Physical Activity, Sports, and Head Injuries

Sarah Romano, National Center for Health Research

If you or a family member is involved in a contact sport like football, soccer, wrestling, or basketball, you probably know something about concussions. Maybe you know someone who has had one, or maybe you’ve had one yourself. But, did you know that even one concussion may cause serious, short-term and long-term harm?  It can harm your brain and can increase the chances that you will have another concussion in the future.

A concussion is a brain injury that causes a change in how your brain works. It’s more than “being dazed” and less than a coma. Sports and bicycle accidents cause most concussions in children between 5 and 14.[1] A concussion does not always cause a person to lose consciousness.  Even when it does, that loss of consciousness may last only a few seconds and may not be noticed. Other symptoms that may not be noticed right away are:

  • Vacant stare (dazed, befuddled facial expression)
  • Delayed responses (slow to answer questions or follow instructions)
  • Easily distracted or unable to follow conversations
  • Disorientated (walking in the wrong direction, unaware of time, date, place)
  • Slurred or incoherent speech (saying things that are hard to understand or make no sense)
  • Stumbling, unable to walk in a straight line
  • Inappropriate emotions (upset or crying for no apparent reason)
  • Memory problems (repeatedly asking a question that has already been answered or having difficult remembering things)
  • Loss of consciousness (coma, unresponsiveness)[2]

A person who suffers a concussion may not even realize that his or her brain has been injured, especially after a mild concussion. Still, just one concussion puts the child or adult at a greater risk for a second. For instance, one study of high school and college football players found that students who suffered a concussion were almost six times more likely to suffer a second concussion within the next five years.[3] The second concussion will probably have symptoms that last longer than the first.[4]  Experts now advise to completely rest for the first 24-48 hours after a concussion, and that means no physical or mental activity – no playing, reading, school work, or watching TV. It is always important to wait until all concussion symptoms are gone before resuming sports or doing anything physically demanding. The National Institutes of Health (NIH) recommends that children with concussion symptoms should “avoid sports, hard play at recess, being overly active, and physical education class.”[5]

Certain concussion symptoms indicate that the person will need more time to recover. Anyone who has more than 4 separate symptoms, a prolonged headache, or the presence of fatigue or “fogginess” should take a few extra days after symptoms go away before they return to play after their concussion.[6]

What if someone suffers a concussion but doesn’t realize it? It’s important for adults to ask the right questions. Children and teens who have suffered a blow to the head are much more likely to report concussion when asked about symptoms in everyday language rather than complicated, medical terms.[7]

Are there long-term effects from getting a concussion? In one study a group of male college athletes who had suffered a concussion more than six months before the start of the study did not differ significantly in neurological tests compared to college athletes who had never had a concussion.[4] However, a study of retired professional football players suggested that those players who suffered more than three separate concussions during their career were at a significantly greater risk of having depressive episodes later in life than retired players with no history of concussion. And, another study of retired NFL players found that players who had suffered more than three concussions during their careers were at greater risk of developing early Alzheimer’s Disease.[8]

Concussions and head impacts also cause instant changes. A 2016 study of heading soccer balls showed immediate problems with thinking and remembering.[9] Fortunately, these abilities went back to normal after 24-hours, but the researchers did not evaluate the effects of repeated heading of the soccer ball over a period of months or years.

Ultimately the decision about how long to wait after a concussion before resuming practice and playing in games should be made in consultation with a medical professional. Every injury and every player is different. A 2015 study in the journal of Pediatrics found that adolescents who rested 5 days after having a concussion reported more daily symptoms and slower recovery than those who rested the usual 1-2 days. The researchers advised resting for 1-2 days and then gradually starting to resume physical activity.[10]

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

  1. Ropper AH, Gorson KC. Concussion. The New England Journal of Medicine. 2007;356:166-172
  2. Is Soccer Bad for Children’s Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Institute of Medicine. National Academy Press. Washington D.C. 2002
  3. Zemper ED. Two-year prospective study of relative risk of second concussion. American Journal of Physical Medicine and Rehabilitation. 2003;82:653-659.
  4. Bruce JM, Echemendia RJ. Concussion history predicts self-reported symptoms before and following a concussive event. Neurology. 2004;63:1516-1518.
  5. Medline Plus. National Library of Medicine and the National Institutes of Health: Concussion-Child-Discharge. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000125.htm
  6. Brunker P, Darby D, Makdissi M, Maruff P, McCrory PR, Ugoni A. Natural History of Concussion in Sport: Markers of Severity and Implications for Management. American Journal of Sports Medicine 2010 38:464-471.
  7. Bay, RC, Heil J, McVeigh SD Valovich TC. Identification of Sport and Recreational Activity Concussion History Through the Preparticipation Screening and a Symptom Survey in Young Athletes. Clinical Journal of Sports Medicine. 2008;18:235-240
  8. Guskiewitz KM, Marshall SW, Bailes J, McCrea M, Harding HP, Matthews A, Mihalik JR, Cantu R. Recurrent concussion and risk of depression in retired professional football players. Medicine & Science in Sports and Exercise. 2007;39:903-909.
  9. Di Virgillio, T. G., Hunter, A., Wilson, L., Stewart, W., Goodall, S., Howatson, G., Donaldson, D., & Ietswaart, M. Evidence for Acute Electrophysiological and Cognitive Changes Following Routine Soccer Heading. EBioMedicine, 2016.
  10. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics. 2015; 135(2).