Concussions are considered the “invisible” injury, since they do not show up on medical imaging tests such as x-rays or CT scans. But they are also considered “invisible” because their effects are often misunderstood. The following resources are designed to help physicians, coaches, parents, and athletes understand and navigate the sometimes difficult process of recovery from concussions.
What is a Concussion?
Concussion is a brain injury. Any blow to the head, face, neck or to the body that causes a sudden shaking or jarring of the brain inside the skull may cause a concussion. A concussion can result from any number of activities including a collision of heads in soccer, receiving a check in hockey, falling from a jungle gym, bring in a motor vehicle collision or slipping on an icy sidewalk. You do not need to lose consciousness to have had a concussion.
What are the Signs and Symptoms?
Note: People with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.
Red Flags: If any of the following are reported, the player should be safely and immediately removed from the field. If no qualified medical professional is available, consider transporting by ambulance for urgent medical assessment:
- Athlete complains of neck pain
- Increasing confusion or irritability
- Repeated vomiting
- Seizure or convulsions
- Weakness or tingling/burning in arms or legs
- Deteriorating conscious state
- Severe or increasing headache
- Unusual behaviour change
- Double vision
Concussion Assessment Tools:
Concussion – Pocket Concussion Recognition Tool
Sport Concussion Assessment Tool (SCAT) for Children ages 5 to 12 years, 3rd Edition
Sport Concussion Assessment Tool (SCAT) for Children over 12 years, 3rd Edition
If you think you have had a concussion, you should immediately remove yourself from the current activity whether its sports, work or school. You should not drive and should seek medical attention. It is important to tell a family member, friend, co-worker, teammate, employer, trainer or coach if you think you have had a concussion.
If you suspect a player of having a concussion, remove the player from the sport or activity right away. They should not be left alone and should be assessed by a medical or health professional as soon as possible. Given that symptoms may worsen later that night or over the next day or two, the injured person should not return to their current activity levels. When concussed, their ability to assess their situation may be impaired.
How is it Treated?
The most important treatment is REST – both physical and mental. Adults and children should not play sports, exercise or participate in recreational activities such as bike riding. Cognitive, or mental rest, includes limiting activities that require mental concentration, such as school, reading, texting, watching television, computer work and electronic games.
Return to Play Guidelines
A concussion is a serious event, but you can recover fully from such an injury if the brain is given enough time to rest and recuperate. Returning to normal activities, including sport participation, is a step-wise process that requires patience, attention, and caution. Each step must take a minimum of one day but could last longer, depending on the player and his or her specific situation.
Step 1: No Activity, Only Complete Rest
Limit school, work and tasks requiring concentration. Refrain from physical activity until symptoms are gone. Once symptoms are gone, a physician, preferably one with experience managing concussions, should be consulted before beginning a step wise return to play process.
Step 2: Light Aerobic Exercise
Activities such as walking or stationary cycling. The player should be supervised by someone who can help monitor for symptoms and signs. No resistance training or weight lifting. The duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day. If there are no symptoms, proceed to Step 3 the next day. If symptoms return, rest until symptoms have resolved; consult a physician it symptoms persist.
Step 3: Sport Specific Activities
Activities such as skating or throwing can begin at step 3. There should be no body contact or other jarring motions such as high speed stops or hitting a baseball with a bat. If there are no symptoms, proceed to Step 4 the next day. If symptoms return, rest until symptoms have resolved; consult a physician if symptoms persist.
Step 4: Begin Drills without Body Contact
The time needed to progress from non-contact exercise will vary with the severity of the concussion and with the player. Proceed to step 5 only after medical clearance. If concussion symptoms arise during drills without body contact, return to rest until symptoms have resolved. If symptoms persist, consult physician.
Step 5: Begin Drills with Body Contact
Proceed to step 6 if no concussion symptoms arise during drills with body contact. If symptoms do arise, return to rest until symptoms have resolved. If symptoms persist, consult a physician.
Step 6: Game Play
Other Concussion Resources:
- Concussion Handbook
- Keeping Quiet Can Keep You Out of the Game – An Athlete’s Story
- A Parent’s Guide to Dealing with Concussions
- Things to Know About Concussions
- Concussion Guidelines for Athletes
- Concussion Guidelines for Parents
- Concussion Guidelines for Coaches
- Return to Play Guidelines
- Ontario Physical Education Safety Guidelines (OPHEA)
- Consensus Statement, Zurich 2013
For more information and concussion resources, please visit Parachute Canada’s Concussion Page.