The Invisible Injury


While a “concussion specialist” will know the most recent research and be able to guide you in the appropriate direction, be aware of the myths you may encounter

Every four years, concussion specialists from around the world convene in Zurich to discuss the new research and the new clues into deciphering the world of concussions. New definitions are proposed and a consensus statement is released providing recommendations on how to evaluate and treat concussions.

Even with all this information, there is still a lot of confusion on what parents and caregivers should do if their child sustains a concussion. This confusion leads to the rise of many myths. While a “concussion specialist” will know the most recent research and be able to guide you in the appropriate direction, be aware of the myths you may encounter:


MYTH 1: If my child sustains a concussion, they should immediately go to the Emergency Room for an MRI or other imaging of the brain.
FACT: A CT scan or MRI contributes little to a concussion evaluation. (McCroy, 2013)
An MRI or CT scan can show bleeding in the brain or a skull fracture, but cannot tell you whether or not a concussion was sustained.

MYTH 2: If my child sustains a concussion, I should wake him/her up every few hours at night to make sure he/she is ok.
FACT: The cornerstone of concussion management is physical and cognitive rest. (McCroy, 2013)
One of the signs and symptoms of a concussion is “feeling more tired” and sleeping more. Rest from school, the phone, the computer and actual sleep all help to manage a concussion.

MYTH 3: My child only got his/her “bell rung” or they just sustained a mild concussion, it’s not a big deal.
FACT: A clinical assessment, rather than using a grading system/scale, is the most common and respective method of assessing concussions. (Lynall, 2013) A Concussion is a BIG deal, no matter how hard the hit or how many signs and symptoms your child may have.

There is no “mild” concussion. If there are signs and symptoms of a concussion as well as a mechanism of injury, such as a blow to the head, then there is a concussion. The use of grading scales can give false information on how severe a concussion may be or how quickly one may return to sport.

A concussion is a trauma-induced alteration in mental status that may or may not involve loss of consciousness. (McCroy, 2013) Signs and symptoms can appear immediately or go unnoticed for days or weeks after the injury. (McCroy, 2013).

(Heads Up, 2015)

• Can’t recall events prior to or after the hit/fall
• Appears dazed or stunned
• Forgets an instruction, is confused about an assignment or position or is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly

• Just not “feeling right,” “feeling down”
• Headache or “pressure” on head; Nausea or vomiting; Balance problems or dizziness
• Double or blurred vision; Bothered by light or noise
• Feeling sluggish, hazy, foggy, or groggy

You should continue to monitor and check signs and symptoms for hours and days following the injury. If any signs or symptoms worsen or increase in intensity, contact your physician and head to the emergency room. This could be signs of something worse then a concussion.


Unfortunately, there are no objective tests, such as an MRI, Xray, and CT scan, which can determine if your child has sustained a concussion. However, there are alternate tools an athletic trainer may use to determine the likelihood a concussion was sustained.

A baseline test can be utilized for pre-concussion screening. A baseline test will assess an athlete’s balance and brain function (including learning and memory skills, ability to pay attention or concentrate, and how quickly he or she thinks and solves problems. (Heads Up, 2015) Baseline tests can be done on the computer or by paper and pencil. A baseline, however, is not a necessity if a concussion has been sustained.

The ImPact test, SCAT 3 and BESS, are a few examples of concussion tests. These tests offer a way for healthcare professionals to compare tests result to normative data as well as baseline testing, where available. They provide objective results for a very subjective injury. It is very difficult to “lie” or “cheat” on these tests and they are easy to administer and are low cost.

These tests and others were created by clinical experts in their field and can be utilized for children under the age of 12. It is recommended that a baseline be done every two years where possible (Heads Up, 2015). All testing should be done and interpreted by a healthcare professional specifically trained in treating concussions.


It is imperative that healthcare professionals follow their states’s concussion policies. At the very least, a return-to-play protocol (RTP) should be utilized. An athlete should be symptom-free for 24 hours before beginning a RTP protocol and have a doctor’s note, where mandated. An athletic trainer can administer the RTP protocol as they are qualified and they are usually the ones at the school/field every day.

Stage 1: Light aerobic activity
Exercise bike, light jogging or walking
Stage 2: Moderate activity
Moderate jogging, brief running, moderate-intensity weightlifting
Stage 3: Heavy non-contact activity
Sports-specific drills, running, regular weightlifting drills
Stage 4: Practice and full-contact
Reintegrate into full practice/full contact
Stage 5: Return to competition
Full competition

The above stages can be adapted depending on the sport and age of the athlete If during any of the stages, symptoms return, the athlete must once again wait 24 hours until they are symptom-free. Once symptom-free, they must begin at stage 1 regardless of where they left off. Following a strict RTP protocol allows for the brain to heal properly and prevent any further damage.


Cognitive rest may be necessary depending on the severity of the concussion. Cognitive rest may include limited computer usage and adjustments made to school schedules.

If after 7-14 days, symptoms remain, further testing and medical intervention may be warranted.


An athletic trainer is a healthcare professional trained in the care and prevention of athletic injuries. All athletic trainers have a minimum of a Bachelor’s Degree, with some having Masters Degrees and PhD’s. Athletic trainers are certified by their governing body (NATABOC) and follow their state’s practice acts by becoming licensed or  registered. Athletic trainers must complete continuing education credits throughout their career to maintain their certification.


Athletic trainers play a key role in identifying and screening potential concussions. They are an invaluable member of the assessment team. Athletic trainers have continuous concussion training throughout their career. They are trained to carry out return-to-play protocols as well as follow their state’s concussion laws. Athletic trainers can prevent injury and provide immediate first-aid care and triage to the athletic population. Athletic trainers can recognize emergency situations such as heat illnesses and are trained to utilize CPR and an AED if necessary.

Athletic Trainers are a liaison between the student-athlete and administration/coaches. They communicate closely with doctors as well as school staff and parents/caregivers to provide the best care possible.

Angelo Marsella MA, ATC, USAW is Partner ND Director of Sports Medicine AT Professional Physical Therapy based in Uniondale, NY. Professional Physical Therapy employs over 100 athletic trainers in multiple settings. They have the ability to offer their services to numerous club teams, schools and organizations. Whether through contracts or consulting, their goal is to make sure all high-risk athletic events go covered by an athletic trainer. With over 25  school contracts and over 1400 events covered in 2015, Professional Physical looks to keep the student-athletes in our communities safe. For more information please visit

Leave a Reply