"What should I do after a head impact while surfing — how do I know if it’s a concussion?"

If you hit your head while surfing and experience any confusion, loss of consciousness, dizziness, nausea, headache, memory problems, visual changes, or balance issues, assume you've sustained a concussion until evaluated. Stop surfing immediately and seek medical or PT evaluation before returning to the water. Return-to-sport follows a graded stepwise protocol guided by symptom resolution.

Quick signs

• Confusion, amnesia for the event, delayed responses

• Dizziness, nausea, headache, blurred vision

• Balance problems or sensitivity to light/sound

Immediate actions

• Get out of the water and rest in a safe place

• If experiencing any of the symptoms above have someone call emergency services

Rehab overview

1. Initial rest and symptom management (24–48 hours of relative cognitive/physical rest)

2. Graduated activity (light aerobic → sport-specific drills) under clinician guidance

   1. Often, exercise/activity tolerance is very limited and needs to be progressed very slowly

   2. PT's can employ specific testing to determine aerobic tolerance

3. Vestibular / vision / cervical rehab as indicated

   1. After concussion it's common for people to experience disequilibrium, dizziness, nausea, sensitivity to light and motion. PT's can guide you in exercises to restore your tolerance to all of these stimuli

General return-to-surf criteria (these may vary depending on your case)

• Symptom-free at rest and with moderate activity

• Complete graduated exertion stages without symptom return

• Normal VORx1, VORx2 (ability to track moving objects while head is stationary or moving)

• Normal balance

• Normal reaction time

• No recent episodes of dizziness

• Normalized CO2 tolerance and breath holding capability

• Medical clearance from clinician experienced with concussion

Prevention tips

• Consider head protection when surfing hazards are present (rocky breaks), crowded line-ups (foilers, sea janitors)

• Protect your head as much as possible during wipeouts

• Always double check before dropping

• Paddle toward the impact zone to avoid colliding the surfer on the incoming wave, they have the right of way

• Surf with a buddy who can keep an eye out for you!

FAQs

• “How long until I can surf again after a concussion?”

  • It's important to consider that concussions are brain injuries. The brain needs time to heal. For some cases, this could be a couple weeks. For some cases this could be months. If you've had a concussion it's important to undergo proper assessment by a neurologist or sports physician and a physical therapist. It's important not to rush back before you're ready as you could sustain another concussion or injury due to slowed reaction time, poor awareness, impaired activity tolerance.

• “What tests will a PT do for post-concussion symptoms?”

  • I'll typically use a variety of tests depending on the severity of ones symptoms. I'll check the vestibular system (inner ear), the visual system (eyes), proprioceptive/sensory system (balance/coordination), reaction time, endurance, heart rate variability and more depending on the case. All of this information helps us to determine concussion severity and guides our treatment choices and prognosis.