Concussion Information for Athletes

The following summary is based on “Concussion Information for Athletes” by Dr. Karen Johnson et al. The full article appears on the ThinkFirst-SportSmart Concussion Education and Awareness Program.

What is a Concussion?

A concussion can be defined as any alteration in brain function resulting from a blow to the head. It may or may not involve a loss of consciousness.

It can be caused by a direct hit to the head  (falling onto the ice) or an indirect hit (the head being “whip lashed” by a check to the body).

When an athlete suffers a blow to the head, the brain can shift inside the skull and knock against the skull's bony surfaces. This can temporarily alter the function of brain cells, leaving them in a vulnerable state. In the minutes to days following a concussion, the brain is more susceptible to a second head injury.

How do concussions occur?

Most concussions occur when the person is moving at a high rate of speed and collides with another object such as boards, an opponent or the ground.

Symptoms and Signs of a Concussion

There may be many different kinds of symptoms.

Some may appear right away and some may show up later. Some may be subtle and may go unnoticed by the athlete, team medical staff or coaches.

Most concussions occur without a loss of consciousness (LOC). If LOC occurs professional help should be sought immediately.

Symptoms:
• Nausea, vomiting
• Dizziness
• Confusion
• Fatigue
• Lightheadedness
• Headaches
• Irritability
• Disorientation
• Seeing bright lights or stars
• Feeling of being stunned
• Depression

Signs:
• Difficulty concentrating
• Inappropriate playing behaviour
• Decreased playing ability
• Inability to perform daily activities
• Reduced attention
• Cognitive and memory dysfunction
• Sleep disturbances
• Vacant stare
• Loss of bowel and bladder control

Other more “vague” symptoms: “head rush”, “lack of focus”, mood changes, feeling “slowed down” and feeling “not myself”.

What should you do if you think a player has had a concussion?

Seek medical advice if a person has symptoms and/or signs of a concussion after a blow to the head or body. Without proper management, a concussion can result in permanent problems and seriously affect one’s quality of life.

If you think you have had a concussion, tell a family member, friend, teammate, or coach. 

Screening and Diagnosis:
Diagnosing a concussion may take several steps.

Your doctor will ask questions about the most recent injury and previous concussions.

He will conduct a neurological exam, which can include checking your memory and concentration, vision, coordination, reflexes and balance.

He may request further tests such as a CT scan or an MRI. (In most concussions these tests will be normal).

Neuropsychological testing may be done if available. It is becoming more valuable and may help identify subtle memory and concentration problems. It may also help with return to play decisions

Ideally, neuropsychological testing will be done as a “baseline” at the time of preseason medicals.

When should an athlete return to play?

A concussed athlete should be removed from play immediately and be assessed by a medical doctor.

Symptoms may worsen as the day passes. Under NO circumstances should a player with a concussion be allowed to return to competition that day.

When concussed, a player’s decision-making may not reflect the best judgment!

Post-concussive symptoms may increase with activity so it is important that return to play be gradual.

Return to Play Steps:

A medical doctor should give the player clearance to return to activity. There should be no return to play if any symptoms or signs persist.

The return to play process begins after all the symptoms have resolved and involves a gradual increase in the intensity of exercise. If any symptoms/signs recur during the process, the player must be re-evaluated by a physician.

Remember, symptoms may return later that day or the next, not necessarily when exercising!

Step 1. No activity, only complete rest. Proceed to step 2 only when symptoms are gone.

Step 2. Light aerobic exercise, such as walking or stationary cycling. No resistance training or weight lifting.

Progress to increased intensity and duration as tolerated.

Step 3. Sport specific activities and training (e.g. skating).

Step 4. Drills without body contact.

Light resistance training may be added at Step 3 or 4 progressing to heavier weights as tolerated.

**The time needed to progress from non-contact to contact exercise will vary with the severity of the concussion and the player. Go to Step 5 after medical clearance.

Step 5. Begin drills with body contact.

Step 6. Game play.

**Note: Players should proceed to the next steps only when they do not experience symptoms or signs. Remember these are steps, not days!

It may take more than one day to progress from one step to the next especially if symptoms have lasted for a while.

If symptoms or signs return, the player should return to the previous step, and be re-evaluated by a physician. Never return to play if symptoms persist!