Sports Head Injuries: What Athletes, Families, and Coaches Need to Know (and How Integrative Care Helps)

Key Takeaway

The most common sports head injury is a concussion, which is a mild traumatic brain injury (mTBI). More severe injuries—like brain contusions, intracranial hematomas (epidural or subdural bleeds), and skull fractures—also happen, though less often. Early recognition, rest, and a step-wise return-to-play plan are essential. Chiropractic and integrative care can help manage neck pain, headaches, balance problems, and other musculoskeletal and neurological symptoms as part of a collaborative medical team that follows current concussion safety guidelines (CDC/CISG). (CDC, 2025; AAOS/AMSSM/CISG statements). PMC+3CDC+3OrthoInfo+3

The Big Picture: Why Head Injuries in Sports Matter

Head injuries are common in contact and collision sports like football, hockey, rugby, soccer, lacrosse, and wrestling. Non-contact sports can also lead to injuries through falls or impacts with equipment. Concussions are by far the most frequent head injury in athletes; they usually result from a blow to the head or a violent shaking motion that makes the brain move inside the skull (CDC; AAOS; Cleveland Clinic). (CDC, 2025; AAOS; Cleveland Clinic). CDC+2OrthoInfo+2

Research and real-world data show that most concussions do not involve loss of consciousness, and brain imaging (CT/MRI) is often normal because a concussion is a metabolic/functional injury, not a visible structural one. (AANS; AAOS). AANS+1

Why this matters: Athletes may “look fine,” continue to play, or downplay symptoms. That raises the risk of a second injury and a longer recovery. (Cleveland Clinic). Cleveland Clinic

Types of Sports Head Injuries (From Most to Least Common)

A. Concussion (mTBI)

A concussion is a temporary brain dysfunction caused by a bump, blow, or jolt to the head—or to the body with enough force to shake the head. Symptoms can appear right away or hours later and often include headache, dizziness, balance problems, nausea, sensitivity to light/noise, fogginess, and trouble concentrating. (Cleveland Clinic; Mayo Clinic; AAOS). Cleveland Clinic+2Mayo Clinic+2

Red flags that need urgent medical care include worsening headache, repeated vomiting, confusion, unequal pupils, seizures, or increasing drowsiness. (Cleveland Clinic; Mayo Clinic). Cleveland Clinic+1

B. Brain Contusion (Bruising of Brain Tissue)

A contusion is a bruise on the brain itself. It may occur with or without a skull fracture and can be associated with swelling or bleeding that needs emergency care. (WebMD/Head Injury overview; Mayo Clinic intracranial hematoma overview). Medscape+1

C. Intracranial Hematomas (Brain Bleeds)

These are collections of blood inside the skull that press on the brain and can be fatal without rapid treatment.

Epidural hematoma: blood between skull and dura mater; often from arterial bleeding; can have a “lucid interval,” then rapid decline. (Mayo Clinic). Mayo Clinic
Subdural hematoma: blood between dura and brain; often due to tearing of bridging veins; acute subdural is a particularly dangerous sports-related emergency. (PMC review).
Intracerebral (intraparenchymal) hematoma: bleeding within brain tissue. (Mayo Clinic). Mayo Clinic

D. Skull Fractures

Skull fractures are breaks in the cranial bones. Linear fractures are most common; depressed and basilar fractures are more serious and may need surgery or special monitoring. (Children’s Minnesota). Children's Minnesota

How Common Is a Concussion—and in Which Sports?

A concussion is the most common sports-related head injury across contact and collision sports. (AAOS; GSA Medicine overview; Cleveland Clinic Athlete Fact Sheet). OrthoInfo+2Genesis Orthopaedics and Spine+2
Contact/collision sports, such as football, soccer, wrestling, ice hockey, lacrosse, and rugby, have the highest risk; however, any sport involving falls or high-speed impacts can cause a concussion. (Cleveland Clinic PDF; CDC HEADS UP). Cleveland Clinic+1

Recognizing a Concussion: Signs and Symptoms

Common symptoms: headache, dizziness, balance problems, nausea, sensitivity to light/noise, fatigue, drowsiness, sleep changes, trouble concentrating, feeling “in a fog.” (Cleveland Clinic; AAOS). Cleveland Clinic+1

Observable clues (often seen by coaches/teammates): dazed appearance, confusion about plays, slow responses, behavior change, or trouble standing. (Mayo Clinic concussion page; AAOS infographic). Mayo Clinic+1

Danger signs (call emergency services): one pupil larger than the other, repeated vomiting, worsening headache, seizures, weakness, slurred speech, confusion, or loss of consciousness. (Cleveland Clinic). Cleveland Clinic

Symptom Questionnaire:

Initial Response and Medical Evaluation

Sideline and immediate steps

Remove from play right away—there is no same-day return to play after a diagnosed concussion. (CISG/Zurich 2012; AAOS Team Physician Statement). PMC+1
Monitor for worsening symptoms for several hours after the injury. (CISG). PMC
Medical evaluation includes symptom checklists, cognitive testing, balance assessment, and a focused neurological exam. (IOM/NRC; AAOS). NCBI+1

Imaging (CT/MRI)

Not routinely required for a simple concussion because scans are often normal. Imaging is used if there are focal neurological deficits, signs of skull fracture, worsening symptoms, seizures, or very low Glasgow Coma Scale scores. (AANS; AAOS; SportsMedToday Choosing Wisely; Medscape). Medscape+3AANS+3OrthoInfo+3

Recovery and the 6-Step Return-to-Play (RTP) Progression

International guidelines and the CDC describe a 6-step progression, with a minimum of 24 hours at each step and medical oversight. If symptoms return, take a step back and rest before trying again. (CDC; CISG/Zurich 2012; PM&R KnowledgeNow). CDC+2PMC+2

Typical 6 steps

Back to regular activities (school/work) with provider approval
Light aerobic activity
Moderate activity
Heavy, non-contact activity
Practice/full contact (if cleared)
Competition (full return)
(CDC). CDC

Why gradual matters: Early overexertion can prolong symptoms; a step-wise build supports safer recovery. (CISG; “Put Me Back In, Coach!”). PMC+1

Beyond Concussion: When It’s Something More Serious

Know the warning patterns of intracranial hemorrhage:

Epidural hematoma can cause a brief “lucid interval,” followed by a rapid decline. (Mayo Clinic). Mayo Clinic
Acute subdural hematoma often involves tearing of bridging veins; it is a leading cause of fatal sports brain injury and needs emergency neurosurgical care. (PMC review).
Skull fractures (especially depressed or basilar) increase the risk of brain injury and may require surgery. (Children’s Minnesota). Children's Minnesota

Bottom line: When red flags are present, skip the sideline tests and call emergency services. (Mayo Clinic; Cleveland Clinic). Mayo Clinic+1

What Chiropractic and Integrative Care Can (and Cannot) Do

Scope and role:
Chiropractic and integrative care do not replace emergency medicine, neurology, or neurosurgery. Instead, they support recovery by treating musculoskeletal and some neurological symptoms linked to concussion—especially neck pain, cervicogenic headaches, postural strain, and vestibular/balance issues. This is best done as part of a team that follows medical guidelines. (AAOS/CISG; Cleveland Clinic; CDC). CDC+3AAOS+3PMC+3

Common supportive strategies in an integrative plan

Cervical spine care: Gentle, evidence-informed manual therapy and mobility exercises for neck dysfunction can help reduce headache triggers and improve comfort, allowing patients to engage in rehabilitation. (Cleveland Clinic PDF; integrative clinic summaries). Cleveland Clinic
Vestibular and balance rehab: Graded exercises for dizziness and balance; often coordinated with physical therapy. (PM&R KnowledgeNow; CDC RTP framework). PM&R KnowledgeNow+1
Sub-symptom aerobic activity: Light, monitored exercise helps recovery when introduced at the right time. (CISG; systematic reviews). PMC+1
Oculomotor/visual drills (when appropriate and supervised): To address tracking, convergence, and visual motion sensitivity. (PM&R KnowledgeNow; IOM/NRC). PM&R KnowledgeNow+1
Education and pacing: Clear rules for rest, sleep, hydration, limiting screen time early on, and graded cognitive load. (Cleveland Clinic; CDC). Cleveland Clinic+1

Important guardrails

Chiropractors and rehabilitation clinicians should screen for red flags and refer patients immediately if a serious injury is suspected. (AAOS; AANS; Mayo Clinic). OrthoInfo+2AANS+2
Care must follow medical clearance rules and align with the athlete’s return-to-play plan. (CDC; CISG). CDC+1

Clinical Observations From Dr. Alexander Jimenez, DC, APRN, FNP-BC (El Paso, TX)

Dr. Jimenez leads an integrative practice that combines chiropractic care with nurse practitioner oversight to support athletes recovering from head and neck injuries. In his clinic content, he emphasizes:

Neck mechanics matter: Cervical and upper thoracic dysfunction can exacerbate headaches, dizziness, and poor posture following a head injury. Correcting mechanics may improve comfort and balance, as well as training tolerance. (Jimenez Clinic posts). El Paso, TX Doctor Of Chiropractic+1
Team-based care: Chiropractic adjustments, soft-tissue therapy, and graded vestibular/postural rehab are coordinated with medical providers to match RTP stages. (Jimenez Clinic posts). El Paso, TX Doctor Of Chiropractic
Recovery is a process: Step-wise activity, symptom tracking, and patient education drive safer returns to school, work, and sport. (Jimenez Clinic posts and LinkedIn). El Paso, TX Doctor Of Chiropractic+1

Practical note from Dr. Jimenez’s approach: “Start low, go slow.” Short, tolerable bouts of exercise that don’t spike symptoms help athletes stay on track and avoid setbacks. (Jimenez clinic posts). El Paso, TX Doctor Of Chiropractic

A Simple, Safe Concussion-Support Plan (After Medical Evaluation)

This plan supports—but does not replace—medical care. Always follow your provider’s instructions.

Phase 1: Relative Rest (24–48 hours)

Sleep, hydrate, and limit screen time. Light walks if approved and symptom-tolerated. (CISG; CDC). PMC+1

Phase 2: Sub-Symptom Activity

10–20 minutes of easy cardio (walk/bike) that doesn’t worsen symptoms during exercise or for 24 hours after. (CISG; Schneider systematic review). PMC+1

Phase 3: Targeted Rehab

Neck care (gentle mobility, isometrics), vestibular drills (gaze stabilization, balance progressions), and visual tasks as directed. (PM&R KnowledgeNow). PM&R KnowledgeNow

Phase 4: Non-contact Sport-Specific Work

Agility footwork, light resistance training, and movement patterns (no contact). (CDC; CISG). CDC+1

Phase 5–6: Full Practice → Competition

Only after medical clearance, and if no new symptoms appear with each step. (CDC). CDC

Preventing Head Injuries Where Possible

Proper helmets and fit for the sport; helmets lower the risk of skull fracture and severe brain injury (but cannot “prevent” all concussions). (Children’s Minnesota). Children's Minnesota+1
Rule changes and technique: Limit dangerous hits, reduce heading in youth soccer, teach safe tackling, and enforce penalties for illegal contact. (CDC; Children’s Minnesota). CDC+1
Sportsmanship and conditioning: Follow rules, practice good technique, and maintain strength/flexibility to reduce risky impacts. (Cleveland Clinic PDF). Cleveland Clinic

When to Go to the ER (Don’t Wait)

Worsening headache, repeated vomiting, seizures, confusion, weakness/numbness, unequal pupils, severe drowsiness, or loss of consciousness. (Cleveland Clinic; Mayo Clinic). Cleveland Clinic+1

Frequently Asked Questions (Quick Answers)

Q: Can I have a concussion even if my scan is normal?
A: Yes. A concussion usually does not show up on standard CT/MRI because it’s a functional/metabolic injury. (AANS; AAOS). AANS+1

Q: How long does recovery take?
A: Many concussions improve within 2–4 weeks, but some take longer, especially if the athlete returns too soon or has risk factors. Follow a gradual RTP plan with medical supervision. (CDC; “Put Me Back In, Coach!”). CDC+1

Q: What does a chiropractor add to care?
A: As part of a team, chiropractors address neck pain, posture, and some balance/vestibular issues so athletes can complete rehab with fewer flare-ups. Urgent or severe signs always require medical imaging and specialty care. (AAOS/CISG; Jimenez Clinic). AAOS+2PMC+2

Putting It All Together

A concussion is the most common sports head injury. Skull fractures and brain bleeds are less common but more dangerous and need urgent care. (AAOS; Mayo; Children’s Minnesota; PMC). OrthoInfo+2Mayo Clinic+2
Safe recovery follows medical evaluation and a 6-step RTP with at least 24 hours per step. (CDC; CISG). CDC+1
Chiropractic and integrative care help manage neck-related pain, headaches, balance issues, and poor posture, allowing athletes to progress through rehabilitation within a team-based plan. (Jimenez Clinic; PM&R KnowledgeNow; Cleveland Clinic). El Paso, TX Doctor Of Chiropractic+2PM&R KnowledgeNow+2

References

American Academy of Neurology/Neurosurgery (AANS). (n.d.). Concussion. https://www.aans.org/patients/conditions-treatments/concussion/ AANS
American Academy of Orthopaedic Surgeons (AAOS). (n.d.). Sports concussion. https://orthoinfo.aaos.org/en/diseases--conditions/sports-concussion/ OrthoInfo
American Academy of Orthopaedic Surgeons (AAOS). (2015). Concussion and the team physician: A consensus statement. https://www.aaos.org/globalassets/about/bylaws-library/information-statements/1029-concussion-mild-traumatic-brain-injury-and-the-team-physician---a-consensus-statement.pdf AAOS
Bailes, J. E., & Hudson, V. (2001). Classification of sport-related head trauma: A spectrum of mild to severe injury. Journal of Athletic Training. https://pmc.ncbi.nlm.nih.gov/articles/PMC155412/ PMC
CDC. (2025, Sept 15). Returning to sports (6-step progression). https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html CDC
Children’s Minnesota. (n.d.). A to Z: Fracture, skull. https://www.childrensmn.org/educationmaterials/parents/article/16232/a-to-z-fracture-skull/ Children's Minnesota
Children’s Minnesota. (n.d.). How can parents help prevent concussions? https://www.childrensmn.org/educationmaterials/parents/article/18480/how-can-parents-help-prevent-concussions/ Children's Minnesota
Cleveland Clinic Florida. (n.d.). Sports concussion—Your silent, invisible opponent (PDF handout). https://my.clevelandclinic.org/-/scassets/files/org/florida/ortho/athlete-concussion-fact-sheet.ashx?la=en Cleveland Clinic
Karger/PMC. (2020). Acute subdural hematoma in sports: Mechanisms and management (review). https://pmc.ncbi.nlm.nih.gov/articles/PMC7755598/
Mayo Clinic. (2024). Intracranial hematoma: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/intracranial-hematoma/symptoms-causes/syc-20356145 Mayo Clinic
McCrory, P., et al. (2013). Consensus statement on concussion in sport: 4th International Conference (Zurich 2012). PM&R / Br J Sports Med (open versions). https://pmc.ncbi.nlm.nih.gov/articles/PMC3715021/ PMC
PM&R KnowledgeNow (AAPM&R). (n.d.). Sports concussion. https://now.aapmr.org/sports-concussion/ PM&R KnowledgeNow
Schneider, K. J., et al. (2017). Rest and active rehabilitation following sport-related concussion: Systematic review. https://folia.unifr.ch/global/documents/258176 FOLIA
“Put Me Back In, Coach!” (2017). Concussion and return to play. https://pmc.ncbi.nlm.nih.gov/articles/PMC6143567/ PMC
SportsMedToday (AMSSM). (n.d.). Choosing Wisely: Imaging recommendations for concussions. https://www.sportsmedtoday.com/choosing-wisely%3A-imaging-recommendations-for-concussions-va-56.htm Sports Medicine Today

Practice-based/clinic context (integrative care examples):

Jimenez, A. (2025). Concussions & post-concussion syndrome. https://dralexjimenez.com/concussions-post-syndrome/ El Paso, TX Doctor Of Chiropractic
Jimenez, A. (2025). Traumatic brain injury and posture: Signs and solutions. https://dralexjimenez.com/traumatic-brain-injury-and-posture-signs-and-solutions/amp/ El Paso, TX Doctor Of Chiropractic
Jimenez, A. (2025). Rehabilitation exercises after head injuries: A step-by-step guide. https://dralexjimenez.com/rehabilitation-exercises-after-head-injuries-step-by-step-plan/amp/ El Paso, TX Doctor Of Chiropractic
Jimenez, A. (2025). Sport injuries—Concussion care overview. https://dralexjimenez.com/sport-injuries-el-paso/ El Paso, TX Doctor Of Chiropractic
Jimenez, A. (LinkedIn profile). https://www.linkedin.com/in/dralexjimenez LinkedIn

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and to identify relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.
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Email: coach@elpasofunctionalmedicine.com
Licensed in: Texas & New Mexico*

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