Managing Concussions in Sport: A Step-by-Step Guide
Concussions are a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head, or by a hit to the body that causes the head and brain to move rapidly back and forth. While often considered a 'minor' brain injury, concussions can have significant short-term and long-term effects on an athlete's health and well-being. This guide provides a step-by-step approach to recognising, assessing, and managing concussions in sports, emphasising athlete safety and proper recovery.
1. Recognising the Signs and Symptoms of Concussion
Recognising the signs and symptoms of a concussion is the first crucial step in managing this injury effectively. It's important to remember that symptoms can appear immediately after the injury or may be delayed by hours or even days. Furthermore, not all individuals experience the same symptoms. Here's a breakdown of common signs and symptoms:
Physical Symptoms:
Headache
Dizziness
Balance problems
Nausea or vomiting
Fatigue or drowsiness
Blurred vision or double vision
Sensitivity to light or noise
Ringing in the ears (tinnitus)
Seizures (rare, but serious)
Cognitive Symptoms:
Difficulty concentrating
Memory problems (forgetting events before or after the injury)
Confusion
Feeling mentally 'foggy' or slowed down
Difficulty finding the right words
Emotional/Behavioural Symptoms:
Irritability
Sadness
Anxiety
Increased emotionality
Changes in personality
Sleep Disturbances:
Sleeping more than usual
Difficulty falling asleep
Difficulty staying asleep
It's crucial to be aware of these signs and symptoms and to report any suspected concussion immediately. Athletes, coaches, parents, and medical personnel all play a vital role in concussion recognition.
2. Immediate On-Field Assessment
When a concussion is suspected, an immediate on-field assessment is critical. The primary goal is to remove the athlete from play and prevent further injury. Here's a step-by-step approach:
- Remove the Athlete from Play: If an athlete exhibits any signs or symptoms of a concussion, they should be immediately removed from the game or practice. "When in doubt, sit them out." This is a crucial principle to prevent further harm.
- First Aid: Ensure the athlete's safety and provide basic first aid if necessary. Check for any other injuries that may require immediate medical attention.
- Observe and Monitor: Carefully observe the athlete for any changes in their condition. Monitor their level of consciousness, breathing, and any other concerning signs.
- Ask Key Questions: If the athlete is conscious, ask them questions to assess their orientation, memory, and cognitive function. Examples include:
"What is your name?"
"Where are you?"
"What time is it?"
"Who are we playing against?"
"What happened?"
- Brief Neurological Assessment (if trained): If you are a trained medical professional, you may perform a brief neurological assessment, including:
Balance testing
Coordination testing
Eye movement assessment
- Communicate with Medical Personnel: Inform the team physician, athletic trainer, or other qualified medical professional about the suspected concussion and the athlete's condition. They will provide further guidance and arrange for a more comprehensive medical evaluation.
- Do Not Allow Return to Play: Under no circumstances should an athlete return to play on the same day if a concussion is suspected. This is a non-negotiable rule to protect the athlete's brain.
3. Medical Evaluation and Diagnosis
A comprehensive medical evaluation by a qualified healthcare professional is essential for diagnosing a concussion and determining the appropriate course of treatment. This evaluation typically includes:
Medical History: The healthcare provider will ask about the athlete's medical history, including any previous concussions or other medical conditions.
Symptom Evaluation: A detailed assessment of the athlete's symptoms, including their severity and duration.
Neurological Examination: A thorough neurological examination to assess cognitive function, balance, coordination, reflexes, and sensory function.
Neuropsychological Testing (Optional): In some cases, neuropsychological testing may be used to assess cognitive function in more detail. This testing can help identify specific cognitive deficits and track recovery over time. Baseline testing, completed before the season starts, can be helpful for comparison. You can learn more about Sportinginjuries and our services for more information on baseline testing.
Imaging Studies (Rare): Imaging studies, such as CT scans or MRIs, are typically not required for diagnosing a concussion. However, they may be ordered if there are concerns about more serious brain injuries, such as bleeding or swelling.
Based on the evaluation, the healthcare provider will make a diagnosis and develop a personalised treatment plan. This plan will typically include rest, symptom management, and a gradual return-to-play protocol.
4. Return-to-Play Protocol
The return-to-play (RTP) protocol is a stepwise process that allows athletes to gradually return to activity after a concussion. It is crucial to follow this protocol under the supervision of a healthcare professional to minimise the risk of re-injury. A typical RTP protocol involves the following stages:
- Rest: Complete physical and cognitive rest is essential in the initial stages of recovery. This means avoiding activities that could worsen symptoms, such as sports, exercise, schoolwork, and screen time.
- Symptom-Limited Activity: Once the athlete is symptom-free at rest, they can begin light activities that do not provoke symptoms. Examples include walking or light stretching.
- Light Aerobic Exercise: If symptom-free with light activity, the athlete can progress to light aerobic exercise, such as jogging or stationary cycling. The intensity and duration of exercise should be gradually increased.
- Sport-Specific Exercise: The athlete can begin sport-specific exercises, such as drills and agility training. These exercises should be performed at a low intensity and gradually increased.
- Non-Contact Training Drills: The athlete can participate in non-contact training drills with their team. This allows them to practice their skills and gradually increase their activity level.
- Full Contact Practice: After being cleared by a healthcare professional, the athlete can participate in full-contact practice. This is the final step before returning to competition.
- Return to Play: If the athlete remains symptom-free throughout the RTP protocol, they can return to competition. It's important to continue monitoring for any delayed symptoms.
Each stage of the RTP protocol should last at least 24 hours. If symptoms return at any stage, the athlete should return to the previous stage and rest until symptom-free again. The entire process typically takes several days or weeks, depending on the severity of the concussion and the individual's recovery rate. It's important to remember that there is no one-size-fits-all approach to RTP, and the protocol should be individualised based on the athlete's needs. If you have frequently asked questions about this protocol, please contact us.
5. Long-Term Considerations and Potential Complications
While most athletes recover fully from a concussion, some may experience long-term complications. These complications can include:
Post-Concussion Syndrome (PCS): PCS is a condition in which concussion symptoms persist for weeks, months, or even years after the initial injury. Symptoms can include headache, dizziness, fatigue, cognitive difficulties, and emotional problems.
Second Impact Syndrome (SIS): SIS is a rare but potentially fatal condition that occurs when an athlete sustains a second concussion before fully recovering from the first. This can lead to rapid brain swelling and death.
Chronic Traumatic Encephalopathy (CTE): CTE is a progressive degenerative brain disease associated with repeated head trauma. It is characterised by cognitive, behavioural, and emotional problems. While CTE is primarily associated with contact sports, it can also occur in individuals with a history of multiple concussions from other causes.
To minimise the risk of long-term complications, it's crucial to properly manage concussions and ensure that athletes fully recover before returning to play. This includes following a strict RTP protocol and seeking medical attention for any persistent symptoms.
6. Preventing Concussions in Sport
Preventing concussions is the best way to protect athletes from the potential short-term and long-term consequences of this injury. Here are some strategies for concussion prevention:
Proper Technique: Teach athletes proper techniques for tackling, blocking, and other activities that can lead to head injuries. Emphasise the importance of avoiding head contact.
Protective Equipment: Ensure that athletes wear properly fitted and well-maintained protective equipment, such as helmets and mouthguards. While helmets can help reduce the risk of skull fractures, they do not completely prevent concussions.
Rule Changes: Implement and enforce rules that prohibit dangerous play, such as head-to-head contact and late hits.
Education: Educate athletes, coaches, parents, and medical personnel about the signs and symptoms of concussion and the importance of proper management. This includes understanding the risks and benefits of playing sports and making informed decisions about participation.
Strength and Conditioning: Implement strength and conditioning programs that focus on neck strength and stability. A stronger neck can help reduce the impact of head trauma.
Fair Play: Promote a culture of fair play and respect for opponents. Encourage athletes to avoid unnecessary risks and to prioritise safety over winning.
By implementing these strategies, we can create a safer sporting environment for athletes and reduce the incidence of concussions. Remember, prioritising athlete safety is paramount. If you are interested in what we offer in terms of concussion management, please contact us.