What is a Concussion?
A concussion is a traumatic head injury resulting in a temporary disturbance of brain function. It is caused by a direct bump or blow, or an indirect jolt to the head from a knock to another part of the body. In other words, you don't have to be hit on the head to become concussed!
You don't have to be playing a sport to get a diagnosis of concussion.
Who is most at risk of concussion?
Although it may seem to be synonymous with partaking in some sports anyone can get a concussion. Specifically, children, adolescents and females -
- appear to be more susceptible
- take longer to recover
- report more symptoms
- and, in the case of the young, are more susceptible to rare complications like death from a single or second impact whilst suffering from symptoms of concussion.
Less than 10% of concussion cases involves loss of concsiousness.
How do I know it's a concussion?
Diagnosing a concussion is not always straight forward and I don't expect the majority of you out there who are not medically trained to make such a call. It is important though that if you see your friend, student, child, teammate present with any of the following you should be able to recognise that something is wrong and either remove them or tell someone who can remove them from further harm's way: RECOGNISE AND REMOVE.
I think it is now common knowledge but it is always worth repeating the fact you don't have to have lost consciousness to be diagnosed with a concussion, so if you see a mechanism that you think may cause the injury, like two heads colliding in a header (soccer), or a person getting up slowly having fallen headfirst off the top of a climbing frame, have an index of suspicion. A concussion can affect your memory, judgement, speech, balance and coordination. Common symptoms include:
- Headache
- Dizziness and/or trouble with balance
- Feeling sick or vomiting (early on)
- Difficulty concentrating
- Problem with your memory - forgetful or difficulty remembering
- Easily irritated by bright lights or noise
- Feeling more tired than usual
- Very commonly you may simply not feel right or feel like you're in a fog.
When should you seek urgent medical care?
A concussion is regarded as a mild traumatic brain injury that most people recover quickly and completely from. Unfortunately, during the early stages, it can be difficult to tell a concussion apart from a more severe brain injury.
You should go to your nearest Emergency Department or call 999 if you have any of the following, or are caring for someone, following a head injury:
- A severe or worsening headache
- Slurred speech
- Weakness, tingling, numbness or decreased coordination in the arms or legs
- Seizures or convulsions
- Loss of consciousness - after the initial injury
- Difficulty waking up
- Double vision
- Continuous vomiting
The HEADCASE (England Rugby) animation provides an overview of what concussion is and how it should be managed. It provides useful information for young people and adults (coaches, parents, teachers etc ) on how they can support a person with a suspected concussion.
What is Post-Concussion Syndrome?
You are said to be suffering from prolonged recovery or post-concussion syndrome if your symptoms have not settled by 3-4 weeks. Over 95% of patients would have recovered by this time.
Post-concussion syndrome is a bit of a misnomer because it assumes it is one diagnosis. Unfortunately, there are a number of things that can be disrupted by mechanical forces that may prolong your recovery:
- You can have a post-traumatic headache/migraine
- Vestibular/neuro-ophthalmic (balance controller) disturbance
- an autonomic nervous system disturbance. This may present as symptoms coming on when you raise your heart rate
- or, if it goes on long enough it can result in you developing a mood disorder.
It is important that you are seen by a specialist or multi-disciplinary team experienced at managing complex/prolonged concussions early as each one of these problems can be treated aggressively.
Frequently asked questions:
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Is it ok to watch television or use my phone if I have a concussion?
The latest evidence shows that abstaining from screen time in the first 24-48 hours of getting a concussion for children aged 10-19 years is associated with a shorter duration of symptoms. That means no phones, screens, total cognitive and physical rest for the first 2 days before returning to school or work.
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If someone is concussed should I stop them falling asleep?
You should not stop someone from sleeping if they are concussed. Drowsiness is one of the symptoms and is the brain's way of using fewer resources whilst trying to recover.
They should be kept under the supervision of a responsible person for the first 2 days, check that they are easily roused/easy to wake up and check that their symptoms are not worsening (see above). If you are concerned at all then call the NHS medical advice line on 111 (in the UK).
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How soon can I return to playing after a concussion?
Assuming you have an uncomplicated recovery process the current earliest return to sport for:
Adults in 14 days
age 19 and below in 23 days
These apply to the community/grassroots settings in case you are wondering why elite athletes are able to return in 7 days (now 12 days in the AFL). Professional sports can provide an Enhanced Care Pathway by having greater resources and tighter supervision of players. Saying that there is a likelihood that the return-to-play protocol will be extended to 10 days following the next International Conference on Concussion in Sports.
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How many concussions is too many in one season?
There is no evidence of a cut off for how many times you can get concussed in one season, BUT different sport governing bodies will mandate a number (usually 2 or 3) that should trigger further assessment by a multi-disciplinary concussion clinic. Check your sport governing body recommendation.
The decision to escalate to see a specialist service or to stop playing is unique to each individual. Factors that influence the decision include:
- number of concussions
- decreasing interval/how soon after a previous episode did you get the next one
- how long it takes you to recover from each episode
- how bad your symptoms are each time
- decreasing threshold/how easy is it to get a concussion
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Is it ok to exercise with a concussion?
If you sustain a concussion you should NOT return to sport on the same day and it is important you get assessed by a medical professional.
The current recommendation is that you have at least 48 hours of physical and cognitive rest before resuming any form of activity.
The latest evidence, as of September 2021, states that doing aerobic exercise for 20 minutes each day at a level that does not provoke your symptoms can reduce your risk of developing post-concussion symptoms by 48%. I would recommend speaking to a health professional first though to make sure this is appropriate for you.
If you have sustained a head injury it is recommended you seek medical care to confirm a diagnosis and get guidance on how to safely return to school, work or sports.
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