The broadest definition of a concussion includes the immediate and transient symptoms of traumatic brain injury (TBI). A simpler definition of a concussion states that a sport-related concussion is a traumatic brain injury induced by biomechanical forces. This means an injury occurs to the brain due to different forces on the body, including a blow to the head, or indirect jarring of the head through a blow to the body. There are a variety of causes of concussions, as well as numerous symptoms that may present themselves in everyone. A concussion can be caused by a direct blow to the head, which can be common in contact sports. Additionally, a concussion may be caused by a direct blow to another portion of the body that permits an impulsive force to be transmitted to the head. This can best be explained as whiplash that occurs during a car accident, or even a blow to the body during contact sports. Often there is a rapid onset of symptoms that may evolve over minutes to hours. Loss of consciousness, or “blacking out”, is not necessarily a sign of concussions. The severity of concussions is not directly related to the severity of the blow to the head or the body. Numerous factors play a role in the overall severity of a concussion, which is why it is important that a qualified health care professional evaluates an individual suspected of sustaining a concussion and proper follow-up care and treatment are provided.
In any event, where a sport-related concussion is suspected, the individual should be immediately removed from practice or competition for an initial evaluation. The Standardized Concussion Assessment Tool 5th edition, is utilized at Brighton High School for the initial assessment of a suspected concussion. The SCAT5 is a useful tool immediately after injury and represents the most well-established and rigorously developed assessment for sideline assessment. This assessment includes an evaluation of symptoms, an assessment of orientation and immediate memory, concentration, a neurological screen, and delayed recall. A symptom checklist is also a useful tool in evaluating and tracking recovery. Once the initial evaluation is completed, each athlete is provided a sheet of home care instructions that are reviewed by the athletic trainer to ensure any questions are answered. Additionally, a parent or guardian will be contacted about the suspected concussion to provide an overview of what happened, the assessment, and a description of home-care instructions, and the follow-up care that will be provided.
Treatment & Management
It is recommended any athlete who has sustained a concussion rest until they become symptom-free. Rest may help to mitigate the symptoms that are present post-injury and help to minimize any brain energy demands post-injury. It is often recommended the period of rest following a concussion occur for a period of 24 to 48 hours, followed by a gradual progression of becoming more active and resuming normal daily life activities while still remaining below the cognitive and physical symptom threshold that may exacerbate symptoms. Daily activity levels should not make symptoms worse.
It may be required to adjust schoolwork to allow for more time to complete homework, post-pone an exam, etc. If adjustments in schoolwork are needed, the athletic trainer will reach out to the school counselor who can help to facilitate these adjustments.
In some cases, an athlete may have lingering symptoms that persist for weeks, or symptoms that strongly influence the vestibular system, or the system that helps you to maintain your balance. In these cases, referral to physical therapy for a concussive head injury may be warranted and can be facilitated by the athletic trainer. Any referral will be made on an individual basis and in conjunction with communication from the attending physician.
Return-to-Play & Clearance
Once an athlete is symptom-free, they may begin a progression through the return-to-play protocol. The RTP protocol is a step-wise progression back into the activity that helps ensure as an athlete is being introduced back into their sport, they a physically capable and remain symptom-free to ensure they are not returning to their sport too soon. The RTP protocol is broken down into six different stages. Each stage is a progression from the previous stage and includes an increase in the amount and intensity of activity. There is a minimum of 24 hours between each stage, and it is required an athlete remain symptom-free to progress through each stage. If symptoms present while completing any phase of the RTP, an athlete will be required to go back to the previous stage until they are symptom-free. Below is a breakdown of the stages of the RTP and associated activities. An athlete is required to complete a symptom check-list before completion of each stage and must follow-up with the athletic trainer after each stage. Once the RTP is successfully completed with the athlete remaining symptom-free, they can be cleared for full-activity by the athletic trainer after they follow-up after completing the full-contact practice.
In specific instances, the athletic trainer may feel that final clearance should be completed by a board-certified physician. This will be determined on an individual basis. It is also important to note that an athlete who sees a doctor when they have been suspected of sustaining a concussion and receives a clearance note, will still be required to complete the RTP protocol.
McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5 th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 2017;51(11):838. doi:10.1136/bjsports-2017-097699
Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training. 2014;49(2):245-265. doi:10.4085/1062-6050-49.1.07
UHSAA Sports Concussion Management Policy & Procedure