September is Concussion Awareness Month and many of us have spent years believing we know exactly what to do and what not to do after a head injury. Members of our outpatient therapy centers share these common myths about concussions and how the science has evolved.

A concussion is a type of traumatic brain injury that results when you hit your head in a way that causes the brain to move quickly back and forth inside your skull. They can happen in multiple ways like when you’re playing sports, during a fall or if you’re involved in a car crash. Common symptoms can include headaches, dizziness, nausea and balance problems among many others, but there are many myths about concussions you should know.

Myth: Don’t go to sleep after a concussion

It is a common misconception that someone who suffers a concussion should be kept awake. This stems from a misunderstanding of the difference between a concussion and a severe traumatic brain injury or TBI. It is now proven that depriving someone of sleep after they’ve suffered a concussion can actually delay their recovery and worsen their symptoms.

Rest helps recovery: Sleep is crucial for brain healing. Restful sleep helps restore energy and supports the brain's repair processes.
Symptom severity: Monitoring severe symptoms such as difficulty waking up or worsening headaches is important; however, these symptoms are rare. If a person is alert and responsive, allowing them to sleep is generally safe.

Myth: You must rest from all activities after a concussion

Total rest is not recommended after a concussion and may even impede recovery in athletes.

Rest is recommended for a 24 to 48 hour period after a concussion followed by a gradual return to school and social activities.
Medical guidelines used to recommend "strict rest" (lying in a dark room with zero stimulation for days) but the newest guidelines advocate for relative rest.
Newer evidence is emerging that sustained rest after acute concussion may not result in faster symptom resolution, and that early moderate levels of physical activity may help prevent a prolonged recovery.

Myth: X-Rays, CT scans and MRI can rule out concussions

A concussion can be present when imaging appears normal or has negative findings. A negative finding means there are no signs of the specific condition. In fact, it is expected that imaging will be normal during diagnosis. Concussions are functional injuries (which means how a tissue works is altered) rather than structural (where the tissue is damaged).

A concussion being a mild traumatic brain injury does not mean it isn’t serious but rather that there is no visible abnormality.
Neuroimaging using a CT scan or MRI is not required for a concussion diagnosis.
Depending on symptoms and type of impact, imaging is sometimes done to rule out skull fracture, brain bleed, contusion, and swelling and to diagnose severe brain injuries which are long term.

Myth: You must sustain a direct hit to the head for a concussion to occur

It is a common misconception that concussions occur only after a direct blow to the head, but sudden, quick movements can also be a cause.

Concussions can occur from a direct impact to the head or an indirect force, such as a whiplash injury.
Rapid movement of the head can cause the brain to rotate or twist within the skull, creating forces that disrupt normal brain function without the head being directly struck. The rapid movement of the head creates forces on the brain that may result in a concussion.
While most research currently surrounds injury during sports-related impacts, they only make a small portion of overall concussions.

Myth: You must lose consciousness to have a concussion

While loss of consciousness can occur with a concussion, research suggests that fewer than 10% of people who sustain a concussion actually lose consciousness.

While each concussion may present differently there are common signs and symptoms including the most common report of a headache following a direct or indirect force to the head or body.
Research suggests that neuropsychological testing is an important part of evaluating changes in thinking and cognitive function. However, studies have not demonstrated consistent differences between individuals who did and did not experience loss of consciousness.

Myth: Helmets prevent concussions

Helmets are an important part of injury prevention, whether it be an athlete or a child riding a bike. While most people think helmets can protect them from any kind of head injury, they do not prevent concussions.
Helmets help reduce the risk of skull fractures and severe traumatic brain injuries, but not concussions.
Helmets are designed with multiple layers of foam and other materials to absorb and distribute force of impact to the head, but the brain still moves within the skull on sudden impact which can result in a concussion.