It’s the time of year when many players in all sporting codes take to the field. Some of these players will suffer a knock to the head or face, or fall heavily and sustain a concussion. Confusion exists as to what a concussion actually is and how it should be managed. Can someone be concussed if they haven’t lost consciousness? Should they be allowed to play on? And how long before the injured player can safely resume sport?
Concussion is a relatively frequent injury arising as a consequence of contact sport or falls, and is often poorly understood and managed. The outcome of repeated or poorly managed traumatic head injury can be serious and long term. This is particularly true for children and adolescents who may return to sport too early following a concussion, and who may suffer long term physical and learning consequences as a result.
Concussion is defined as a disturbance of brain function as a consequence of a direct or indirect blow to the head. It results in a variety of non- specific symptoms (such as those listed) and often does not involve a loss of consciousness. Concussion should be suspected in the presence of one or more of the following
– Symptoms (headache) or
– Physical signs (such as unsteadiness) or
– Impaired brain function (confusion) or
– Abnormal behaviour
Any athlete with a suspected concussion should be REMOVED FROM PLAY, medically assessed, monitored for deterioration (i.e. should not be left alone) and should not drive a motor vehicle.
(Taken from SCAT2 –Sport Concussion Assessment Tool).
These symptoms may last for a short time only, but if present, indicate that the player should not return to play.
Most (80-90%) concussions resolve within 7-10 days, although this time frame may be longer in children and adolescents. Recovery requires physical and “cognitive” (activities requiring brain concentration and attention) rest. This may mean some days off school or work and refraining from activities such as text messaging and playing video games. More serious concussions may require specialised medical testing and retesting to determine recovery and return to activity timeframes. It is important to realise that previous concussion makes you more susceptible and vulnerable if you receive a further injury. Return to sport before concussion symptoms have completely resolved puts you at risk of suffering a serious or potentially life threatening consequence if you suffer a further injury.
Return to sport will vary between individuals and be determined by the extent of the injury, whether this is the first episode of concussion, and how rapidly symptoms resolve. Current ACC and NZRU guidelines recommend a minimum of 3 weeks stand down from sport after concussion. This period should allow sufficient time for the resolution of symptoms in most concussions. However, should symptoms persist after this period of time further medical advice should be sought before return to sport.
The guidelines outlined in the following table (from Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, Br J Sports Med 2009;43:i76-i84 P McCrory , W Meeuwisse , J Dvorak , M Aubry , M Molloy , R Cantu ) provide a stepwise progression to guide return to sport. The player should proceed to the next level of activity only when he/she experiences no symptoms at the previous level. If symptoms are present the player should drop back to the previous level. The player should not return to contact sport until completely symptom free. This is especially important for children and adolescents, and the time frame for recovery in these players may be longer than for adults.