Concussion in Sport

What is Concussion?

Concussion is a brain injury caused by a knock to the head or anywhere on the body, where the force is transmitted to the head. It can also be caused by a fall. Concussion involves temporary neurological impairment. The symptoms may evolve over the hours or days following the injury. While all concussions should be assessed by a doctor, most will resolve without the need for specific treatment. Rest, followed by gradual return to activity is the main treatment.

All concussion is serious.

Concussion in Sport Policy

Sports Medicine Australia’s 2018 Concussion in Sport policy was developed with the support of the New South Wales Office of Sport. This policy is a resource to help State Sporting Organisations recognise and manage concussion in sport, creating safe sporting environments.

Consensus Statement on Concussion in Sport

The ‘Consensus Statement on Concussion in Sport’ was devised at the 6th International Conference on Concussion in Sport held in Amsterdam in October 2022 to help develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. Ultimately the aim of the Consensus Statement is to assist those involved in athlete care – whether at a recreational, elite or professional level – in managing concussion safely.

How do I recognize a concussion?

Recognising concussion can be difficult. It is important to know when to suspect concussion, because appropriate response and management can help prevent further injury or even death. There are several possible symptoms and signs, but they can be subtle and they are not specific only to concussion.

Onlookers should suspect concussion when an injury results in a knock to the head or body that transmits a force to the head. A hard knock is not required—concussion can occur from relatively minor knocks.

Use the Concussion Recognition Tool 6 to help you recognize concussion

What are the most common signs and symptoms of Concussion?

The signs of concussion vary and may be difficult to detect. For example athletes may:

appear normal apart from appearing vacant, dazed or stunned
be disoriented and unable to recall team plays, scores, who the opponent is or be disoriented in terms of place and time
ask repeatedly about what happened or what the score is; amnesia is common
have difficulty concentrating and answering specific questions.

Loss of consciousness, seizure or balance difficulties are clear signs that an athlete has sustained a significant injury. Urgent medical support is critical in these circumstances. In some instances, it will be obvious that there has been a significant injury where the athlete loses consciousness, has a seizure or has significant balance difficulties.

Symptoms of concussion can be very subtle and may present as nothing more than the athlete reporting that they do not ‘feel right’. Concussed athletes often report these symptoms:

visual disturbance
feeling ‘foggy’, lethargic or slow
having sensitivity to light or noise
feeling dizzy or nauseous
headache.

What to do if you suspect a player has concussion?

First-aid principles apply. You can check out our blog articles on this topic. Neck injuries should be suspected if there is any loss of consciousness, neck pain or a mechanism that could lead to spinal injury. Athletes in this type of situation shouldn’t be moved without guidance from appropriately trained individuals.

To assist the treating doctor, it is helpful to note the following details at the time of the injury:

When: what time did the injury take place?

How: how did the injury occur? For example, is the injury from a knock to the head by a cricket bat or by an opponent’s shoulder?

Where: where on the body was hit? For example, the temple, shoulder or back of head.

What: what occurred next? Including symptoms such as loss of consciousness, convulsions, amnesia, vomiting or confusion.

Additional useful information: any further symptoms such as behavioural changes or loss of memory.

If in doubt, sit them out!

If there is any doubt about whether an athlete is concussed, that athlete should not be allowed to return to sport until cleared by a medical practitioner.

The standard in sideline assessment is the Concussion Recognition Tool (CRT). Every sports trainer and/or parent should have easy access to this in the event of a concussive event so they can make the right decision for the player’s welfare.

How is concussion managed?

Any athlete with suspected or confirmed concussion should:

remain in the company of a responsible adult
not be allowed to drive
be advised to avoid alcohol
check their medications with their doctor.

Specifically, concussed athletes should avoid:

aspirin
anti-inflammatories (such as ibuprofen, diclofenac or naproxen),
sleeping tablets
sedating pain medications.

If diagnosed with concussion, athletes require immediate physical and mental rest; this allows the brain to recover.

To properly rest, time off school or work may be needed. Mental rest may include refraining from playing computer games, reading and watching television.

Children and adolescents

Children and adolescents aged 18 years or younger take longer to recover so a more conservative approach to concussion management should be taken. Concussive symptoms usually resolve in less than four weeks.

The child should not return to contact or collision activities less than 14 days after all symptoms are cleared.

Please refer to the Concussion Management Flow Chart to effectively deal with any suspected concussive event.

Australian Concussion Guidelines for Youth and Community Sport

The Australian Concussion Guidelines for Youth and Community Sport have been designed to provide clear and consistent guidance on concussion for parents, teachers, coaches, sideline staff and others involved in youth and community sport. Click the link to download and view.

These guidelines provide information on how to recognise and manage concussion from the time of injury through to a safe return to education, work and playing sport. This information is intended for the general public and for individuals participating in youth (those aged under 19 years) and community sports where healthcare practitioners are less likely to be available to diagnose and monitor symptom progression of individuals with concussion.

They have been developed in a collaboration between the Australian Institute of Sport, Sports Medicine Australia, the Australasian College of Sport and Exercise Physicians, and the Australian Physiotherapy Association, and released in February 2024.

Sport Specific Concussion Guidelines

Different sports leagues may have different protocols set in place. Many leagues will require reporting of concussive events to the governing body and will also require medical clearance prior to return to play. It is best to contact your league and ask them specifically what their protocols are for managing player concussion

Main Reference – https://sma.org.au/resources/concussion/

Articles