Sports-Related Head Injuries: From Concussions to Skull Fractures—and How Chiropractic & Integrative Care Can Help

Key Takeaways

• Concussions are the most common sports head injury, but more serious problems—like brain contusions, epidural or subdural hematomas, and skull fractures—also occur (Aptiva Health, n.d.; Children’s Minnesota, n.d.; Mosenthal et al., 2012/2013).

• A blow to the head or forceful shaking is the usual cause of a concussion (Cleveland Clinic, n.d.; Mayo Clinic, n.d.).

• High-risk sports include football, ice hockey, soccer (especially heading and collisions), wrestling, basketball, lacrosse, and cheerleading; even “non-contact” sports can involve falls or impacts (CDC, n.d.; Arsenian & Associates, n.d.).

• Chiropractic and integrative clinicians can help with neck pain, cervicogenic headaches, vestibular issues, posture and balance problems, and graded return-to-activity—working within a multidisciplinary team and referring for emergency care when needed (Carr Chiropractic Clinic, n.d.; Thinkvida, n.d.; Aurora Chiropractic, n.d.; Eastlake Chiropractic, n.d.; Mountain Movement Center, n.d.).

• Red-flag symptoms (worsening headache, repeated vomiting, seizure, unequal pupils, confusion that worsens, focal weakness, or loss of consciousness) need immediate emergency evaluation (Mayo Clinic, n.d.; WebMD, n.d.; Cleveland Clinic, n.d.).

• Return-to-play should follow a stepwise, evidence-based progression (e.g., a 6-stage protocol) overseen by qualified clinicians (Schneider et al., 2013; OrthoInfo/AAOS, n.d.; Mayo Clinic, n.d.).

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What Counts as a Sports Head Injury?

Sports head injuries span a spectrum—from mild to life-threatening. The most frequent is concussion, a mild traumatic brain injury (mTBI). But athletes can also sustain brain contusions (bruising), intracranial hematomas (bleeding inside the skull, such as epidural or subdural hematomas), and skull fractures (Cleveland Clinic, n.d.; Mayo Clinic, n.d.; Mosenthal et al., 2012/2013; Children’s Minnesota, n.d.). While many injuries resolve, some lead to lasting issues with attention, memory, balance, and headache—especially if not recognized early (Aptiva Health, n.d.; CDC, n.d.).

Concussion (mTBI)

A concussion happens when mechanical forces—like a direct blow, whiplash, or rapid acceleration/deceleration—disrupt brain function (Cleveland Clinic, n.d.; Mayo Clinic, n.d.). You don’t need to lose consciousness to have a concussion. Typical symptoms include headache, dizziness, “foggy” thinking, balance problems, nausea, sensitivity to light/noise, and changes in sleep patterns (Cleveland Clinic, n.d.; OrthoInfo/AAOS, n.d.). Symptoms may start immediately or be delayed by hours (Cleveland Clinic, n.d.).

Brain Contusions and Intracranial Hematomas

A contusion is a bruise to brain tissue, often from impact. Intracranial hematomas are collections of blood that press on the brain. Common types include:

• Epidural hematoma (bleeding between skull and dura): often arterial and may have a brief “lucid interval.”

• Subdural hematoma (bleeding under the dura): often from tearing bridging veins, which can be rapidly life-threatening in acute cases (Bajsarowicz et al., 2015; Servadei et al., 2002/2010/2013).

Both can follow sports impacts or falls and require immediate emergency care (Mosenthal et al., 2012/2013).

Skull Fractures

A skull fracture is a break in one of the cranial bones from significant trauma. Signs can include swelling, bruising behind the ear, blood or clear fluid from the nose/ears, or a depressed area over the skull (Children’s Minnesota, n.d.). Any suspected skull fracture demands urgent medical evaluation.

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How Do These Injuries Happen?

Sports and activities that include collisions, falls, rapid direction changes, slams, throws, takedowns, or heading the ball increase risk (CDC, n.d.; Arsenian & Associates, n.d.). Even in the gym, straining with heavy lifts can be linked with acute headache or blood pressure spikes that worsen pain (Studio Athletica, n.d.). In youth and school settings, the highest number of concussions tends to occur where participation is greatest and contact is frequent (CDC, n.d.; Neural Effects, n.d.).

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Signs, Symptoms, and Red Flags

Common Concussion Symptoms

• Headache, pressure in the head

• Dizziness, balance problems, nausea

• Confusion, slowed thinking, memory gaps, or “fog”

• Light/noise sensitivity, sleep disturbance, fatigue

• Possible brief loss of consciousness (not required) (Cleveland Clinic, n.d.; OrthoInfo/AAOS, n.d.; Mayo Clinic, n.d.)

Red-Flag Symptoms (Call Emergency Services)

• Worsening headache or repeated vomiting

• Seizure, unusual drowsiness, or inability to wake

• Unequal pupils, slurred speech, weakness, or numbness

• Neck pain with neurological deficits or suspected skull fracture

• Any rapidly worsening confusion or behavior changes (Mayo Clinic, n.d.; WebMD, n.d.; Cleveland Clinic, n.d.)

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Immediate Steps After a Suspected Concussion

1. Remove from play immediately. When in doubt, sit them out (OrthoInfo/AAOS, n.d.).

2. Medical evaluation by a trained clinician. Neuro checks and symptom scales guide next steps (OrthoInfo/AAOS, n.d.).

3. Imaging (CT/MRI) is reserved for red flags or concern for structural injury (OrthoInfo/AAOS, n.d.; Mayo Clinic, n.d.).

4. Relative rest for 24–48 hours, then gradual activity as symptoms allow (Mayo Clinic, n.d.; Schneider et al., 2013).

5. No same-day return to play after a concussion (OrthoInfo/AAOS, n.d.).

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The Stepwise Return-to-Play (RTP) Progression

Evidence supports a graded, 6-stage progression that begins with symptom-limited activity and advances to sport-specific drills, non-contact practice, full-contact practice, and finally competition—only if the athlete is symptom-free at each stage and medically cleared (Schneider et al., 2013; OrthoInfo/AAOS, n.d.; Mayo Clinic, n.d.). If symptoms return, step back and rest before retrying.

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Common Post-Concussion Issues

• Neck pain and stiffness from whiplash-type forces

• Cervicogenic headaches (headaches driven by neck dysfunction)

• Vestibular problems (dizziness, imbalance, visual motion sensitivity)

• Postural changes and decreased spinal mobility

• Cognitive-fatigue and reduced exercise tolerance (Cleveland Clinic, n.d.; Mountain Movement Center, n.d.; Studio Athletica, n.d.)

These problems often overlap. For example, a tight upper cervical spine can worsen headaches and balance complaints, while vestibular issues can increase neck muscle guarding. This is why multidisciplinary care is most effective.

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Where Chiropractic & Integrative Care Fit In—As Part of the Team

Chiropractic and integrative medicine clinicians contribute to post-concussion care by addressing the musculoskeletal and neuromotor components of recovery and coordinating with the broader team (primary care, neurology, sports medicine, physical therapy, vestibular therapy, athletic training, and, when needed, emergency medicine) (Carr Chiropractic Clinic, n.d.; Thinkvida, n.d.; Eastlake Chiropractic, n.d.; Mountain Movement Center, n.d.).

Typical Focus Areas (Within Scope and With Medical Clearance)

1. Cervical spine assessment and treatment

   • Gentle, evidence-informed manual therapies (including spinal manipulation or mobilization when appropriate) to improve neck motion, reduce cervicogenic headache triggers, and normalize muscle tone (Aurora Chiropractic, n.d.; Mountain Movement Center, n.d.).

   • Soft-tissue techniques for tender or guarded muscles after impact.

2. Vestibular and balance support

   • Collaboration with vestibular/physical therapists for gaze stabilization, balance, and habituation exercises when dizziness or visual motion sensitivity is present (Schneider et al., 2013).

3. Posture and movement retraining

   • Addressing thoracic/cervical posture, scapular control, and core-hip patterns to reduce strain on the neck and head (Mountain Movement Center, n.d.).

4. Headache management

   • For cervicogenic and tension-type patterns, a combination of manual therapy, graded activity, hydration, sleep education, and stress management can help (Studio Athletica, n.d.; Mountain Movement Center, n.d.).

5. Graded aerobic activity

   • Low-intensity cardio under guidance can improve brain blood flow and symptom tolerance—introduced gradually according to RTP steps and medical guidance (Schneider et al., 2013; OrthoInfo/AAOS, n.d.).

6. Education and load management

   • Guidance on screen time, sleep hygiene, hydration, nutrition, and staged return to school/work and sport (Mayo Clinic, n.d.; OrthoInfo/AAOS, n.d.).

7. Team communication

   • Chiropractors and integrative providers work closely with physicians and therapists, document patient progress, and refer patients promptly if any red flags arise or if recovery stalls (Carr Chiropractic Clinic, n.d.).

Clinical perspective: Dr. Alexander Jimenez, DC, APRN, FNP-BC—who works in dual-scope, integrative settings—emphasizes thorough neck and spine evaluation, early identification of vestibular and balance deficits, and collaboration with primary and specialty care. In his experience, addressing the cervical spine, posture, and movement patterns often reduces headache burden and improves tolerance for graduated exercise, while close monitoring ensures quick referral for imaging or specialty care if warning signs appear (Dr. Alex Jimenez—Website; LinkedIn).

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Special Considerations for Youth and School Athletics

• Many concussions occur in school-aged athletes due to high participation rates in contact and collision sports (CDC, n.d.; Neural Effects, n.d.).

• Youth may need longer recovery periods and clear rest guidelines for schoolwork and screen time.

• A unified plan among parents, coaches, school nurses, athletic trainers, and clinicians improves safety and compliance (CDC, n.d.; OrthoInfo/AAOS, n.d.).

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Prevention: Lower the Risk, Raise the Awareness

1. Proper technique and coaching: Avoid dangerous plays (leading with the head, blindside hits) and follow rules that minimize head impacts (CDC, n.d.).

2. Protective gear: Sport-specific helmets and mouthguards as recommended (CDC, n.d.).

3. Conditioning: Neck strengthening, core stability, balance training, and aerobic fitness.

4. Culture of safety: Encourage reporting symptoms; no pressure to “tough it out.”

5. Baseline testing: When available, supports comparison after injury.

6. Education: Athletes and families should know red flags and RTP rules (CDC, n.d.; OrthoInfo/AAOS, n.d.).

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When to Seek Emergency Care—Right Now

Call emergency services or go to the ER for any of the following after a head impact:

• Seizure, repeated vomiting, or worsening headache

• Loss of consciousness or increasing confusion

• Weakness, numbness, slurred speech, or unequal pupils

• Clear fluid from nose/ears, suspected skull fracture, or severe neck pain (Mayo Clinic, n.d.; WebMD, n.d.; Cleveland Clinic, n.d.; Children’s Minnesota, n.d.)

These signs can point to intracranial bleeding or skull fracture and must be taken seriously (Mosenthal et al., 2012/2013; Bajsarowicz et al., 2015).

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Putting It All Together: A Simple Recovery Roadmap

1. Recognize & remove: If concussion is suspected, stop play and get evaluated (OrthoInfo/AAOS, n.d.).

2. Rule out emergencies: Watch for red flags and seek urgent care if they are present (Mayo Clinic, n.d.).

3. Relative rest (24–48 h): Short period of calm, then gradual activity (Mayo Clinic, n.d.).

4. Team-based rehab: Address neck, vestibular, posture, and aerobic tolerance with clinicians experienced in concussion care (Schneider et al., 2013).

5. Stepwise RTP: Follow 6-stage progression; do not rush (Schneider et al., 2013; OrthoInfo/AAOS, n.d.).

6. Monitor & communicate: Keep your care team informed; adjust the plan as needed.

7. Prevent the next one: Improve technique, fitness, and safety culture (CDC, n.d.).

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Frequently Asked Questions (FAQ)

Do I need a scan after every head injury?

No. CT or MRI is used when there are red flags or concern for structural injury. Many concussions show no changes on imaging (OrthoInfo/AAOS, n.d.; Mayo Clinic, n.d.).

Can chiropractic care “cure” a concussion?

No single therapy “cures” a concussion. Chiropractic care can help by treating neck dysfunction, cervicogenic headaches, and musculoskeletal contributors to symptoms, within a coordinated, medically supervised plan. Providers should refer for emergency care when needed (Carr Chiropractic Clinic, n.d.; Thinkvida, n.d.; Aurora Chiropractic, n.d.; Eastlake Chiropractic, n.d.).

How long does recovery take?

Most mild concussions improve over days to weeks, but some cases take longer. Youth may recover more slowly. Adhering to RTP steps and addressing neck/vestibular issues can help (Mayo Clinic, n.d.; OrthoInfo/AAOS, n.d.; CDC, n.d.).

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Conclusion

Sports build strength, focus, and community—but they also carry head-injury risks. While concussions are most common, brain contusions, intracranial hematomas, and skull fractures can occur and sometimes demand emergency care. Early recognition, team-based management, and a stepwise return-to-play approach are the most effective paths to a safe recovery. Within that team, chiropractic and integrative medicine can support the neck, spine, vestibular system, posture, and movement patterns that often drive persistent symptoms—always with careful screening, collaboration, and respect for medical red flags. With the right plan and communication, most athletes can return to school, work, and sport safely and confidently.

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References

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