What is concussion?

Key Points

1. Concussion is a significant concern in contact sports: Concussions are more frequent in full-contact and collision sports, posing substantial risks to athletes.
2. Underreporting and inconsistent data hinder accurate assessment: Differences in concussion definitions and underreporting contribute to varying incidence rates across studies.
3. Diagnosis and management are crucial for recovery: Diagnosing concussions accurately is essential, and conservative management is recommended to ensure full recovery before returning to play.
4. Athletes often return to play too soon: Many athletes return to play without proper medical clearance, risking further injury.
5. Clinical implication and study limitations: Understanding concussion incidence and effective management can improve athlete safety, but inconsistencies in data collection limit broader conclusions.

What is a concussion?

A concussion is a type of traumatic brain injury induced by biomechanical forces. It commonly occurs due to a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head.

The injury results in a rapid onset of short-lived neurological impairment, which can resolve spontaneously. However, the symptoms can evolve over several minutes to hours, and in some cases, may persist longer.

Concussions are characterized by a range of clinical signs and symptoms, which may or may not involve loss of consciousness. Common symptoms include headaches, dizziness, nausea, vomiting, balance problems, blurred vision, confusion, and memory disturbances. It’s essential to note that a concussion is primarily a functional disturbance rather than a structural injury, meaning it does not typically show up on standard neuroimaging studies.

How often do athletes experience concussions, and which sport is the highest risk?

Concussions are a prevalent injury in sports, particularly in full-contact and collision sports. The incidence of concussion varies significantly across different sports and levels of competition. For instance, high school athletes have a higher rate of concussion compared to adult athletes. Among school sports, boys’ football has the highest concussion rate, with 76.8 concussions per 100,000 athletic exposures. Other high-risk sports include boys’ ice hockey (61.9 concussions per 100,000 athletic exposures) and boys’ lacrosse (46.6 concussions per 100,000 athletic exposures). Girls’ soccer and lacrosse also have high concussion rates, with 33.0 and 31.0 concussions per 100,000 athletic exposures, respectively.

In professional sports, rugby and American football are particularly high-risk, with rugby players experiencing concussion rates as high as 7.7 concussions per 1,000 match-hours. The risk of sustaining a concussion increases with the intensity of the sport, the level of competition, and the player’s position within the game.

Symptoms of concussion

Concussion symptoms can vary widely among individuals and can present immediately after the injury or develop gradually over the course of several hours. The symptoms can be grouped into four main categories: physical, cognitive, emotional, and sleep-related.

• Physical symptoms:
• Headaches
• Dizziness or balance problems
• Nausea or vomiting
• Sensitivity to light or noise
• Fatigue or drowsiness
• Blurred vision
• Ringing in the ears
• Cognitive symptoms:
• Difficulty concentrating
• Memory problems
• Feeling slowed down or “in a fog”
• Confusion or disorientation
• Trouble with processing information
• Emotional symptoms:
• Irritability
• Sadness or depression
• Anxiety
• Mood swings
• Feeling more emotional than usual
• Sleep-related symptoms:
• Trouble falling asleep
• Sleeping more or less than usual
• Disturbed sleep patterns

These symptoms may not all be present in every individual, and their severity can vary. It is important to monitor for any signs of deterioration in the days following the injury, as delayed symptoms can indicate complications.

What are the issues faced in concussion?

Several challenges complicate the accurate assessment and management of concussions in sports. One of the primary issues is the underreporting of concussions, which can occur due to various factors, such as athletes not recognizing their symptoms, fearing they will be removed from play, or not wanting to let their team down. This underreporting leads to an underestimation of the true incidence of concussion and can delay the appropriate treatment and recovery.

Another issue is the variability in the definitions of concussion used in different studies, making it difficult to compare data across different sports or levels of play. Additionally, the lack of standardized diagnostic criteria and the reliance on self-reported symptoms can lead to inconsistent and inaccurate diagnosis, further complicating the management of the injury.

How do we diagnose concussion?

Diagnosing a concussion requires a multi-step approach that includes immediate post-injury assessment, repeated evaluations within the first few hours, and follow-up assessments 36 to 48 hours after the injury. This staged approach helps capture the evolving nature of concussion symptoms and ensures that the diagnosis is accurate.

The diagnosis of concussion is primarily clinical, based on the history of the injury and the presence of specific symptoms. There are no definitive biomarkers or imaging tests that can confirm a concussion, so the diagnosis relies on the clinical judgment of the healthcare provider. The assessment typically includes a review of symptoms, cognitive testing, and physical examination, focusing on neurological function.

Tools like the SCAT (Sport Concussion Assessment Tool) are commonly used in the initial assessment, providing a standardized method for evaluating concussion symptoms and cognitive function. However, given the variability in symptom presentation and the subjective nature of many symptoms, diagnosing a concussion remains challenging and requires careful clinical evaluation.

How do we decide when the patient is able to return to play or sport?

Deciding when an athlete can safely return to play after a concussion is a critical aspect of concussion management. It is generally recommended that athletes follow a stepwise return-to-play protocol, where they gradually resume physical activity under close supervision, ensuring that they remain symptom-free at each stage before progressing to the next level.

The process typically begins with complete rest, followed by light aerobic exercise, then sport-specific exercises, non-contact training drills, and finally, full-contact practice before returning to competition. If symptoms recur at any stage, the athlete must return to the previous step and try again after a period of rest.

The decision to return to play should always be made by a qualified healthcare professional, considering the athlete’s symptoms, cognitive function, and overall health. Premature return to play increases the risk of further injury, including the possibility of second-impact syndrome, a potentially life-threatening condition where a second concussion occurs before the symptoms from the first concussion have fully resolved.

Unsure what you can if you’ve experienced a concussion? Contact us to allow our Physiotherapists to help you on your road to recovery! 

References

Gardner, A. J., Quarrie, K. L., & Iverson, G. L. (2019). The epidemiology of sport-related concussion: What the rehabilitation clinician needs to know. Journal of Orthopaedic & Sports Physical Therapy, 49(11), 768-778. https://doi.org/10.2519/jospt.2019.9105

Frequently Asked Questions