Dr. Ballantine on sports concussions: 'The sooner they're treated, the better.'

Hits are almost unavoidable in contact sports. But with any bump to the head, neck — or even the body — caution should be the name of the game. That bump could cause a concussion.

A concussion is a type of traumatic brain injury triggered by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. In athletes, concussions are extremely common. In fact, between 1.7 and 3 million sports- and recreation-related concussions occur each year. As importantly, five in 10 concussions go unreported.

“Concussions need to be managed by a health care professional to help avoid potential long-term complications such as chronic headaches, cognitive challenges and emotional difficulties. The sooner treatment is received, the better the chance of a quicker and more complete recovery," said board-certified sports medicine physician Sherrie Ballantine-Talmadge, DO, during a free online health lecture on "Best Ways to Handle Sports Concussions." Dr. Ballantine-Talmadge has worked with three Division 1 universities and travels as a team physician with US Figure Skating.

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Video: Watch "Best Ways to Handle Sport Concussions"

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Symptoms of concussion

Dr. Ballantine-Talmadge emphasized, “A concussion is a traumatic brain injury that’s transient and immediate. A concussion is not always the result of a hit to the head; it can also result from whiplash, or even a hard hit to the rear-end.”

She added, “Eighty-six to 93% of concussions will improve in seven to 10 days with modified activity. However, for those younger than 18 or even 21, it may take three to four weeks.”

Symptoms of concussion include:

• Headache, nausea, vision loss
• Fog-like feeling, everything slows down
• Uncontrollable mood changes, more tearful, anxious
• Change in level of consciousness, amnesia, vomiting
• Not being yourself
• Slowed reactions, impaired ability to perform simple functions
• Drowsiness, difficulty falling asleep

What to do and not to do if you suspect concussion

“Most importantly, if concussion is a possibility, the athlete needs to be immediately removed from play. When in doubt, sit them out,” said Dr. Ballantine-Talmadge.

She recommends asking questions that are specific to the circumstances surrounding the sport such as, “What ski area are you at, what quarter is this, what team are you playing?” and not ask questions like, “Who is the current president or the date.”

She also emphasized the importance of understanding that symptoms can be rapid or delayed and can appear, resolve and return. “An athlete who you suspect may have suffered a concussion should be monitored. They should not be left alone for several hours and evaluated as soon as possible,” said Dr. Ballantine-Talmadge. "And while ER/urgent care can diagnose a concussion, it is extremely important to seek follow-up concussion management with a qualified health care professional.”

When do we worry?

We worry when we see:

• Prolonged loss of consciousness
• Other distracting injuries
• Repetitive vomiting
• Horrible headaches
• Unresponsiveness
• Rapid decline of consciousness
• Difficulty in arousing the injured athlete​

Graduated Return-to-Play 

The first question typically asked is, “When can I get back to my sport?” She explained, “This is not something that we can predict. Each athlete’s concussion experience is unique.” In addition, she noted, “It is not true that once your headache is gone you can return to your sport or that multiple head injuries cause chronic traumatic encephalopathy (CTE).”

There are six steps that are a part of a Graduated Return-to-Play Strategy. “Each step,” said Dr. Ballantine-Talmadge, “has to have 24 hours in between to see if symptoms are continuing to improve, or not.” The average return to play time is 19.8 days.

Step 1 – Return to daily activities. Ones that do not exacerbate symptoms such as walking.

Step 2 - Light aerobic exercise. Walking or stationary cycling at slow-to-medium pace. No resistance training.

Step 3 - Sport-specific exercise. Running or skating drills. No head impact activities.

Step 4- Non-contact training drills. Harder training drills, e.g., passing drills. May start progressive resistance training.

Step 5 - Full contact practice. Following medical clearance, participate in normal training activities.

Step 6 - Return to sport. Normal game play.

Second Impact Syndrome

Second impact syndrome is rare and not well understood. "However, if you get a concussion, keep playing and suffer another head injury, you may experience a sudden collapse of the nervous system that will lead to death. This is why, if you continue to be symptomatic, we don’t let you back in the game. In addition, this is why there are laws in every state protecting suspected head injury players,” explained Dr. Ballantine-Talmadge.

Schedule an appointment

Call 303-315-9000 to schedule a consultation with Dr. Ballantine-Talmadge from the CU Sports Medicine and Performance Center, which provides care for athletes of all skill levels – from elite competitors to weekend warriors.

Click here to view/download lecture slides from the lecture on "Best Ways to Handle Sports Concussions."

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