Concussion: What Does It Look Like? How Do You Treat It?

Over recent years, concussion in sports has been a controversial topic of discussion. Concussion can be defined as a pathophysiological process affecting the brain, induced by biomechanical forces. Concussions may be caused either by a direct hit to the head, face, neck or anywhere else on the body where an impulsive force is transmitted to the head. Concussions are characterized by a rapid onset of impairment to neurological functioning that are relatively short-lived, however, in some cases symptoms may persist for longer. Since concussions are a form of brain injury, it is important that they are treated as such, and are taken seriously in the context of sports, a domain in which athletes are suffering concussions on a daily basis.
Proper treatment is often neglected for a player to get back on the ice, field or court, and concussion treatment then falls to the wayside. Unfortunately, this lack of immediate treatment can result in serious long-term neurological effects and impairments to their athletic career.

During the 4th International Conference on Concussion in Sport held in Zurich in 2012, a consensus statement was developed which provides  a comprehensive, evidence-based approach to recognition and management of concussions. The statement claims that with proper detection and evaluation, concussions can have a relatively short recovery period spanning from 7 to 10 days. That being said, this is only the case if concussions are detected fast enough, and are evaluated properly. Proper evaluation involves a variety of steps including on-field evaluation at the time of the incident, evaluation in the emergency room, investigations, and a neuropsychological assessment.

Most importantly, the consensus emphasizes that physical and cognitive rest are essential to the recovery process. Therefore, a concussed player’s return to physical exercise and play should be a gradual process as returning to the same level of intensity all at once can be very detrimental to the recovery process.

As a parent, coach or healthcare professional involved with an athlete’s injury, it is very important to be aware of these suggestions and to keep in mind that the appearance of symptoms or cognitive deficits may be delayed for several hours following the onset of a concussion.

WHAT TO DO IF YOU HAVE HAD A CONCUSSION?

BRAIN INJURY ADVICE CARD (SHORT VERSION)

Information included on this advice card was adapted from the Guidelines for Mild Traumatic Brain Injury
following a Closed Head Injury (New South Wales Motor Accident Authority, 2008) and the Information
about Mild Head Injury or Concussion booklet (Ponsford, Willmott, Nelms & Curran, 2004).

Important Points about Mild Brain Injury

• You had a mild brain injury or what is sometimes called a concussion. Most people recover quickly following a mild brain injury. A few people may experience symptoms over a longer period.
• There is a small risk of you developing serious complications so you should be watched closely by another adult for 24 hours after the accident.
• Please read the following. It outlines what signs to look for after a brain injury and what you need to do if you have problems.

 Warning Signs

If you show any of these symptoms or signs after your brain injury, or you get worse, go to the nearest hospital, doctor or call 911 immediately.

• Fainting or blacking out, drowsiness, or can’t be woken up
• A constant severe headache or a headache that gets worse
• Vomiting or throwing up more than twice
• Cannot remember new events, recognise people or places (increased confusion)
• Acting strange, saying things that do not make sense (change in behaviour)
• Having a seizure (any jerking of the body or limbs)
• Inability to move parts of your body, weakness in arms or legs, or clumsiness
• Blurred vision or slurred speech
• Being unsteady on your feet or loss of balance
• Continual fluid or bleeding from the ear or nose

The First 24-48 Hours after Injury

• Warning Signs: You should be observed and return to hospital if you develop any of the above warning signs.
• Rest/Sleeping: Rest (both physical and mental) and avoid strenuous activity for at least 24 hours. It is alright for you to sleep tonight but you should be checked every four hours by someone to make sure you are alright.
• Driving: Do not drive for at least 24 hours. You should not drive until you feel much better and can concentrate properly. Talk to your doctor.
• Drinking/Drugs: Do not drink alcohol or take sleeping pills or recreational drugs in the next 48 hours. All of these can make you feel worse. They also make it hard for other people to tell whether the injury is affecting you or not.
• Pain Relief: Use acetaminophen or acetaminophen/codeine for headaches. Do not use aspirin or anti inflammatory pain relievers such as ibuprofen or naproxen (NSAIDs), which may increase the risk of complications.
• Sports: Do not play sports for at least 24 hours.

See your local doctor if you are not starting to feel better within a few days of your injury.

 52 Guidelines for mTBI and Persistent Symptoms

The First 4 Weeks after Injury

You may have some common effects from the brain injury which usually resolve in several weeks to three months. These are called post concussion symptoms. Tiredness can exaggerate the symptoms. Return to your normal activities gradually (not all at once) during the first weeks or months.

You can help yourself get better by:

• Rest/Sleeping: Your brain needs time to recover. It is important to get adequate amounts of sleep as you may feel more tired than normal and you need to get adequate amounts of both physical and mental rest.
• Driving: Do not drive or operate machinery until you feel much better and can concentrate properly. Talk to your doctor.
• Drinking/Drugs: Do not drink alcohol or use recreational drugs until you are fully recovered. They will make you feel much worse. Do not take medication unless advised by your doctor.
• Work/Study: You may need to take time off work or study until you can concentrate better. Most people need a day or two off work but are back full time in less than 2 weeks. How much time you need off work or study will depend on the type of job you do. See your doctor and let your employer or teachers know if you are having problems at work or with study. You may need to return to study or work gradually.
• Sport/Lifestyle: It is dangerous for the brain to be injured again if it has not recovered from the first injury. Talk to your doctor about the steps you need to take to gradually increase sports activity and return to play. If in doubt, sit out.
• Relationships: Sometimes your symptoms will affect your relationship with family and friends. You may suffer irritability and mood swings. See your doctor if you or your family are worried.

Recovery

• You should start to feel better within a few days and be ‘back to normal’ within about 4 weeks. See your local doctor if you are not starting to feel better.
• Your doctor will monitor these symptoms and may refer you to a specialist if you do not improve over 4 weeks up to 3 months.

Sources

Information included on this advice card was adapted from the Guidelines for Mild Traumatic Brain Injury following a Closed Head Injury (New South Wales Motor Accident Authority, 2008) and the Information about Mild Head Injury or Concussion booklet (Ponsford, Willmott, Nelms & Curran, 2004).

Kolt, Gregory S. Concussion in Sport. Journal of Science and Medicine in Sport (2013)
Schwenk, Thomas L. Updated Expert Guidelines on Risks for and Management of Sports Concussion, 2013
McCrory Paul. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich. 2013