You can never be too careful! Symptoms may actually be worse later the same day of an injury or even the next day.
It is important to tell a family member, friend, teammate, trainer or coach if you think you have had a concussion. Memory loss or amnesia associated with the trauma is one hallmark of a concussion and some people may forget that they were injured until after the diagnosis is established.
1. What is a Concussion?
A concussion is the most common form of head injury suffered by athletes. A concussion can be caused by a direct or indirect hit to the head or body (for example, a hard tackle or check).
This causes a change in brain function which results in a variety of symptoms (see below). With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans appear normal.
2. What actually happens?
When an athlete suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull’s bony surface. A hard hit to the body can result in an acceleration/ deceleration injury when the brain brushes against bony protuberances inside the skull. Such forces can also result in a rotational injury in which the brain twists, potentially causing shearing of the brain nerve fibres.
In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself but the abnormality causes functional damage of the brain cells, i.e. how they work.
The exact length of this period is unclear, but the brain temporarily does not function normally and during this time it is more vulnerable to a second head injury.
3. How do concussions occur?
Most concussions occur as a result of a collision with another object while the person is moving at a high rate of speed. When the person comes into sudden contact with arena glass or boards, opponent, stick or the ground direct trauma may result. Forces such as these (and others) can result in deceleration and rotational concussive injuries.
4. Who to tell?
It is extremely important to seek medical advice after any blow to the head or body in which you suffer signs and symptoms of a concussion. Often, concussions in athletes can go untreated (and even unnoticed by others) because few symptoms are visible to casual observers. Many times the symptoms of a concussion may not be identified until the athlete recovers to the point where increased exertion causes symptoms to worsen. In fact, 4 out of 5 professional athletes do not even know that they have been concussed (Delaney et al, CJSM 2001)
Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive and emotional changes.
You can never be too careful! Symptoms may actually be worse
later the same day of an injury or even the next day.
Athletes may be reluctant to report symptoms of concussion because of a fear that they will be removed from the game, or that it may jeopardize their status on a team or adversely affect promising careers. But, it is important to consider the permanent repercussions of a concussion.
Without proper management, a concussion can result in permanent problems and seriously affect one’s quality of life.
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It is important to tell a family member, friend, teammate, trainer or coach if you think you have had a concussion. Memory loss or amnesia associated with the trauma is one hallmark of a concussion and some people may forget that they were injured until after the diagnosis is established. However if the athlete is aware of the signs of concussion, informing someone will help assure proper medical care. If you think you have had a concussion, you should immediately remove yourself from the game or practice.
5. Symptoms of a concussion
Following a concussion the athlete may experience many different kinds of symptoms.
Contrary to popular belief most concussions occur without a loss of consciousness (LOC). It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. It is important to remember that some symptoms may appear right away and some may show up later. Symptoms may be a little different for everyone although certain combinations of symptoms classically occur. Some may be subtle and may go unnoticed by the athlete, team medical staff or coaches. Also, some symptoms may be attributed to any accompanying neck strain, scalp bruises and other injuries, not just the brain injury. **LOC is not necessary for the diagnosis of a concussion, but if it occurs there should be professional help called immediately.Some symptoms and signs include:
Symptoms Signs• Nausea, vomiting
• Light headedness
• Seeing bright lights or stars
• Feeling of being stunned
• 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 that are described include “head rush”, “lack of focus”, mood changes, feeling “slowed down” and feeling “not myself”.
6. Screening and Diagnosis
Concussion is a common occurrence and usually resolves uneventfully. A concussion always has the potential to cause serious harm and always needs to be checked by a medical doctor.
If symptoms are not gone in 10 days (simple concussion), further consultation by a concussion expert is recommended (complex concussion).
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A number of concussion-grading systems have been proposed but consensus is that none can be supported or endorsed because none are based on scientific evidence. Severity is probably impacted by a number of factors. For example severity may be impacted by the athlete’s history of previous head injuries. These may lead to a different, slower recovery, which is why concussion history should always be monitored. Return to exertional activity or play while still concussed and symptomatic may also prolong recovery.
Diagnosing a concussion may take several steps. Your doctor may ask questions about your concussion and sport history, the most recent injury and will conduct a neurological exam. This can include checking your memory and concentration, vision, coordination, reflexes and balance. Your doctor may request further tests:
Computerized Tomography (CT scan
Magnetic Resonance Imaging (MRI) –
More important is the role of neuropsychological testing. This testing may identify subtle cognitive (i.e. memory, concentration) problems caused by the concussion and may at times help to contribute to return to play decisions. In addition, balance testing may be required.
Ideally, neuropsychological and balance testing should have been done in “baseline” in your preseason medicals for good comparison.
7. When should I return to play?
A concussed athlete will be removed from play immediately and should be assessed by a medical doctor. Under NO circumstances should a player be returned to competition when concussed. Because symptoms may worsen later that night and next day, you should not return to the current game or practice. When concussed, your decision-making about this may not reflect the best judgment! Post-concussive symptoms may increase with increase in activity so it is important that return to play is gradual.
An MRI uses magnetic fields and radio waves to generate images of the brain. The athlete lies inside a cylindrical machine for 15-60 minutes while images are made. This technique is also painless. In the majority of sport related concussions there will not be any obvious damage found on these tests. At times they can be important to assess for other skull or brain injury but in general they currently have little to add to concussion management.)- CT is fast, patient friendly and has the ability to image a combination of soft tissue, bone, and blood vessels. It is a sophisticated X-ray machine linked to a computer to produce detailed, two-dimensional images of the athlete’s brain. The athlete lies still on a movable table that is guided into a large X-ray machine where the images are taken. A CT scan is painless and usually takes around 10 minutes.