A Heads Up: Concussion in Sport

The risks and dangers of concussions are slowly becoming mainstream information in the public eye. It is important for anyone involved in sport to be aware of the risk, signs and symptoms, and management of an individual with concussion.

Thankfully, concussion has become a hot topic among medical and sporting people across the world over the past several years, and this has reverberated to the general sporting public. This article intends to give the reader a general guide to the identification, initial treatment, and return-to-play for someone who experiences concussion.

What is a concussion?

By definition, concussion is a traumatic brain injury, causing disruption of normal brain function following a direct or indirect force to the head. It is important to note that a concussion does not need to result from a direct trauma to the head. Indirect forces can include trauma to the body, causing enough force to affect the head and neck area. 

Symptoms arising from a concussion are discussed further below. Anyone involved in any level of sport (from amateur to elite) needs to be aware of the risks, signs and symptoms, and correct management of concussion.

How can you tell if someone has had a concussion?

There are a number of signs and symptoms that may present following a trauma. These include:

• headache
• dizziness
• nausea
• blurred vision
• slow to get up after impact
• unbalance and/or uncoordinated
• appear dazed and/or confused
• temporary loss of consciousness or "blacking out"
• irritability, anxiety, sadness

How is concussion managed?

It is important for a concussion to be properly managed, as improper management can lead to prolonged symptoms, increased risk of future concussions, psychological problems and brain damage.

If a concussion is suspected, the individual should be removed from activity immediately. This can be met by some resistance from coaches and other athletes, however allowing an individual to return to sport after a suspected concussion can lead to 'Second Impact Syndrome' - an increased susceptibility to a concussion following an initial incident. Contact does not need to be as forceful as the first incident for Second Impact Syndrome to occur. Thus, it is important to ensure that the individual is removed from activity if a concussion is suspected.

Immediate assessment can be conducted using the SCAT3 tool, which is readily available for downloading online. This tool asks a series of questions to evaluate a number of physical and psychological factors in the individual.

It is important to note that the use of the SCAT3 is to evaluate an individual in the initial stages, and is not a substitute for a medical assessment from a doctor if a concussion is indeed present. It is imperative that the confirmation of a concussion via the SCAT3 should lead directly to a referral to a medical practitioner to evaluate the severity of the incident, or whether a more significant injury has occurred. 

Assessment of a concussion should err on the side of caution, and the "in in doubt, sit them out" phrase should be used. If a concussion is confirmed using the SCAT3 tool, the individual must not return to activity under any circumstances.

Some symptoms of concussion may not present until a few hours after the initial incident. This, someone with concussion should not be left alone. It is important to organise for the individual to be driven back to their residence or accommodation, and be supervised by a friend or relative for the remainder of the day. 

Returning to activity following a concussion

Any individual diagnosed with a concussion must be given a medical clearance from a doctor before resuming any form of exercise. 

A general set of guidelines can be followed during the return-to-sport phase of concussion management. The individual should not participate in any form of physical activity until all symptoms have ceased for 24-48 hours. At this point, light aerobic activity may begin. The individual can gradually build up to sports-specific, non-contact, contact, and return-to-play stages respectively, with a 24-hour period separating each stage. Medical clearance should be granted before contact resumes. Individuals should remain symptom-free during this process. If symptoms occur, training should be regressed to the last point where no symptoms were present.

Things to remember

1. Concussion is a mild traumatic brain injury
2. Everyone involved in sport should be aware of the risk, signs and symptoms, and management of concussion
3. An individual with a suspected concussion should be removed from activity immediately, and a SCAT3 assessment should be given
4. An individual should not return to any form of physical activity until a medical clearance is granted and symptoms have ceased for 24-48 hours
5. Return-to-sport needs to be carefully monitored