Concussions, also known as mild traumatic brain injuries (MTBI) can happen to anyone, on or off the sports field. One misconception about concussion is that you must hit your head to get a concussion when in fact you do not. Post concussive symptoms can occur after any blow to the head, face, neck or elsewhere on the body in which a substantial force is transmitted to the head.1
A concussion is typically a temporary disturbance of brain function as opposed to structural damage therefore the neurological impairments experienced typically resolve spontaneously given proper time to recover. And because the impairment is functional, positive findings are often not found on MRI or CT scan.1
What are the signs and symptoms?
If any one sign or symptom is detected after an injury, it can indicate a suspected concussion.
Physical: head ache, neck pain, dizziness, nausea or vomiting, feeling ‘unsteady’, feeling stunned, feeling dazed, ‘don’t feel right’, visual disturbances, sensitive to light, ringing in the ears, double vision, fatigue, balance problems, “pressure in the head”
Cognitive: easily distracted, poor concentration, slow response time, confusion, amnesia, disorientation, memory loss or disturbance of consciousness.
Emotional: depression, irritability, moodiness, lability, nervousness or anxious, sadness
Behavioral: irritable or moody, personality change, inappropriate behavior
Sleep disturbance: Insomnia, drowsiness1,2,4
If a child/athlete experiences a hard fall or collision and concussion is suspected, remove them from play immediately.
1. The player should be evaluated by a physician or other licensed healthcare provider onsite using standard emergency management principles for overt injury. Particular attention should be given to excluding a cervical spine injury.
2. The disposition of the player must be determined by the treating healthcare provider in a timely manner. If no healthcare provider is available, the player should be safely removed from practice or play and urgent referral to a physician arranged.
3. Once the first aid issues are addressed, an assessment of the concussive injury should be made using the SCAT3 or other sideline assessment tools.
4. The player should not be left alone following the injury and regular monitoring for deterioration is essential over the initial few hours following injury.
Important Signs to watch for: a headache that gets worse, extreme drowsiness or can’t be awakened, can’t recognize people or places, have repeated vomiting, behave unusually or seem confused, very irritable, have seizures, weakness or numbness in arms/legs, unsteady on feet, slurred speech. If any of these signs are present the athlete should be taken to the closest emergency room.
5. A player with diagnosed concussion should never be allowed to return to play on the day of injury.1,4
Please review the SCAT 3 and SCAT 3 for children assessment tools. http://www.thinkfirst.ca/downloads/concussion/scat3.pdf
80-90% of concussions resolve within a 7-10 days or up to 3 months. Children and adolescents may have longer recovery times.1 Once someone has experienced a concussion return to play guidelines (discussed below) are key to a safe and full recovery. If a second concussion is experienced before optimal recovery then symptoms can re-occur more severe and may persist.
Persistent post concussive symptoms (PPCS) are a serious concern. Up to 15% of people may experience disabling symptoms such as persistent sleep disturbances, headaches, cognitive, balance or fatigue disorders. 3
The return to play guidelines involves 6 steps. The athlete can only proceed to the next step if no post concussive symptoms are present. If symptoms occur then the athlete must return to the previous step for a minimum of 24 hours.
Step 1 – No activity. This may include no TV watching, or reading depending on severity.
Step 2 – Light aerobic exercise such as walking or stationary bike
Step 3 – Sport specific training, ie. running or skating
Step 4 – Non-contact drills
Step 5 – Full contact training after medical clearance
Step 6 – Game play1
This stepwise process can be applied to non-athletes to help re-integration into school studies and social settings.
It is extremely important that coaches, teachers, and parents are familiar with the signs and symptoms of concussions and communicate openly when they suspect this type of injury in a child or athlete. There are several tools and resources available.
ThinkFirst Canada http://www.thinkfirst.ca/programs/concussion.aspx
SCAT 3 and SCAT 3 children http://www.thinkfirst.ca/downloads/concussion/scat3.pdf
ACE (Acute Concussion Evaluation) http://www.cdc.gov/concussion/headsup/pdf/ace-a.pdf
The role of Chiropractors
“Chiropractors are key members of appropriate team management in concussion injuries. The etiology of concussion is traumatic and such must be differentiated or managed concurrently with other effects of the trauma such as whiplash, subluxation, neck strain, facet syndromes and muscles spasm. Chiropractors are uniquely capable, and some of the best trained professionals to deal with the multiple facets of a concussion injury and should be involved in the health team from prevention to return to play.
Prevention, pre-injury status, post-injury assessment, diagnosis, treatment and follow-up are all key components in considering the big picture of concussion for our young athletes, and there is a role for chiropractic in all of these areas. Our training and education in neurology combined with our specialized knowledge and experience in musculoskeletal function, nutrition and exercise are powerful tools to make a difference in our communities by keeping our children safe and active in sports!”
Canadian Chiropractor Magazine June 2012, Concussion and post concussive syndrome. Geanopulos, S and McPhee, W. http://www.canadianchiropractor.ca
1 McCrory et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, Novmeber 2012. Br J Sports Med. 2013;47:250-258
2 Coghlin et al. The ability of parents to accurately report concussion occurrence in their bantam-aged minor hockey league children. J Can Chiropracic Assoc. 2009;53(4)
3 Marshall, S., Bayley, M., McCullagh, S. et al. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Canadian family physician. March 2012 Vol. 58
Dr. Jennifer Fergusson graduated Cum Laude with Clinic Honours from the Canadian Memorial Chiropractic College. She maintains a family practice in Almonte at the Hands on Healing Clinic.