletes can then gradually return to more strenuous upright land-based exercise like jogging.

Exercise can normalize symptoms

Dr. Scales has helped train former NFL players who have endured numerous concussions over the years. “They’ve also experienced orthopedic injuries and metabolic changes that have adversely impacted their blood pressure, cholesterol, blood glucose and body weight. We find that they have aged prematurely, partly because of their sport,” Dr. Scales says. However, “Even with those individuals, we can help them normalize the symptoms and live a healthy life.”

The collaboration between neurology and cardiology, Dr. Scales believes, is an untapped potential therapy. “It can help people,” he says. “And I think as evidence-based research continues to grow, we will be able to write clinical practice guidelines that are more defined.”


Robert Scales, PhD, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

What to Do After a Suspected Concussion

If you experience a head injury, follow these five steps

Concussions are a form of traumatic head injury caused by a bump or blow to the head, or even a subtle, sharp jolt. While their symptoms can seem minor or take some time to appear, concussions carry serious risks and can have long-lasting side effects. If you feel “off” after a head injury and think you might have a concussion, follow these five steps to evaluate your symptoms and figure out what to do next.

1. Immediately Respond

Don’t be dismissive about any form of head trauma: Concussions can occur from even a minor bump, and you don’t need to be knocked out to experience a concussion. If you’ve sustained a head injury during an activity, like playing sports, immediately remove yourself from play and take inventory of how you’re feeling. Symptoms of concussion might not develop until hours—or even days—after a blow to the head, according to the CDC. It’s best to take it easy and err on the side of caution. Ignoring the signs of a concussion—especially by resuming physical activity too soon after a head injury—can make those symptoms worse, make recovery take longer, according to the Centers for Disease Control, or even cause lasting side effects like post-traumatic headache.

2. Sit Out

Whether you’ve just pulled over after a fender-bender or removed yourself from play during a game, consult a medical professional if one is available, or call your a primary care doctor to discuss your injury. Recovery from a concussion takes up to two weeks for many people, or even longer for about 20 percent of the population, according to the Mayo Clinic. Don’t try to rush back into action until you’ve been cleared by a doctor.

3. See a Doctor

It’s best to seek medical attention as soon as you recognize concussion symptoms for an exam and diagnosis. Even if you felt well initially after your head injury, visit your doctor if you start to feel any concussion symptoms later. It’s not unusual for the effects of a concussion to be delayed by days or weeks. Post-concussive syndrome can appear even months after your initial injury. Untreated concussions can have serious, long-term effects, including post-traumatic headache and neurodegenerative issues, according to the Mayo Clinic.

4. Watch for Additional Symptoms

Concussion symptoms aren’t limited to head pain. Sluggishness, clumsiness and just feeling “off” are key indicators that your head injury could be more serious. Even if you don’t feel different immediately after bumping your head, you might still have a concussion and should watch out for the typical warning signs. Nausea, loss of consciousness and head pain are more noticeable symptoms of concussion, while others—like changes in your behavior or personality, or mood swings—can be harder for you to recognize. Concussion symptoms can vary from person to person, and they can emerge or worsen when you engage in physical activities or activities that require concentration. Be as detailed as possible in describing when your symptoms appeared and how severe they were; this can help a doctor determine the severity of your injury.

5. Recovery

Once you’ve been diagnosed with a concussion, follow your doctor’s prescribed treatment plan. There’s no one “cure” for a concussion, but following your treatment plan will give your brain the time and care it needs. It can take several weeks to recover from a concussion, and during this time you’re especially vulnerable to brain injuries like second impact syndrome—a second concussion before the first one had time to heal. So take it nice and slow. The CDC recommends asking your doctor for guidelines on when you’ll be well enough to drive or ride a bike and return to work. Get plenty of rest and avoid alcohol, drugs and physically demanding activities, and reintroduce things into your routine gradually.

People with concussion can return to playing sports and being active once their concussion has healed and they’ve been cleared by a medical professional. Returning to play should be done with the utmost care. Follow the CDC’s five-step approach to returning to physical activities safely. Ease in with light aerobic activities, gradually working your way back, and monitor your concussion symptoms closely during this time.