Concussion management

With the recent retirement of another AFL player due to ongoing health issues as a result of multiple concussions sustained on the field, the topic of concussion diagnosis and ongoing management has again surfaced.

With the winter sports season looming, it is timely that allied health professionals who will be dealing with diagnosis and ongoing management of concussion are reminded about the latest information and recommendations. It is also important to remember that concussion is not limited to elite sportspeople or high-level sports – it can be sustained in all levels of junior and community sport.

In February 2019, a number of peak sporting and allied health bodies released new guidelines about the diagnosis and treatment of concussion. This included the Australian Medical Association (AMA), Australian Institute of Sport (AIS), The Australasian College of Sport and Exercise Physicians (ACSEP) and Sports Medicine Australia (SMA). These guidelines can be found here and they are an invaluable resource to all sporting codes as it presents a unified response and agreed recommendations.

What is concussion?

  • A subset of mild traumatic brain injury which is a complex pathophysiological process affecting the brain, induced by biomechanical forces

In simple terms a concussion can occur through any physical contact that causes the brain to move within the skull. This can be as simple as heavy contact to the chest or side with no contact to the head.

Incidence

  • Amongst 15 – 24 years it is the second most common cause of traumatic brain injury
  • Females suffer a higher number of concussive events with a greater number of symptoms and longer resolution

Signs and symptoms of a concussion

  • Loss of consciousness
  • Lying motionless for > 5 seconds
  • Confusion/disorientation
  • Amnesia
  • Vacant look
  • Motor incoordination
  • Tonic posturing
  • Impact seizure
  • Ataxia – stumbling/uncoordinated walking

On-field management at community level

  • Any suspicion of concussion, the player should be removed from the field
  • Player should not return to sport until had a medical evaluation
  • If in doubt – sit them out
  • Attention should also be made to;
    • Cervical spine
    • Possible facial injuries
    • Maintenance of airway

Post-concussion management

  • 24 hours after concussion
  • No driving until medically cleared
  • No return to activity or training
  • Decrease stimuli
  • Minimal use of phones, TVs, computers etc.
  • No alcohol or recreational drugs
  • Limit academic activities
  • Avoid:
    • Aspirin
    • Anti-inflammatories
    • Sleeping tablets
    • Sedating painkillers

Returning to activity or sport

  • If diagnosed with concussion athlete should not return to field on the day of injury
  • Serial evaluations should occur over a minimum of 48 hours
  • There should be a gradual increase in physical demands, sport specific activities and risk of contact
  • If symptoms occur through these steps progression should be halted
    • Restart at the symptom free step

Recovery

  • No specific time frame can resolve in 24 hours or symptoms may last for months or years
  • A second injury within this time period of the first concussion can lead to a worsening effect on the brain cells and lead to more significant cognitive deficits
  • Following a concussion, the risk of a second concussion is increased

Please visit the Concussion in Sport Australia website for more information.

Lifecare provide complete concussion management offering evidence-based concussion care to those impacted by, or at risk of concussion.

Physiotherapists can be an integral part of the concussion recovery process. Assessment includes a battery of tests to address the potential causes of symptoms (both acute and chronic), which may be present following concussion.

These include assessment and treatment of the:

  • Visual system
  • Vestibular system
  • Cervical spine (neck) joints and musculature
  • Cardiovascular system

Education and advice regarding:

  • Return to activity and return to sport
  • Diet
  • Supplements
  • The nature and mechanism of concussion
  • Up-to-date research