There is a lot to know about concussions and their proper management. This section deals in depth with the most common issues associated with concussions. Read on to learn:
A concussion is a common form of brain injury and can be caused by a direct or indirect hit to the head or body (for example, a check to the boards, a hit to the head or car crash). This causes a change in the brain function, which results in a variety of symptoms. With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal.
When a person suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull's bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bony protuberances inside the skull. Such force can also result in a rotational injury in which the brain twists, potentially causing shearing of the brain nerve fibres. It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself, but how the brain is working. The exact length of this change is unclear. During this time period, the brain does not function normally on a temporary basis, and is more vulnerable to a second head injury.
Most concussions occur as a result of a collision with another object while the object or person is moving at a high rate of speed. Forces such as these (and others) can result in deceleration and rotational concussive injuries.
It is extremely important to seek medical advice immediately upon receiving a blow to the head or body that results in signs or symptoms of a concussion. Often, concussions can go untreated (and even unnoticed by others) because few symptoms are visible to casual observers. Many times, the symptoms of a concussion may not be identified until the person recovers to the point where increased exertion causes symptoms to worsen. In fact, 4 out of 5 professional athletes do not even know that they have been concussed (Delaney et al, CJSM 2001).
Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive and emotional changes. You can never be too careful! Symptoms may actually worsen throughout the day of the injury or even the next day. Without proper management, a concussion can result in permanent problems and seriously affect one's quality of life.
It is important to tell a family member, friend, co-worker, teammate, employer, trainer or coach if you think you have had a concussion. Because a concussion affects the function of the brain, and can result in symptoms such as memory loss or amnesia, therefore it is important that others be aware of the signs and symptoms of concussions in order to help identify the injury in others. If you think you have had a concussion, you should immediately remove yourself from the current activity whether it is sports, work or school. You should not drive and should seek medical attention immediately.
Following a concussion, you may experience many different signs and symptoms. A symptom is something the athlete will feel, whereas a sign is something your friends, family or coach may notice. It is important to remember that some symptoms may appear right away and some may appear later. Just like no person is the same, no concussion is the same and so the signs and symptoms may be a little different for everyone. Some may be subtle and may go unnoticed by you as the injured person, co-workers, friends and family.
Contrary to popular belief, most concussions occur without a loss of consciousness (LOC).
Common symptoms and signs include:
|Loss of consciousness||
|Seizures or convulsions||Balance Problems||Fatigue or low energy|
|Amnesia||Sensitivity to light||Confusion|
|Headache||Sensitivity to noise||Drowsiness|
|“Pressure in the head”||Feeling slowed down||More emotional|
|Neck pain||Feeling like “in a fog”||Irritability|
|Nausea or vomiting||“don’t feel right”||Sadness|
|Dizziness||Difficulty concentrating||Nervous or anxious|
From the Consensus Statement on Concussion in Sport (2009 and SCAT2 Resources)
Concussions typically resolve fully with proper rest and management in about a week or two, but concussions which are not diagnosed can lead to long term and more serious health implications. The first and most important step is to consult a doctor, preferably one familiar in concussion management.
There are many potential factors which may help to inform individual diagnosis, concussion management and recovery, although many of these are still being researched to find the exact link. For example, severity is probably impacted by a number of factors such as the person's history of previous head injuries, including number of past concussions, length of recovery time, timing between past concussions, age and style of play. Factors such as this may lead to a different, slower recovery, which is why concussion history should always be monitored.
Return to activity while still concussed and symptomatic can lead to an increased risk for another concussion, more intense symptoms, also a prolong recovery.
Diagnosing a concussion may take several steps. Your doctor may ask questions about your concussion and work/ sport history, the most recent injury, and will conduct a neurological exam. This can include checking your memory and concentration, vision, coordination and balance.
Your doctor may request further tests including a CT scan or MRI, these tests can be important to assess for other skull or brain injury but they do not inform concussion diagnosis. In the majority of concussions there will not be any obvious damage found on these tests.
Neuropsychological testing - Sometimes the role of neuropsychological testing is important in identifying subtle cognitive (i.e. memory, concentration) problems caused by the concussion and may at times help to plan return to pre-injury activity. In addition, balance testing may be required. Usually these are arranged by the concussion expert.
You should not return to activity or play until you have completed the 6 Steps to Return to Play and have been cleared by your doctor. A concussed person should be removed from activity immediately and should be assessed by a medical doctor. Given that symptoms may worsen later that night and the next day, you should not return to your current activity. When concussed, your ability to assess your situation may be impaired. Post-concussive symptoms may intensify with an increase in activity, so it is important that return to activity is gradual and monitored/supervised by a medical professional.
The 6 Steps to Return to Play include:
1. No Activity, Mental and Physical Rest until symptom free
2. Light Aerobic Activity like walking of stationary cycling
3. Sport Specific Activity like skating or running
5. Training Drills without Body Contact
5. Training Drills with Body Contact - only once cleared by a physician
6. Game Play
These steps do not correspond to days, though each step should take a minimum of one day. If symptoms return during this process, the individual should stop the activity and return to rest until symptoms resolve before they try any activity again. A physician should be consulted if symptoms persist.
For more detailed information about returning to play, please see our Return to Play Guidelines.
The best medical management for a concussion is rest, both physical and mental. A person who has suffered a concussion may often feel lethargic and tired. It is important to admit this fatigue to yourself. Your brain is telling you that you need rest and it is extremely important that you listen to it. If you continue pushing yourself and struggling on, it is likely you will make the symptoms worse.
The first thing to fail when you get tired is your concentration. If there is something important to get done, it is best to complete it when you are fresh after resting. When your attention starts to fade you may need to stop, rest again and write down the important things for later. Many patients who have suffered a concussion often complain of being very irritable. You may find that things that would not normally annoy you suddenly do. Patients sometimes find themselves losing their temper, snapping at family members or friends and being very annoyed over things. This may be because one's own self-control needs a fresh, working brain as well. In order to cope with this you need to be aware of emotions. Some patients have learned personal relaxation methods such as imagery and progressive relaxation methods to optimize their coping skills.
Other symptoms such as dizziness and clumsiness appear because the brain is reacting slowly and less efficiently. Concussions can upset balance organs in the ear, resulting in vertigo. One way to deal with these types of symptoms is to take special care in actions and movements, which means walking slowly and being aware of your surroundings.
Other problems such as noise sensitivity and visual changes are also the result of a concussion. Putting up with noise and bright lights needs brain energy and you may find that you do not have the energy level to do so. You may be around a loud radio, bright lights or a stimulating environment and find yourself suffering from bad headaches. One answer to coping with this is to avoid loud noise and bright lights as much as possible. Many people find it helpful to wear sunglasses everywhere, even indoors.
When dealing with other symptoms it is crucial to only take medications that your doctor has prescribed or approved of. Also, do not drink alcohol or take any drugs not prescribed by a medical doctor, as it may hinder recovery and can put you at risk for further injury. Remember, although in most cases symptoms resolve spontaneously, usually in a couple of weeks, the process of healing from a concussion may take considerably more time. It is important to pace yourself and increase activity gradually as well as consult with your family or friends before making any important decisions.
When coping with a concussion, it is not uncommon for the person to become overwhelmed by a variety of emotions. Often times the patient feels concerned, anxious and sometimes depressed. The first part of the healing process is to understand that these emotions are normal. After an injury, most people go through an initial stage of denial. You may refuse to believe that you are injured or unable to participate in your selected work, activity or sport. It is extremely tough to realize that after sustaining a concussion, your body may not be able to respond as it did before.
Other emotions such as anger and depression are also common when suffering a concussion. You may find yourself being angry, displaced, and blaming others for your injury. It is quite common to become very angry at your co-workers, family and friends. As you continue to become more aware about the extent of your injury, depression may set in. This may include self-pity, crying, insomnia, etc. When you are unable to work, play and participate in your normal life, you may become doubtful of your personal abilities and struggle with your personal worth. You may worry that if you are out of the "loop", somebody will take your spot or permanent position. You may suffer a blow to your ego and it is not uncommon to isolate or alienate yourself.
With time, most patients learn to accept the injury. It is important to allow yourself to mourn, be sad and then move on. Attempting to be mad or tough and find blame for your injury is a waste of time. It is important to leave the "should haves" or "would haves" out of the picture and focus on the future. The reality is that you have suffered a concussion and you have to deal with it. This may include setting goals for yourself and maintaining a positive attitude. You may find yourself weighing the pros and cons of your future. Dealing with a serious concussion is very demanding and can result in economic loss and emotional burden for you and your family. A positive, optimistic outlook can help to speed up the healing process and lessen the emotional pain, while thinking negatively discourages everyone around you. It is also important to take an active role in your recovery and seek out the resources available to you. Continue to participate in daily functions and activities, as your step-wise recovery allows. Do not isolate yourself.
Lastly, it is important to be patient. Concussion can result in permanent damage and seriously affect your quality of life. Do not rush your recovery because it will only lead to negative results. Follow the advice of the doctor and trust in the healing process.
It is important to take a preventative approach when dealing with concussions. This is especially true with recent concussions as the brain is still very vulnerable at that time. Prevention of concussion and head injury is most successful when workers and athletes are properly educated and the safety rules of the working and sporting environment are enforced. Concussions are an invisible injury, making it important to share information with the people surrounding you. This will help them understand your own situation and educate them for the future.
Protective equipment can reduce the risk and severity of injuries to the face and skull, but there is no concussion proof helmet, nor is there research to support that mouth guards prevent concussions. It is important that hard hats/helmets are of high quality and properly fitted, for work environments and collision sports. Workers should follow safety procedures mandated on work sites and all protective equipment should be certified and well maintained.
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