What We All Should Know About Sports Concussion

What is concussion?

• Concussion is an injury to the brain resulting from a direct or indirect force to the head that results in a disturbance of brain function.
• Concussion may present with loss of consciousness or amnesia (forgetting of events immediately before or after the injury) BUT lack of loss of consciousness or amnesia does NOT mean that a player may not have suffered a significant concussion.
• Concussion is the most common form of sports related brain injury.
• Most concussions are temporary and should be allowed to recover fully.

How does the injury occur?

• A violent blow to the head; this may be a punch, fast moving object such as a cricket or baseball, or a clash of body parts (e.g. head-to-head or head-to-knee).
• A collision with another player.
• The head striking the ground.
• A whiplash-type jerking movement of the head and neck.

What actually happens?

The impact to the head, neck or other portion of the body results in the brain shifting inside the skull and knocking against the inner bony surface. This may be enough to cause microscopic shearing of nerve fibres and probably sets off a process of swelling and a series of chemical reactions; this not only affects the way the brain works (e.g. thinking and co-ordination) but makes the brain susceptible to further injury during the period of recovery.

What are the most common symptoms (what the player tells us) & signs (what we can see) of concussion?

What should I do if I suspect that a player has been concussed?

• Remove the player from the field immediately.
• If there is loss of consciousness assume that there is a neck injury, stabilize the head and neck and stretcher the player off.
• Do not allow the player to return to that practice or match.
• Inform the parent/guardian and coach that a concussion is suspected.
• The player must be assessed by a doctor – the team physician, event doctor or emergency room doctor.
• The doctor will either discharge the player home – he or she must be accompanied by a responsible adult (see guidelines for the first 48 hours) or admitted to hospital for neurological observation and investigation.
• Whether discharged or admitted, the player must be followed up by a doctor experienced in concussion management – a sports physician, neurologist or neurosurgeon before performing ANY exercise again.

How will a player know when it is safe to return to play?

Modern concussion management relies on several criteria:

• The player’s symptoms must have cleared completely.
• His or her neurological examination must be normal; this evaluation should include tests that assess cognitive function (thinking ability) and balance.
• Computerized brain function tests may be used to assess a player’s reaction times and information processing; this should ideally be compared to a similar test performed at the beginning of the season (the baseline test) when the player was well; the test score should be comparable to baseline before returning to exercise.
• Finally, the player should be exposed to gradually increasing intensities of exercise; should he or she be asymptomatic through this process then contact sport may be resumed.

Does a normal CT or MRI scan mean that a player is not concussed?

No. The injury occurring to the brain is not detectable by most forms of brain scan. There may still be significant injury despite a normal scan. A scan is useful in excluding bleeding around or in the brain, but clinical criteria and brain function tests are more useful means of monitoring how a player has been affected by concussion.

What is Second Impact Syndrome?

A very serious and even fatal brain injury that may occur even with a relatively mild impact. A rare disorder, Second Impact Syndrome, occurs when an athlete suffers a concussion and then, within a short time later (usually within one week), receives a second blow to the head before the brain has recovered from the first concussion. It is possible for rapid brain deterioration and even death to occur. This happens because the brain is still affected from the first injury and the second injury results in rapid swelling and pressure within the skull. This intracranial pressure, if uncontrolled, can lead to death.