It is important to recognise signs and symptoms of a concussion for prompt management. In this article we’ll delve into the definition of concussion, its symptoms, duration, management strategies, when to seek medical attention, the possibility of long-term treatment and measures to prevent future occurrences.
What is a concussion?
Concussion is a mild traumatic brain injury, caused by forces to the head, or anywhere on the body which transmits an impulsive force to the head (McCrory et al., 2017). Concussion causes short-lived neurological impairment however some symptoms may evolve over the hours or days following the injury.
It can occur from a fall or any injury that 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 minor knocks. The acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury (no abnormality is seen on imaging).
What symptoms should I look for?
Concussion involves a range of clinical signs and symptoms which are non-specific and may be subtle. As parents, spectators, and coaches it is important to keep an eye out for these symptoms.
Definite or obvious signs of concussion include:
- Loss of consciousness
- Brief convulsions
- Difficulty balancing or walking (ataxia)
Players should be taken from the play immediately for further assessment by a medical practitioner. The player should not be allowed to return to play that day.
Suspected concussion symptoms include:
- ‘don’t feel right’
- ‘pressure in the head’
- difficulty concentrating
- neck pain
- difficulty remembering
- nausea or vomiting
- fatigue or low energy
- blurred vision
- balance problems
- sensitivity to light
- more emotional
- sensitivity to noise
- feeling slowed down
- Feeling like you're ‘in a fog’
- nervous or anxious
- trouble falling asleep (if applicable)
How long will a concussion last?
The majority of concussion symptoms for adults will resolve in 10- 14 days. In children it can take a little longer up to 4 weeks for symptoms to resolve, but most concussions will get better on their own over several days.
Once the diagnosis of concussion has been made, immediate management is physical and cognitive rest. This may include time off school or work and relative rest from cognitive activity. Having rested for 24–48 hours after sustaining a concussion, players are encouraged to become gradually and progressively more active as long as such activity does not cause a significant and sustained deterioration in symptoms.
Graduated Return to School
Return to school and learning should take priority before returning to sport. Gradually increasing the load on the brain without provoking symptoms is recommended. School programs may need to be modified to include more regular breaks, rests and increased time to complete tasks. Exams during that period may need to be postponed.
Graduated Return to Sport
Children and adolescents should not return to sport until they have successfully returned to school. You should allow at least 24 hours for each step and only move onto the next step if your child is not showing any symptoms of concussion.
When should I seek medical attention?
If at the time of the suspected concussion no medical assessment was performed by a trained professional you should seek medical attention in order to clear any red flags, provide support and education around the gradual return to learn and sport frameworks after a concussion.
You should seek urgent medical attention if you or your child’s symptoms get worse or they develop new symptoms of concussion.
It is also recommended according to Australian Institute of Sport’s graded return to sport guidelines that players get medical clearance to return to full contact training.
Do I need to continue treatment long term?
Most people will recover well after a concussion however at times players can experience more persistent symptoms (>10-14 days for adults, > 4 weeks for children). If this is the case for you or your child after a concussion they should be reviewed by their GP for a medical assessment.
Long term care may include:
- an individualised symptom-limited aerobic exercise programme in patients with persistent post-concussive symptoms associated with physical deconditioning.
- a targeted physical therapy programme in patients with cervical spine or vestibular dysfunction.
- a collaborative approach including cognitive behavioural therapy to deal with any persistent mood or behavioural issues
How can I prevent a concussion?
Concussion risk factors are not well understood but may include genetics, age, recurrent head trauma and premature return to play after a concussion.
Following repeated concussions, it may be recommended that your child avoid contact sports and any activities with increased risk of head injury for a period of time. This is because after a head injury, children’s reaction times and thinking may be slower, and this can put them further at risk of recurrent concussions.
Contrary to popular opinion headgear and mouth guards offer little if any benefit in the prevention of concussion in sports such as AFL (Australian Institute of Sport, 2019). The research into protective gear is continuing. Helmets and protective gear are important however for sports such as horse riding, cricket, to prevent other traumatic head injuries.
Resources for parents, coaches, players
Head Check App - Home | Concussion App - HeadCheck
Concussion in Sport Australia - https://www.concussioninsport.gov.au/home
Concussion in Sport Australia: Position Statement (ais.gov.au)
McCrory P, Feddermann-Demont N, Dvorák J, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med. 2017; 51(11):877-87