Concussions in the Performing Arts

March is National Brain Injury Awareness Month

The most common brain injury suffered by athletes and performers is a concussion. A concussion is a traumatic injury to the brain, and it comes with a plethora of symptoms that can affect nearly all of the systems in the body. Even with prompt and proper care and recovery, suffering a concussion can result in permanent or life-threatening consequences.

When people think of activity-related concussions, they typically think of high-impact sports like football, hockey, or boxing, but performing artists are at risk of suffering concussions, too. Most commonly, activity-related concussions are caused by collisions, falls, or blunt trauma to the head (getting hit in the head or hitting the head on something). In the performing arts, concussions are almost always caused by accidents or mistakes while executing choreographed movements.

Mechanism of Injury

Concussions happen when the head rapidly accelerates, decelerates, changes direction (which is decelerating and then accelerating), or rotates. When these motions occur at very high speeds, the brain’s natural cushioning and protection mechanism (it’s called CSF: cerebrospinal fluid) cannot function properly, allowing the brain to smash into the inside of the skull, sometimes more than once and in more than one location of the brain. This high-force collision between the brain and the skull is what causes the brain injury. It is important to note that there does not need to be a direct blow to the head to cause a concussion. Concussions can be caused by a whiplash-type mechanism as well.

Signs and Symptoms

Your brain controls everything that happens in your body and is the processing center for communications between your body and you. So, when your brain is injured, these systems and their communications to you often become disrupted or distorted. This is why people with concussions may have symptoms arising from things entirely contained within the head (vision problems, headache, noise sensitivity) as well as symptoms coming from body parts and systems that are outside of the head (weakness in the arms, nausea, vomiting). Concussion symptoms can be related to balance, sleeping, vision, hearing, coordination, speech processing, emotional state, level of alertness and focus/clarity, pain, nausea/vomiting, numbness, or weakness.

The amount and intensity of concussion symptoms can vary from person to person and even from one concussion to the next within the same person. It’s important to make a distinction between amount or intensity of symptoms and severity of injury. While having a high number of symptoms and/or several very intense symptoms may be related to having a more significant or longer-lasting concussion, the presence – or absence – of specific symptoms does not correlate with a prognosis. Previously, loss of consciousness was thought to be the prime indicator of a severe injury, but a person with a concussion does not have to lose consciousness to have significant and life-altering consequences. (Also, you do not need to lose consciousness in order to be diagnosed with a concussion.)

Not all symptoms will appear right away. Some may appear a day or two after the injuring incident.

What to Do

***If you have suffered a head injury (or someone else), call 911 or have someone take you to the ER if you: have neck pain, are vomiting, are slipping in and out of consciousness, or are experiencing the worst headache of your life. If you suffered a head injury and you have neck pain, try to restrict your neck movement as much as possible (if you were injured during a collision or fall, stay where you are and don’t move. Have someone call 911 for you in case you also suffered a neck injury).***

If you think you’ve suffered a concussion, make an appointment with a physician. Some sports medicine physicians or clinics may have specific appointment slots for concussion patients. While you are waiting for your doctor’s appointment, rest your brain from practically everything, including exercise, bright lights, loud noises, mental tasks, and electronics (this includes your phone!). If you are in school, ask your doctor about academic accommodations during your recovery.


Just like with any musculoskeletal injury, you need to take appropriate steps to heal and rehabilitate from a concussion. Complete recovery minimizes physical and mental health consequences of concussions. To be medically cleared to return to rehearsals, you must complete a gradual return to physical activity, monitored by a sports medicine professional.