The Educated Patient Podcast: Concussion Myths, Recovery and Red Flags

Concussions aren’t just a football problem, and you don’t need to be knocked out to have one. That was one of the key messages from Scott R. Laker, M.D., FAAPMR, a professor of physical medicine and rehabilitation at the University of Colorado Anschutz who practices at UCHealth Steadman Hawkins Clinic Denver, in a conversation with Mike DeMarco, host of The Educated Patient Podcast.

Laker has worked with concussions throughout his career. He started in Washington state, home of the nation’s first concussion law; today, all 50 states have one.

Concussions happen far beyond the football field

Laker said he has seen concussions from nearly every sport, including cross country, and even from a student who fell off a stage during a drama production.

One of the most persistent myths is that a person must lose consciousness to have a concussion. “Most concussions don’t have a loss of consciousness,” Laker said. Symptoms also don’t always show up right away. If someone takes a hit and develops symptoms within a couple of days, clinicians may still diagnose a concussion.

A supply and demand problem inside the brain

A concussion happens when force travels through the head directly or through the neck in a whiplash-type motion, causing the brain to move inside the skull. Contrary to popular belief, Laker said, it isn’t primarily a brain swelling problem.

Instead, injured brain cells struggle to take in glucose, the fuel they need to work. Laker compared it to “a hungry kid that won’t eat.” When a person demands more of their brain by running a race or taking a big exam, symptoms tend to get worse because the energy supply can’t keep up.

Concussions don’t show up on an MRI or X-ray, so diagnosis depends on a clinician’s evaluation. Laker added that parents’ observations matter, since they often notice subtle changes that a doctor seeing a patient briefly might miss.

Out of the dark room and into active recovery

Years ago, patients were often kept in a dark room until they felt better. Today, the approach is very different.

Laker said patients typically need relative rest for the first 48 hours or so, and they should not return to any sport during that time. After symptoms ease or stabilize, they can begin light exercise, such as walking or riding a stationary bike, as long as it doesn’t make symptoms worse. Research comparing these approaches shows that people who follow an active recovery plan generally get better faster.

The same idea applies to school. Students may need a few days off, a lighter homework load or a delay on high-stakes tests like the SAT or a driving test. Half days and gradual increases, coordinated with families and counselors, can help them ease back in.

Helmets, mouth guards and the limits of prevention

No equipment eliminates concussion risk. “We wear helmets in football to prevent the risk of more severe brain injury and skull fracture,” Laker said. Still, properly fitted helmets, mouth guards, neck strengthening, good coaching and rule changes that reduce head contact can help lower risk.

The biggest concern, he said, is an athlete returning to play before fully recovering, which can lead to a more severe and longer-lasting injury.

Repeat injuries and questions about CTE

People with several concussions may recover more slowly, have more symptoms and get concussed from smaller hits. However, there is no single number that means it’s time to quit a sport. Decisions depend on the person’s goals, health history and level of play.

Chronic traumatic encephalopathy (CTE) is linked more to repeated head impacts over time than to concussions alone. It can only be diagnosed after death, and risk appears to rise with more years of collision sports. Laker noted that sports offer real benefits, and families can reduce risk by choosing options like flag football or delaying tackle football and ice hockey.

Symptoms that can appear hours later

Headache is the most common symptom, followed by confusion or disorientation. Others may develop later, including mood changes, anxiety, trouble sleeping, nausea, ringing in the ears and sensitivity to light. If you’re worried, Laker recommends having the person evaluated at an urgent care clinic or emergency department.

His most important advice for parents and coaches is simple: “When in doubt, sit them out.”