How Do You Know If You Have A Concussion?

As an athlete, you’re likely to hear the word “concussion” often. A concussion is a brain injury caused by a blow to the head or a force to the body that causes the brain to rattle within the skull. These sudden movements and contacts happen frequently in sports, which is why concussions are most common among athletes. But they also occur outside of sports, often caused by falls or accidents.

Joshua Scheidler, MD, board-certified physical medicine and rehabilitation doctor with the Franciscan Physician Network in Crown Point, said that helmets protect against severe head injuries but not against concussions. “A concussion is caused by movement of the brain within the skull from acceleration-deceleration injuries caused by things like whiplash, tackling and blast injuries, in addition to direct impacts to the skull.”

Understanding how concussions are diagnosed helps patients and families know what to expect when they see a provider.

Learn how concussions happen and what early symptoms to watch for.

What Type Of Doctor Diagnoses A Concussion?

Many types of physicians may diagnose and treat concussions, depending on the situation. These include specialists in:

• Emergency medicine
• Pediatrics
• Family medicine
• Internal medicine
• Sports medicine and orthopedics
• Neurology
• Neurosurgery
• Physical medicine and rehabilitation
• Physiatry

What Is A Concussion Test?

A concussion is diagnosed with a physical exam and by evaluating a person’s cognitive ability, mood and symptoms. A CT scan or MRI might be ordered to check for bleeding in the skull, and in some cases patients may need to be observed in the hospital overnight.

Core elements of a concussion exam

• A detailed medical history review
• A full physical exam
• Cognitive, neurologic and balance testing

Commonly used standardized tools

• Standardized Assessment of Concussion (SAC):A brief test that checks memory, orientation and concentration right after an injury.
• Acute Concussion Evaluation (ACE):A structured tool providers use to record symptoms, injury details and risk factors for concussion.
• Sport Concussion Assessment Tool, 5th Edition (SCAT5):A comprehensive exam combining symptom checklists, balance tests and memory questions, most often used for athletes.

“Often, the questionnaires and standardized forms that cover a person’s orientation, mental status, balance and symptom self-report checklists are also used for screening in the sports setting or before seeing a physician in the office or ER [emergency room],” Dr. Scheidler said. All these combined steps — history, physical exam and standardized tools — form a thorough concussion evaluation that helps providers confirm the diagnosis and guide treatment.

Computer-based testing

Some patients also may take a baseline ImPACT test— a computer-based exam that measures attention span, working memory, problem solving and reaction time.

Franciscan Health sports medicine athletic trainer Craig Voll, PhD, PT, said, “Tests help us determine which part of the brain has been injured. We can start with the appropriate treatment sooner, based on the type of concussion they have and their goals.”

Clinical judgment matters

Blake Averill, DO, a Greenwood sports medicine physician, said that diagnosis is ultimately clinical.

“Even if they were to go to the ER before they saw me, almost every time that scan is going to be normal," he said. "So, it comes down to the history — having them talk me through what happened, what did you feel after, what have you been feeling since? Do you have any memory loss?

"Then we do a protocol-based exam, assessing orientation, short-term and delayed memory, concentration, balance and how the eyes move together. All things that we do in and out of the office can help us diagnose a concussion.”

What Tests Can Detect A Concussion?

“A concussion is a clinical diagnosis, meaning a clinician must diagnose the condition based on a history and physical exam,” Dr. Scheidler said. A CT scan, and occasionally MRI imaging, may be needed in higher-risk cases, such as:

• Risk of more serious head or brain trauma
• Difficulty speaking or facial weakness
• Progressive mental status changes
• Age 60 years or older
• Two or more episodes of vomiting
• Patients on blood thinners or with a history of bleeding disorder
• Seizures associated with the injury
• Very high-impact trauma
• Signs of skull fracture
• Lack of memory 30 minutes or more before the injury

“While there is active and promising research into diagnostic tests for concussion, including blood laboratory studies, currently none are validated for everyday use,” Dr. Scheidler said.

How Long Does Concussion Testing Take?

As complex as concussion testing may sound, it usually doesn’t take long. “Typical testing for a simple concussion may take only five to 10 minutes but can take longer if more testing is needed,” Dr. Scheidler said.

What Questions Should Patients Expect?

“The most important questions for concussion diagnosis are the ones that get the details of the injury from the patient or witnesses,” Dr. Scheidler said. “These important details include the speed and cause of the injury — such as a motor vehicle accident, fall, collision with another person or object — and the patient’s memories of the injury, including any surrounding events.”

While many concussion symptoms can be recognized at home, your provider also will review new or worsening symptoms, such as:

• Loss of consciousness
• Confusion or slowed thinking
• Trouble with memory and concentration
• Headaches
• Neck pain
• Vision changes
• Nausea and vomiting
• Balance problems
• Light and sound sensitivity
• Emotional changes such as irritability, nervousness or sadness
• Drowsiness

“Finally, the physician will want to rule out other conditions that would cause such symptoms, including alcohol or drug intoxication, post-traumatic stress disorder or other injuries,” Dr. Scheidler said.

Follow-up Testing For Concussion

Follow-up concussion tests are done to check for symptom improvements or persistence. 

“Usually, a self-report symptom questionnaire will be given to assess ongoing symptoms," Dr. Scheidler said. "Rarely, more extensive neuropsychological testing may be needed, usually if cognitive symptoms continue for more than 30 days after the injury.”

Recovery After Diagnosis

“The most important element of recovery is mental and physical rest for one to three days after the injury, followed by a gradual return to activity,” Dr. Scheidler said. “Not only can patients resume low-impact, low-intensity aerobic activity such as stationary cycling or walking, but this type of early return to light activity may improve recovery times.”

Athletes follow a structured, step-wise program for returning to sport and must avoid high-risk activities until they are fully cleared. A healthy diet, adequate sleep and avoiding alcohol, drugs, tobacco or excessive caffeine can help speed up recovery. You can learn more about what recovery looks like in Coming back from a concussion: rehab and recovery.

While most patients recover within a few weeks, some continue to experience ongoing symptoms beyond the usual recovery period. This is called post-concussion syndrome. If symptoms continue, don’t wait it out, getting expert care early can make all the difference.

Request an appointment or learn more about concussion treatment at Franciscan Health.