Concussion in Sport - Do you know how to identify it in your athletes?

Concussion is a possibility in any sport; there are obviously more instances of this in higher impact sports such as rugby, hockey, football and many others. The rules of these sports are designed to try and protect the players from head injuries. However, collisions can never be completely eliminated.

What is concussion?

A concussion is a minor brain injury which is caused by impact to the head or body. The impact jars or shakes the individual's brain inside their skull. This then causes a temporary loss of normal brain function. In most cases there are no visual signs of head trauma to the individual's head. And, unlike most assumptions, loss of consciousness rarely occurs. In fact, this only occurs in around 10% of reported cases. This is why it's very important not to rely on this as an indication of concussion.

So, what are the indications?

The symptoms of a concussion are sometimes difficult to identify, especially during a sports event. Some of the symptoms themselves can be slow to develop, or the individual could suffer a delayed onset concussion, which would see the individual not feel anything initially but then in time begin to display the signs and symptoms as time goes on.

It is particularly difficult in a competitive sport context, as many individuals will hide symptoms in order to stay on the field/in the game. Due to this difficulty, and the high risks involved in leaving players on the field once an injury has been sustained. This makes it imperative that anyone who has received a blow to the head should be treated initially, then constantly assessed. Once a player has been removed from play their improvement or deterioration can then be monitored and treated accordingly.

Symptoms

Headache - usually won't go away, even with painkillers
Short term memory loss - they may not remember how their injury occurred
Nausea - and in some situations they may possibly vomit
Irritability - behaving unusual and being irritated easily
Imbalanced - becoming unsteady on their feet
Confusion - the individual will be dazed and confused in their situation
Slurred speech - they may struggle to speak clearly
Distorted vision - sometimes blurry or seeing double

and in some situations being knocked out or the individual struggling to stay awake

What if a player shows any of these symptoms?

If one of your players has any of the above symptoms or is behaving in an unusual manner, remove them from the game immediately and get them medical attention. Also, they should not be allowed to return to the match.

Once the player is away from the game, they should then be monitored with regular checks and these results need to be recorded every 5 minutes. There are several assessment tools used when dealing with a possible concussion injury, the most widespread of these being SCAT (Sideline Assessment Concussion Tool) which is used by FIFA, IIHF, Olympics, IRB and FEI. You can download your own copy from the British Journal of Sports Medicine by clicking here. If the individual begins to deteriorate, they should be taken to hospital immediately.

The risk of playing through a concussion

Because of the impossibility of knowing the extent of damage from certain head injuries, this can create a problem. A player may think they are fine and hide certain symptoms because they want to stay in the game. However, the injury will evolve and the symptoms can worsen or even be delayed and come on later. If taken out of the game and given appropriate rest and medical treatment there is no long-term damage in most cases.

Unfortunately if misdiagnosed or ignored, a player returning to a match faces significant risks. A second blow to the head without allowing the brain to recover from the initial concussion can in some situations be fatal. This fatal instance is known as Second-Impact Syndrome (SIS) which is a rapid and catastrophic swelling of the brain.

The concussion itself will also inhibit the individual's performance both physically and cognitively, which could lead to them getting injured in other ways.

The important message to remember, which everyone should follow 'if in doubt - sit it out'.