Concussion: the importance of identifying it

Concussions in sport have received a lot of media attention in recent years. Fortunately, more and more research is being carried out on the subject, and health professionals are learning more about it(1). This growing concern is a consequence of recent discoveries concerning the potentially harmful long-term repercussions of concussions (2-10). To minimize these harmful effects, it’s vital to be able to identify concussion when it occurs. To do this, you need to know what a concussion is.

Concussion is a clinical diagnosis based on observation of the injury mechanism and certain signs and symptoms. More specifically, it is a dysfunction in neuronal metabolism and microscopic brain anatomy following impact(12,14). In short, the movement of the brain within the skull, which is not necessarily secondary to a blow to the head, leads to metabolic changes that can result in an amalgam of signs and symptoms such as (11):

• Headache
• “Pressure in the skull
• Neck pain
• Nausea or vomiting
• Dizziness
• Blurred vision
• Balance problem
• Light sensitivity
• Noise sensitivity
• Feeling slowed down
• A feeling of being “in the fog
• Not feeling normal
• Concentration problems
• Memory problems
• Fatigue or no energy
• Confusion
• Sleepiness
• Difficulty falling asleep
• Increased emotionality
• Irritability
• Sadness
• Nervousness or anxiety

As soon as it is suspected that a player has suffered a concussion, he or she should be removed from the game and assessed by a medical professional(11). The duration of symptoms can range from a few minutes to a few months, but can also be longer in some cases(12). Symptoms may appear immediately or several minutes after the trauma(12,13), sometimes making management more difficult.

It is important to understand that no return to play is permitted on the day of the incident, even if the symptoms have been resolved. The return-to-play protocol should be guided by one or more healthcare professionals. It should be progressive and follow different stages depending on the evolution of symptoms and the athlete’s particularities(11).

In short, it’s vital to identify concussion when it occurs. Remember, when in doubt, err on the side of caution. Some simple tools, such as the Scat 3 and Scat 3 for children, have been designed to assess concussion and are available free of charge online.

Written by Maxime Provencher, M. Physiotherapy

References :
1. Halstead ME, Walter KD, Council on Sports M, Fitness. American Academy of Pediatrics. Clinical report-sport-related concussion in children and adolescents. Pediatrics. 2010;126(3):597-615.
2. Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, et al. Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players. American Medical Association. 2003;290(19):7.
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11. McCrory P, Meeuwisse WH, Aubry M, Cantu R, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport, the 4th Internation Conference on Concussion in Sport held in Zurich, November 2012. British journal of sports medicine. 2013;47(5):250-8.
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13. McCrea M, Guskiewiez KM, Marshall SW, Barr W, Randolph C, Cantu RC, et al. Acute Effects and Recovery Time Following Concussion in Collegiate Football Players. Journal of the American Medical
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15. Provencher M, Desloges C & Frémont P. The impact of a structured protocol for the follow-up of concussions in young high school soccer players in the Quebec City region. Unpublished essay submitted to the Faculty of Graduate Studies, Université Laval, as part of the Master’s program in physiotherapy for the Master’s degree (M. en physiothérapie).