Concussion is a form of traumatic brain injury that typically results from shaking of the brain within the skull. A loss of consciousness does not have to occur. Other symptoms include confusion, loss of memory, tiredness, headache, dizziness and poor balance which may occur immediately and last for minutes to weeks after the injury. In a sporting context the injured person may not appreciate the extent of the injury and feel as though they can play on, only to feel progressively worse during and after the game. It is important for players, coaches and parents to be able to recognise the signs and remove an injured person if in any doubt.
The condition isn’t considered life-threatening and is reversible, but concussion injuries should be taken seriously. Most sporting bodies today, especially those overseeing contact sports, have developed guidelines to minimise damage caused by concussion. A concussed individual should be removed from the field of play and evaluated. They should not return to play that day. Some exclude play for a period of time after the concussion, e.g. 2 weeks. Other sports have policies where players can be returned if a medical professional assesses them as having recovered.
Symptoms of concussion can be mild or severe, short-lived or prolonged. There does not have to be a loss of consciousness for symptoms to be severe or prolonged. In fact only 10% of concussion injuries cause loss of consciousness.
Symptoms of concussion include:
- Momentary loss of consciousness
- Poor balance
- Temporarily blurred vision
- Short-term memory loss
- Inability to concentrate
- Fatigue or sleepiness
Signs that a more serious brain injury, for example bleeding into the brain, might have occurred:
- Prolonged loss of consciousness
- Ongoing vomiting
- Persistent restlessness, agitation or confusion
- Inability to walk unassisted including loss of balance
- Seizures, convulsions or slurred speech
- Amnesia regarding a significant time period either before or after the incident
- Severe and prolonged headache
- Worsening symptoms
If any of these features are present, the player should be taken to the nearest hospital’s casualty department. An ambulance (000) should be called if there is prolonged loss of consciousness, fear of a neck injury or the situation is a worsening rapidly.
In mild cases, recovery is fast, although it’s still important to seek advice from your doctor in order to properly evaluate the situation. Accidents in contact sports are inevitable and qualified Sports and Exercise Medicine Physicians have become an essential component of team staff for professional sideline assessment.
On the field, a Doctor, trainer or other support person will first rule out the possibility of greater injury sustained as a result of the impact, such as skull, facial, neck, or spinal problems. After this, the player should be removed from the field of play and assessed properly for concussion. If a doctor is present, they will perform a specific concussion sideline test. If this is abnormal, the player should not be returned to play that day. If a trained professional is not available to do this sideline test, the player should not be returned to play that day.
The player should be assessed by an experienced doctor in the days following the concussion. They will exclude other forms of brain injury, test neurological function, perform a concussion tests, give advice regarding symptoms and create a plan for return to school or work, training and competition. Rest is the most important thing after having a concussion.
A full recovery usually occurs over a week or two, although in some cases this may take several weeks, even months. Some players seem to be prone to repeat episodes.
In most cases of non-professional sport, a simple approach to treating concussion is applicable:
- Assess the player for neck injury
- Remove the individual from the field of play
- Rest and observe
- Have an evaluation performed by a doctor or Sports and Exercise Medicine Physician in the days after the injury
- Return to activity or exercise should not take place until symptoms have resolved and the all-clear is given by a doctor qualified in concussion injuries.
Repeat concussions can involve slower recovery times and also have the potential to create ongoing health problems. In extreme cases when an individual is repeatedly concussed, the sport or activity may have to be given up entirely.
It is not clear that concussion is prevented by wearing protective headgear. Contact activities should also be played within safe guidelines while overseen by competent trainers and coaching staff. It is important that coaches, trainers and parents are educated about the signs and dangers of concussion. Player safety is paramount.
Our Sports and Exercise Medicine Physicians are the team doctors for many of Australia’s sporting teams and take pride in caring for the well-being of their patients. They can perform concussion tests and give best advice on planning to return to sport. Concussion is very real and should be taken seriously.