Blog Article: Concussion in Sports

Concussions in Sports


Concussion has been a hot topic over the past few years. More so than ever with the big outcry over the NFL and player concussions, and now with the new Concussion movie starring Will Smith coming out this week. The awareness of the seriousness and possible implications of this injury are much more known to the general public.  While the public has a better understanding of what a concussion is and what some of the symptoms are, I feel the majority do not have a grasp on the complexity of this injury.

You can see your favorite NFL star get knocked out on a Sunday and be able to play next week’s game. While this is the case most of the time (80-90% recover within 7 days), there is a smaller percentage where this injury can be completely debilitating for weeks, months or even years. I currently work with individuals who are dealing with “post-concussion” symptoms anywhere from 2 weeks to 3 years after their injury.

What is a concussion?

According to the American Association of Neurological Surgeons the definition is “a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma.”

In many cases, concussions result in a coup and contrecoup force in which the brain forcibly contacts one portion of the skull, rebounds and contacts another area of the skull.  This leads to diffuse axonal injury in which the structures that transmit messages to and from the brain are stretched and twisted. This results in an immediate chemical inflammatory response due to the trauma. Many believe that this mechanism of injury is what leads to the initial “dazed and confused” appearance. Injuries to axons can take an extremely long time to heal and in some cases can result in permanent damage.



Many people relate concussions with a loss of consciousness. While it can be pretty much guaranteed that you have a concussion if  you lose consciousness after a blow to the head;  you can also have a concussion without losing consciousness.

Concussions are considered a “functional injury” in that many times there are no clear-cut medical indicators. A MRI or CT scan will not diagnose concussion. MRI’s are used to rule out a more serious injury such as intracranial bleeding. Diagnoses are usually made on symptom presentation.


As stated earlier, a smaller percentage of individuals who get a concussion struggle with symptoms for months or years afterwards. From working with many people that are dealing with chronic symptoms, I tend to see that the following are the most common and significant symptoms:

Headache, Dizziness, Neck Pain, Fatigue, Anxiety and Depression

The psychosocial symptoms seem to spur from post traumatic stress, mental stress and mental fatigue from dealing with prolonged headaches, dizziness, physical fatigue and lack of sleep for months. Many times people end up being taken out of their work or even losing their job because of the inability to perform their work duties. This significantly increases psychological stress and tends to exacerbate all of their physical symptoms.


From my personal clinical experience, the individuals who tend to have more prolonged symptoms are those who have multiple concussions. Research has shown that receiving multiple concussions tend to cause more severe symptom presentation in the successive events. One of the big issues being discovered is Chronic Traumatic Encephalopathy (CTE) as a result of repeated sub-concussive blows to the head. CTE has been found on the autopsies in some of the high-profile NFL players such as Junior Seau.  CTE has been linked to memory loss, mood swings such as rage, depression and other severe psychological disorders.


Physical symptoms that I have seen and worked on are headache caused from either mechanical of muscular neck trauma, dizziness due to visual and/or vestibular (inner ear) deficits, poor balance due to vestibular or multi-system deficits.

Current research is finding that one of the primary acute symptoms that may lead to prolonged recovery time is dizziness at time of injury or shortly thereafter.  Dizziness is being considered as a possible greater risk factor over loss of consciousness, headache and seizures. This is likely due to the fact that dizziness in many cases is an indicator of vestibular system dysfunction. The vestibular system plays an important role in oculo-motor (quality of eye movement) function and postural stability (balance). Deficits in oculo-motor function tend require a longer process of rehabilitation, in some cases require evaluation by a neuro-ophthalmologist and even vision therapy.

It is extremely important to recognize a concussion when it occurs on the field of play to avoid a phenomenon called Second Impact Syndrome (SIS). SIS is when an individual receives a second concussion before recovering from their initial injury. This results in diffuse swelling of the brain and can cause death. SIS resulting in death has been seen in football players who, for whatever reason, have been allowed to continue playing in the same game where they receive an initial head injury.



Again, most concussions resolve within 7-10 days, the ones that don’t can require treatment. Physical therapy can be effective in reducing the “post-concussion” symptoms. Sessions are based on the individual’s symptom presentation but usually involve neck soft tissue mobilization, neck mobilization and stabilization exercises. Balance or proprioception training is commonly worked on.

Vestibular based interventions are effective at reducing dizziness. These include adaptation and habituation exercises in which the individual repeatedly performs eye and/or head movements that reproduce symptoms. Repetition of these tasks strengthen the connection between the inner ear and the brain, and ultimately can significantly reduce or abolish dizziness.





Lastly, Vision assessment and treatment is very important. Convergence insufficiency is a common deficit found after head injury and can cause dizziness and headaches due to one or both eyes not moving correctly. Popular exercises for this deficit include thumb pushups and “String and bead” exercises.



Once the individual is at the point where symptoms are significantly reduced or abolished, then they start the return to play protocol. The return to play protocol consists of gradual increases in physical exertion tasks with at least 24 hours rest in-between each task. If the athlete can pass through each phase without reproduction of symptoms, then they likely can safely return to playing sports.


Baseline Testing

Baseline concussion testing is becoming more and more popular. This consists of a preseason screen of the athlete’s cognitive performance and balance. Some baseline testing can be very in-depth and include fancy equipment such as force plates to measure balance. However, research is finding that this is not necessary and that you can get good objective results testing an athlete on a Wii balance board or even just a piece of foam padding.  A standardized, acute post-concussion tool that is used on the sidelines has also been found to be effective to use as a baseline testing tool.  This is the Sport Concussion Assessment Tool-3 (SCAT-3). We created our baseline testing off of this standardized tool. Baseline testing is a quick and easy way to gather an athlete’s “normal” functioning and the results can be used to compare re-test scores in the unfortunate event that the athlete was to receive a concussion.


Baseline test comparisons are just one tool that should be used in the return to play decision making and should not be the sole factor in deciding whether an athlete returns to the field or not. It is recommended that any athlete who plays a sport with any risk of head injury receive baseline tests on a yearly basis to have the most accurate data.

SPI Fitness is comprised of two physical therapists with years of experience assessing and treating athletes with concussions. Ryan Monaco DPT, ATC has been one of the area’s leaders in raising concussion awareness along with the importance of baseline testing. He also has experience working with athletes from the sideline as an athletic trainer to the clinic as a physical therapist. Michael Jarmak DPT, CSCS has worked with athletes with concussions for the past 3 years. He currently works as a physical therapist at Syracuse’s CNY Sports Concussion Center, considered by many as the area’s top concussion management program. He has experience working with individuals anywhere from 2 weeks to 3 years post-concussion. Both Ryan and Michael are certified Vestibular Rehabilitation Therapists.

If you would like to learn more on about concussions, have baseline testing performed on your child or your team please contact us at or call 315-527-8383.

$99 College Winter Break Special

We are now offering our college student winter break training special. This includes unlimited semi-private training sessions for $99

Our semi-private training schedule is:

Monday thru Friday 3-6 pm and Saturday 10am-12pm

As always, we offer initial assessments on your fist day of training. These consist of some functional and sport specific screens to find your strengths and weaknesses which will help create the best training program for you.  If you would like an assessment just mention it to the trainer on your first day.

For any questions feel free to call us at 527-8383