By Kasia Nastalska, Clinical Exercise Physiologist, Concussion Program Manager at Fortius
In 2016, experts and researchers from across the world descended on Berlin, Germany for the Fifth International Consensus Conference on Concussion in Sport. Including, our very own Director of Sport Medicine Tommy Gerschman.
One of the objectives of this conference was to develop a concussion consensus document that would be used by physicians and healthcare professionals involved in the care of injured athletes at all levels of sport. After reviewing over 60,000 research articles, the consenus statement was released in April covering the 11 ‘R’s: Recognize, Remove, Re-evaluate, Rest, Rehabilitation, Refer, Recovery, Return to Sport, Reconsider, Residual Effects and Sequelae, and Risk Reduction.
The information in this consensus helps debunk a number of common misconceptions around concussion. Using this research, we’ve outlined and explained the eight that we hear most often.
1. Myth: If you weren’t hit directly to the head, or lose consciousness, you can’t have a concussion
FACT: A concussion is a mild traumatic brain injury. It can occur after an impact to the head or body that causes the head and brain to shake back and forth. This can happen through jolting motions such as whiplash, spinning at high speeds, or from a blow to the head, face or neck that transmits an impulsive force to the head. You don’t need to lose consciousness to sustain a concussion.
2. Myth: If you don’t show signs or symptoms right away, you don’t have a concussion
Fact: Symptoms may be apparent directly after the injury, or be delayed by 24-48 hours, days or even weeks. An injured athlete should not be left alone after injury, and should be monitored for several hours after. Concussions can result in a range of signs and symptoms, some of which can include: headaches, pressure in the head, neck pain, dizziness, vision problems, sensitivity to light or sound, feeling like in a fog, fatigue, difficulty concentrating and/or remembering, confusion, irritability, sadness, nervousness or anxiousness or being more emotional.
3. Myth: You can return to play within the same game or day
Fact: An injured athlete should be evaluated by a physician or other licensed healthcare provider who has training in concussion management. First aid issues should be addressed, and a medical assessment sought out in a timely manner (within 24-48 hours). An athlete with a suspected concussion should not return to play on the same day, and should seek medical attention and clearance prior to returning to play.
4. Myth: A concussion isn’t serious enough to need to go to the Emergency Room
Fact: Any athlete exhibiting red flags such as loss of consciousness, neck pain, increased confusion or irritability, repeated vomiting, seizures or convulsions, weakness in the arms or legs, tingling in the arms or legs, deteriorating consciousness, severe or increasing headache, unusual behaviour change, or double vision should be taken to the emergency department right away.
5. Myth: A CT scan or MRI is the definitive way to diagnose a concussion
Fact: A concussion results in acute clinical signs and symptoms that largely reflect a functional disturbance rather than a structural injury. Therefore the is no abnormality seen on standard structural neuroimaging studies.
6. Myth: You should rest for at least a week after concussion
Fact: There is currently insufficient evidence to support complete rest as a means to recovery. Athletes are encouraged to rest for 24-48 hours after injury. They are then encouraged to become gradually more active, both physically and cognitively, while staying below their symptom-exacerbation thresholds. Proper medical management along with a supervised Return-to-Play and Return-to-School progression is recommended. Each step in the progression should be 24-hours apart. If the athlete experiences symptoms at any step, they should return to the previous step.
7. Myth: You will recover completely in 2-3 days
Fact: Most adults (18+) will recover in 10-14 days, while children (ages 5-12) and adolescents (ages 13-18) may take up to 4 weeks to recover. Some athletes may experience symptoms for longer, which is usually referred to as post-concussion syndrome, and require medical management.
8. Myth: You can prevent concussions entirely by wearing a helmet
Fact: Concussions occur when the brain shakes back and forth in the skull (picture an egg in an eggshell). Wearing a helmet may help absorb some of the impact should there be a direct blow to the head, and may help protect the skull. However, helmets alone cannot prevent concussions. Mouthguard use could have a protective effect. Policy changes such as disallowing body checking in hockey (under age 13), and vision training in football athletes show the most promise in reducing the incidence of sport-related-concussion.
THE BOTTOM LINE
When it comes to concussion, keep it simple: When in doubt, sit them out! Remove the athlete from the situation, look for red flags, consider using a pocket concussion recognition tool and seek medical attention.
Fortius Sport & Health focus is acute sport concussion. If you have sustained a concussion during play, practice or competition in your sport, they may be able to help you. Working in collaboration with your family physician, Fortius sport medicine physicians reviews the injury, completes a comprehensive history and exam, compares to baseline testing when possible, and develops an individual plan to help manage the injury.
For more information on concussion management at Fortius, please contact Kasia Nastalska at 604-292-2542 or firstname.lastname@example.org
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This article was provided by our partner in sport, Fortius Sport & Health.
ADDITIONAL RESOURCES & REFERENCES
- A full copy of the 5th International Consensus Conference on Concussion in Sport. Recommendations outlined in the consensus statement cover the 11 R’s: Recognize, Remove, Re-evaluate, Rest, Rehabilitation, Refer, Recovery, Return to Sport, Reconsider, Residual Effects and Sequelae, and Risk Reduction.
- A comprehensive library of resources relating to concussion can be found on the Concussion Awareness Training Tool website
- A pocket concussion recognition tool can be found here.