Concussion Management


What is Concussion?

A concussion is the most common form of brain injury and should be taken seriously. It can be caused either by direct contact to the head, or an impact to another part of the body resulting in rapid movement of the brain inside the skull. 


The sudden force causes some brain cells to stop working properly. This results in symptoms that can last for a variable amount of time. Sometimes symptoms are only brief and resolve quickly, but then return a few hours or even days later. This is where the challenge lies to recognise the injury as soon as it happens and be removed from further physical activity immediately. Studies show that continued physical exertion after a concussion prolongs recovery by weeks or even months. These long-term symptoms can include headaches, dizziness, anxiety, sleep disturbance, impaired memory and concentration problems. 


Less than 10% of concussions involve a loss of consciousness (being 'knocked out'). This leaves 90% of concussions to be detected by an onlooker or reported by the individual. This can sometimes be challenging if initial symptoms are subtle or short-lived. 


Here is a list of the most common concussion symptoms: being slow to get up from the ground, unsteady on your feet, feeling dazed, ‘seeing stars’, having a blank expression, difficulty remembering, sensitivity to light or sound, headache, nausea, dizziness, blurred vision, feeling slowed down, difficulty concentrating, drowsiness, irritability, sadness, anxiousness, brief loss of consciousness and sleep disturbances. No two concussions are the same - some concussions may have just one or two symptoms while others may have several more. 


What symptoms you feel depends on what part of the brain has been injured. Injury occurs at a microscopic level, so it is unlike a broken arm, or other injuries that you can feel with your hands or see on an X-ray. It is a temporary disruption of how the brain works at a cellular level. It is not a bruise to the brain, which is why brain CT scans and MRI scans are normal with concussion. 

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In sport, there will often be a reluctance on the part of an athlete to stop play after a knock to the head, particularly when the symptoms are subtle, and the rest of the body feels normal. In addition, a head injury impairs a player’s decision making ability in this regard. The decision must therefore be taken out of the athlete’s hands. It is the responsibility of the coach, parent, referee, physiotherapist or team doctor to detect the signs of a head injury following a hard knock, rest these players immediately and ensure they see a doctor knowledgeable in concussion management. 


The brain is also more susceptible to further injury while recovering from a concussion. A second head injury soon after an initial one can result in permanent brain damage or even ‘second impact syndrome’, a severe brain swelling which is usually fatal. This is why all athletes should be immediately removed from play if a concussion is suspected, and cleared medically before returning to sport, only after being fully assessed and rehabilitated. Returning to sport before full recovery leads to a higher risk of repeated or prolonged concussions which can occur at lower impacts than the original one. Such repeated concussions can shorten an athlete’s playing career, and may lead to longer-term neurological problems.


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