How to Recognise and Treat Concussions in Sport

Concussions are a common injury in many contact sports, including football, soccer, rugby league and basketball. While concussion in everyday life can sometimes be considered a mild injury, concussion in sport often has serious and long-lasting consequences if not properly recognised and managed.

In this article, we discuss what a concussion is, how to properly recognise it, the steps to take to manage a head injury, and resources to aid in returning to sport after a concussion.

What is Sport Related Concussion?

Sport related concussion is a type of brain injury that occurs from contact to the head or body. It is classified as a traumatic brain injury that causes short-lived neurological impairments and symptoms that may occur in seconds, minutes, hours, or days following the injury.

These neurological impairments are caused by chemical disruption and changes in the brain’s function. From the research, we know that once an athlete has experienced one concussion, their likelihood of experiencing another concussion is substantially increased. 

Risk of concussion is heightened with a head injury sport like AFL, rugby or soccer, which can involve contact such as tackling. While concussion can occur in any type of sport, it’s important to be aware of the risks associated with contact sports and know how to recognise head injuries should they occur.

How To Recognise a Head Injury in Sport

Head injuries like concussions are difficult to recognise and require a medical practitioner such as a GP or sports physician for a confirmed diagnosis. The Concussion Recognition Tool 5 (CRT5) developed by the Concussion in Sport Group (CISG) can assist in recognising athletes who may have experienced a concussion during training or playing. This user-friendly tool outlines four steps to aid in determining whether the athlete has sustained a serious head injury, starting with Red Flags – Call an Ambulance, and finishing with Memory Assessment.

The following table identifies observable signs and symptoms that may suggest a player has experienced a concussion:

Observable Signs

• Lying motionless on the playing surface
• Slow to stand up after a direct or indirect hit to the head
• Disorientation or confusion
• Unable to respond appropriately to questions
• Blank or vacant look
• Motor difficulty with balance or walking
• Slow or stumbling movements
• Facial injury after trauma

Symptoms

• Headache 
• Pressure in head 
• Balance problems 
• Nausea or vomiting 
• Drowsiness 
• Dizziness 
• Blurred vision 
• Sensitivity to light and/or noise 
• Fatigue or low energy 
• The player not feeling ‘right’
• Heightened emotion
• Irritability
• Sadness
• Nervousness or anxiety
• Neck pain 
• Difficulty concentrating 
• Difficulty remembering 
• Feeling slowed down 
• Feeling in a fog

Failure to recognise concussion in sport, and to subsequently remove a player from training or play who has experienced a head injury, can lead to:

• An increased risk of a musculoskeletal injury such as a lateral ankle sprain or knee injury. 
• The athlete sustaining another concussion. 
• Prolonged concussion signs and/or symptoms.

Managing Concussion in Sport

Most concussion symptoms should resolve within 10-14 days, though children and adolescents can take longer to recover. The Concussion in Sport Group advises to wait a minimum of 14 days from when symptoms cease before returning to sport after receiving medical clearance.

Once an athlete is suspected or confirmed to be diagnosed with a sport-related concussion, that athlete must be removed from play and be given adequate head injury advice. This should include:

• They cannot return to the match or play in any other sports that day.
• Be accompanied by a responsible adult and cannot be allowed to drive. 
• To not consume alcohol.
• To review with their local medical practitioner for assessment of sports related concussion and for medication review.

Once the concussion diagnosis is confirmed by a qualified medical practitioner and the athlete receives clearance, the athlete can commence the gradual return to play protocol. During each phase of the return to play concussion protocol, the athlete is to be closely monitored and must be symptom-free prior to progressing to the next stage. We recommend working closely with an Exercise Physiologist or Physiotherapist to get the most out of your rehabilitation program.

Stage 1: Physical & cognitive rest for 24-48 hours

This could include time off from work and school with gradual exposure.

Stage 2: Light aerobic activity

• Exercise that can be completed while still being able to hold a conversation.
• Activities can include walking or stationary cycling.

Stage 3: Basic sport-specific drills

• These drills cannot expose the athlete to potential contact with the head.
• Head injury sport and training must be resumed with caution and should be overseen by a professional.

Stage 4: Advanced sport-specific drills

• These drills can be more complex but still need to avoid contact with the head.
• The athlete can participate in resistance training at this stage.
• The athlete needs to be reviewed by a medical practitioner prior to advancing to the next stage.

Stage 5: Return to training

The athlete is now able to participate in full contact training depending on medical practitioner review.

Stage 6: Return to sporting activity

Pending a final clearance from a medical practitioner, the athlete is now cleared to resume normal training and play.

Returning to Sport After a Head Injury

Prior to returning to sport, it is essential that the athlete is symptom-free and receives full clearance from their medical practitioner. 

The following resources include sport-specific information on concussion in sport management, head injury sport types, and the Concussion Recognition Tool 5 (CRT5):

• Australian Football league (AFL): AFL – News, Fixtures, Scores & Results – AFL.com.au
• Basketball: BA-Concussion-Guidelines-Harcourt-FINAL.pdf (australia.basketball)
• Cricket: Policies & Guidelines | MyCricket Community
• Football/Soccer: Football Federation Australia (footballaustralia.com.au)
• Rugby League: the-management-of-concussion-in-rugby-league-final.pdf (playrugbyleague.com)
• Netball: Concussion-Policy-Netball-Australia-approved-2019 (1).pdf
• Rugby Union: Report a Concern Concussion Management | Rugby Australia
• Concussion Recognition Tool 5: Concussion recognition tool 5© (bmj.com)

Book a Consult With Coast Sport

Whether you have recently sustained a concussion in sport or you’ve started the recovery process after a head injury, careful and regular monitoring by professionals is essential during every step in your return to sport.

At Coast Sport, our experienced Exercise Physiologists can work with you to move through your return to play protocol. No matter your sport or training style, we can assist you with a safe, efficient, and effective transition back onto the field or court.

Enquire with us about your circumstances, or schedule a consultation with one of our Exercise Physiologists today.

References:

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. 

McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017; Published Online First: 26 April 2017. doi: 10.1136/ bjsports-2017-097699. 

Sport Concussion Assessment Tool – 5th edition. Br J Sports Med. 2017; 51(11):851-58.