CONCUSSIONS…

Over the past few years, concussions have been getting more medical (and media) attention. Fortunately, they are now taken more seriously, have been researched thoroughly, and there is much more information readily available.

So, what is a concussion and how should they be managed?

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WHAT IS A CONCUSSION?

 

Concussions have recently been redefined and are now classified as a traumatic brain injury. This is the same classification as a brain injury that is a result of a car accident (for example) and can be of varying severity.

 

A concussion…

  • Causes disturbances to brain function, which is reflected by the post-injury symptoms.
  • Occurs most commonly after impact to the head, but can also occur following injury to the neck, jaw and other areas of the body.
  • Can occur without loss of consciousness (ie. without a person being ‘knocked out), but if a person does lose consciousness they have a concussion.
  • May be symptomatic at the time of injury, however, symptoms may also take 24-48hours to develop.
  • Will resolve in most people with physical and mental rest.
  • In children and adolescents has potential to be more severe. Those under 18 are more susceptible to concussion, take longer to recover, and are more likely to have rare and dangerous complications.
  • That is ignored can be fatal.

SIGNS AND SYMPTOMS OF CONCUSSION

 

The signs and symptoms of a concussion vary person to person, however, if a person experiences any of the following, they must be taken to the nearest emergency department or an ambulance must be called.

 

  • Severe neck pain,
  • Deteriorating consciousness,
  • Increasing confusion or irritability,
  • Worsening headache,
  • Vomiting more than once,
  • Unusual or uncharacteristic behaviour,
  • Seizure (fitting),
  • Double vision, or
  • Weakness or tingling or burning in arms or legs.

 

Other signs and symptoms are described in the table below. Any person exhibiting any of the signs and/or symptoms must be assessed by a medical professional who has knowledge, understanding and experience in the management of concussions.

SIGNS (what may be seen) 
  • Dazed, blank or vacant look
  • Lying motionless on ground or slow to get up
  • Unsteady on feet, balance problems or falling over, uncoordinated
  • Loss of consciousness or unresponsive
  • Confused or not aware of plays or events
  • Grabbing or clutching of head
  • Seizure (fits)
  • More emotional, irritable than normal for that person
SYMPTOMS (what may be reported)
  • Headache
  • Dizziness
  • Mental clouding, confusion, or feeling slowed down
  • Visual problems
  • Nausea or vomiting
  • Fatigue
  • Drowsiness, feeling like “in a fog”, difficulty concentrating
  • “Pressure in head”
  • Sensitivity to light or noise
MEMORY (questions to ask)
  • “What venue are we at today?”
  • “Which half is it now?”
  • “Who scored last in this game?”
  • “What team did you play last week / game?”
  • “Did your team win the last game?”

MANAGEMENT OF CONCUSSION & RETURN TO SPORT

 

The first question a person often asks is ‘when can I play again?’. The answer will always be dependant on the severity of the concussion and the duration of symptoms that follow post injury. The table below outlines the safe return to sport procedure. Please note, a person must rest completely before they return to any form of exercise. For those 18 and over, there is a minimum rest period of one week. For those 18 and under there is a minimum rest period of two weeks.

STAGE EXERCISE EXAMPLE PROGRESSION
1 Rest Complete rest of the brain and body. This is dependant on the age of the person injured.  A person 18 and under MUST rest for at least two weeks prior to starting stage 2. A person over the age of 18 MUST rest for at least a week prior to starting stage 2.

All symptoms must resolve prior to progression to stage 2.

2 Light cardiovascular exercise Light jogging for 10-15 minutes, swimming or stationary cycling at low to moderate intensity.
No weights training.
If no symptoms, start Stage 3 after minimum of 24 hours.

If symptoms occur, rest 24 hours & repeat Stage 2.

3 Sport-specific exercise Individual running drills and skills without contact.
No weights training.
If no symptoms, start Stage 4 after minimum of 24 hours.

If symptoms occur, rest 24 hours & repeat Stage 2, then progress.

4 Sport specific non-contact training More complex training drills e.g. passing drills.May start progressive (low level) weights training. If no symptoms, review by a medical doctor and presentation of a medical certificate required before Stage 5.

If symptoms occur, rest 24 hours & repeat Stage 3, then progress.

5 Full practice Full contact practice following medical clearance. Certificate being handed to the club or school sport master. Player, coach, or parent to report any symptoms to a medical doctor.

If symptoms occur, then medical doctor to review.

6 Full game Full contact game. Monitor for recurring symptoms or signs.

IN SUMMARY…

 

A concussion is a traumatic brain injury and should be monitored and managed appropriately. For more information, please contact the clinic on (03) 5229 3911 or info@theinjuryclinic.com.au. Alternatively, follow the links below for the AFL, NRL and ARU guidelines.

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