"Unfortunately, concussion doesn't show up on a lot of the diagnostic tests that team doctors are used to looking at," says Christopher Bailey, Ph.D., neuropsychologist at University Hospitals.
Tonight's In Focus looks at the anatomy of a concussion. For other stories in WKYC's week-long series "Use Your Head," click here.
When an athlete takes a hit to the head and is concussed, the brain doesn't bounce against the skull.
"Instead, what happens is, the brain stretches, and when that happens, there are small tears that happen along the axons or neurons of the brain that then leads to a difficulty in the neurons firing in a way that they're used to firing," Dr. Bailey explains.
He says the damage happens on a cellular level but will typically heal if given time, anywhere between days and weeks.
"The biggest myth is that concussions are benign because they're not they can have a cumulative effect," says Dr. Paul Gubanich, a Cleveland Clinic team physician for the Cleveland Browns who specializes in concussions.
The danger is when an athlete receives a second concussion before the first has had time to heal. It's called "post concussion syndrome." The cognitive problems can become permanent or even cause death.
Physical symptoms of initial concussion include headache, nausea, dizziness, memory loss, sensitivity to light and noise. Later, the athlete may experience cognitive problems, such as delayed reaction, attention problems and trouble thinking fast.
"Kids will have trouble concentrating, they'll have poor energy, they won't sleep well. They may get depressed, so all of these can impact their academic performance and the things that they're able to do in life eventually," says Dr. Amanda Weiss-Kelly, head of Pediatric Sports Medicine at Rainbow Babies and Children's Hospital.
Once they've had one concussion, the chances of another increase. Continued head trauma may also lead to problems later in life, such as dementia, Parkinson's disease, epilepsy and Alzheimer's disease.
As for helmets, they protect against skull fracture and contusions but they don't prevent concussion.
"The brain will feel less force when there's a helmet on. However, this has not translated to a decrease in the number of concussions in sports where people wear helmets," says Dr. Weiss-Kelly.
As for keeping someone awake who may have sustained a concussion, that's just dangerous. It's important to observe them but continually waking them doesn't let the brain heal. Sleep is the best medicine.
"The standard of care is what we call 'cognitive rest,' so not only do we try to remove them from their sports activity, we're trying to remove them from any activity that would challenge their brain, both physically and mentally," says Dr. Gubanich.
That includes no cell phones, video games, television or anything else that requires one to think.
The potential permanent damage is why it's key for athletes and their parents to take concussions seriously.
"The culture of athletics kind of works against us there because, really, most athletes are kind of encouraged to play through things and to kind of minimize their symptoms," says Dr. Bailey.
It's a practice that can end a future in sports and potentially life.