Individuals suspected of having a concussion should be evaluated by a health care provider (HCP) experienced in concussion management. Often a school athletic trainer is the first to evaluate an athlete. Determining if a serious neck/spine injury was sustained is done first. Next, the HCP will determine if a concussion was sustained using a symptom questionnaire, balance assessment, and short mental tests that can easily be administered at the scene. The player should be monitored after a diagnosed concussion for any worsening or development of symptoms that indicate a more serious brain injury (a bleed). Table 10.2 is a common list of symptoms and signs to look for in cases of a more serious brain injury. Typically, brain imaging such as a CT scan is not required, but the decision will be made by a treating doctor. However, when in doubt, always seek medical care.

SRC is a transient disorder from which 90 % will recover from fully within 30 days. Age, gender, and certain medical history determine the length of time it takes to recover. Concussions are highly individualistic and predicting recovery time is difficult. Often, younger athletes take longer to recover [22]. It can take two weeks for a concussion to resolve, but sometimes it can take upwards of over 1 month. However, such factors as gender, number of prior concussions, history of ADHD, LD, or psychiatric illness or increase the recovery period from SRC.

About 10 % take longer than 1 month and even a smaller percentage have a longer period of SRC symptoms and cognitive problems referred to as a post-concussive syndrome (PCS). There appear to be several factors that contribute to PCS such as concussion severity, number of prior concussions, history of ADHD, LD or psychiatric disease and psychological factors [8, 17].

After any neurological emergency has been ruled out rest is the best medicine for treating an acute concussion. Contrary to a popular wives-tail, it is alright to allow a child with a concussion to sleep at night without waking him/her up every hour as long as he/she has been cleared by a HCP. Long stretches of sleep at night with a few shorter naps in the day (not in the early evening) is often the quickest way to help the brain heal. Often times it is better to allow the child to stay home from school and rest for a few days immediately after the concussion because the loud and bright school environments often worsen concussion symptoms. Besides, the student often has trouble focusing, paying attention and remembering in classes in the early stages of a concussion. In addition, we often recommend that the student not be responsible for homework or quizzes and tests for a period of time after the concussion because of concentration and memory problems with worsening headaches. A gradual increase in classes and homework is often the best way to return a child to school following a concussion (see Table 10.3).

Over the counter pain medication can be used after a concussion to help with headache pain. No aspirin for the first 48 h because of its blood thinning properties. Some doctors will not use NSAIDs for the first 48 hours (e.g., ibuprofen or naproxen sodium) for the same reason. Thus, acetaminophen is the OTC pain medication of choice. Some physicians will use a variety of prescription medications to treat headache pain, however, there are no set guidelines.

Athletes who sustain a concussion should not be allowed to return to contact sports until they are symptom free, cognitively intact (or return to baseline), have intact balance, and are functionally normally at school. The typical guideline suggestions a period of gradually increasing cardio-aerobic activity, followed by sport specific drills, weight lifting, non-contact practice, contact practice and finally competition (see Table 10.4 for an example). The athlete must maintain a symptom free status through each step. If not, the athlete rests until symptom free and starts again.