What is concussion?
Concussion is a mild form of traumatic brain injury. It results in transient impairment of neurological function. In sport, it usually occurs from a blow or knock to the head but this isn’t the only way someone can sustain a concussion. It is important to recognise concussion early and remove the athlete from play. If there is any doubt about whether a concussion injury has occurred, the athlete should sit out until an appropriate medical specialist can review them.
“If in doubt, sit it out”.
What are the symptoms of concussion?
Symptoms of concussion can be variable and not everyone will get all the symptoms. They can include:
- Nausea and vomiting
- Pressure in the head
- Balance problems
- Difficulty remembering
- Difficulty concentrating
- Not feeling right
- Feeling like in a fog
- Feeling slowed down
- Change in behaviour
- More emotional
- Sensitive to light
- Sensitive to noise
- Trouble falling asleep
Symptoms may not be apparent straight away and may develop hours later. There is not always loss of consciousness during a concussion injury but any loss of consciousness in sport after contact should be considered a concussion injury.
The signs and symptoms are commonly due to a functional injury to the brain after a concussion and not a structural injury; therefore standard structural neuroimaging studies such as MRI will be normal.
What are the complications of concussion?
Most concussions resolve completely with adequate treatment but there are some acute complications that can occur. These include acute progressive cerebral oedema (previously called second impact syndrome), persistent or prolonged symptoms (greater than 14 days in adults or 4 weeks in children), and higher risk of musculoskeletal injury or repeat concussion on return to play after concussion. Other medium to long-term complications include mental health issues and cognitive health issues.
How is concussion diagnosed?
There is no one gold standard diagnostic test for concussion and clinical evaluation is needed by a medical practitioner skilled in the diagnosis and management of concussion. The SCAT5 is a comprehensive concussion assessment tool for use by medical professionals to help with the diagnosis and management of concussion.
The concussion recognition tool (CRT5) is for use by non-medically trained people to help recognise signs and symptoms of a concussion at sport and provides guidance for initial management.
How is concussion managed?
Initial management of concussion involves complete physical and cognitive rest for the first 1-2 days. This includes rest from work, school or education and limiting screen time. After 48 hours the athlete can return to a small amount of light physical activity as long as there is no increase in symptoms. This may be a light 10 – 15 min walk and also includes returning to driving if relevant. It’s important to see a medical provider experienced in the assessment and management of concussion as soon as possible after the incident. Once all the symptoms have completely resolved the athlete can begin a graduated return to activity (and school if applicable) plan under the guidance of their treating medical practitioner.
A graded return to play protocol starts once the athlete is symptom free. There are 6 levels of the return to play plan and at least 24 hour is spent at each level. If the athlete’s symptoms reoccur at any time, they are to rest for 24 hours and then go back to the previous level that didn’t cause any symptoms and start again from there. They need to be reviewed by their medical practitioner before returning to full contact training. If they tolerate full contact training without any symptoms they can return to sport.
When can a concussed athlete go back to sport?
The minimum time required prior to return to sport after a concussion is 7 days if there is immediate resolution of the symptoms after the incident. Some sports have different protocols that may use even more time as the standard management. Longer time frames are recommended for young athletes. A minimum of 2 weeks is recommended for all athletes under the age of 18 returning from concussion before any contact training is resumed prior to return to sport.
Can my child go to school after a concussion?
Concussion may affect the child’s ability to learn at school and they may need some days off school after the incident. Some children may need to return to school gradually and initially avoid activities that make their symptoms worse. They may need more time to complete tasks and may need to be in a quieter area of the school and be given more breaks in learning. The treating medical practitioner can liaise with the school to develop the best plan for the individual child. The child should not start a return to play protocol until they are back at school participating in normal learning activities without symptoms.
Where can I learn more?
More information on concussion can be found on the Concussion in Sport Australia website.
If you or your child has sustained a concussion, Shire Sports Medicine has specific sports medicine consultations for individualised advice and assessment regarding return to school and sport after concussion.