To learn about our efforts to improve the accessibility and usability of our website, please visit our Accessibility Information page. Skip to main content

Concussion signs, symptoms and return to Play

Introduction

Concussions in sports are a major topic in the press and medical literature over the past several years. Concussions account for one in 10 of all sports injuries, and for young people ages 15-24, sports are second only to motor-vehicle accidents as the leading cause of brain injury. Although baseball is not a high-risk sport for concussions, these injuries do occur in baseball and it is important for athletes, coaches and parents to be aware of concussion signs and symptoms and the appropriate treatment of these injuries.

Definition

A concussion is a traumatic brain injury that causes impairment in normal brain function. It is important to understand that the trauma to the brain can be the result of a direct blow to the head, a collision or an incident where the head or neck is forcibly rotated (such as whiplash).

Common Concussion Signs and Symptoms

All concussions are different and can cause a wide variety of signs and symptoms that may develop immediately after the injury or evolve over time. It is important to note that concussions most often do NOT result in loss of consciousness. Initial symptoms may include:

  • Poor balance or coordination
  • Disorientation
  • Blurred vision or visual disturbances
  • Confusion
  • Headaches
  • Dizziness
  • Nausea
  • Amnesia
  • Ringing in the ears
  • Vacant stare
  • Light/sound sensitivity
  • Numbness or tingling
  • Cognitive issues
  • Loss of consciousness

Concussion Management

Any athlete showing any signs or complaining of any symptoms of a concussion should be removed from practice or a game and undergo immediate medical evaluation. If no health care provider is available on-site to evaluate the injury, the player should remain out of play until an evaluation by a qualified medical professional can be conducted. The player should not be left alone following the injury and should be monitored by a responsible adult to ensure that his/her condition does not deteriorate. A player with a suspected or a diagnosed concussion should NEVER be allowed to return to play on the day of the injury.

Clearance to Return to Play

No concussed athlete should be permitted to return to play without clearance and a signed statement from a qualified physician. Concussed athletes should not begin a gradual return-to-play-progression until cleared by a physician to do so, after all symptoms have resolved and all cognitive and physical exertion tests are back within the normal range.

Additional important information

Repeat head trauma before resolution of an initial concussion can slow recovery time, cause significant worsening of the concussion and may increase the possibility of long-term problems. In some rare cases, repeat head injuries prior to resolution of the initial concussion can result in permanent brain damage or death. All 50 states and the District of Columbia now have laws on concussions in sports for youth and/or high school athletes. The following website contains information about each state's requirements. These laws vary from state-to-state, but generally include the following three components:

  1. Education of athletes, coaches and parents;
  2. Mandated removal from play of any athlete with a suspected concussion; and
  3. Permission to return to play only after evaluation and clearance by a physician

Conclusions

It is important for athletes, coaches and parents to be aware of the signs and symptoms of concussions, how to prevent concussions and to never allow an athlete to return to play following a concussion without proper evaluation and appropriate care. USA Baseball encourages every organization to have a concussion component as part of its injury management protocol and to acknowledge and abide by the specifics of the laws in the state in which they are competing.

KEY POINTS

  • No athlete should return to play on the same day of a concussion.
  • No athlete should be permitted to return to play without an evaluation and clearance from a qualified physician.
  • The signs and symptoms of concussions can evolve over time and are not always immediately apparent.
  • Once concussion symptoms have resolved, all athletes should go through a progressive return-to-play protocol prior to being cleared.
  • Concussions are traumatic brain injuries and vary significantly from athlete to athlete in terms of signs, symptoms and recovery time. Accordingly, every concussion warrants a thorough evaluation to identify the individual's deficits and appropriate treatment.
  • Only a small percentage of concussions involve loss of consciousness.
  • Although baseball is not a high-risk sport for concussions, concussions can occur in baseball. Concussions in baseball are most commonly caused by: being struck in the head with a thrown or batted ball, being struck in the head with a bat and collisions with a wall or another player.
  • All 50 states have laws regarding concussion assessment and management.
  • When in doubt, sit them out!

Concussion Resources

CDC concussion website

CDC baseball specific clipboard sticker

American Academy of Neurology concussion toolkit

Youth sports safety alliance training

National Federation of State High School Association's training

American Medical Society position statement on concussion in sport 12/2012

Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

American Academy of Neurology sports concussion guidelines 2013