Concussions in Sport

One Strike and You’re Out!
(At LEAST for 6 Days!)

Concussions are no longer being looked upon as just getting your “bell rung”. The long term outcome of concussion has become much better understood. Repeated mild concussions occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits and an increased risk for conditions such as Alzheimer’s disease, Parkinson’s disease, Depression and other brain disorders typically seen in the elderly. In a study in the Journal of Neurosurgery it was found “Retired players with three or more reported concussions had a fivefold prevalence of Mild Cognitive Impairment diagnosis and a threefold prevalence of reported significant memory problems compared with retirees without a history of concussion”

Hockey Canada revealed concussions in minor hockey were 7x greater than previously reported in the literature. A young developing brain is more vulnerable to injury. 25% of junior hockey players have been concussed according to a recent study in Journal of Neurosurgery.

There is NO CURE for concussion!! Prevention is the KEY!

The 3rd International Conference on Concussion in Sport held in Zurich, November 2008 developed the following consensus statement on concussion.

What is Concussion?

Concussion is a type of brain injury caused by a blow to the head, face, and jaw OR elsewhere in the body causing the head and neck to move rapidly. It causes short term impairment in brain function; it is the cumulative effect that is the greatest concern! This trauma cannot be detected on brain scans (MRI or CT scans).

Anatomy of a Concussion

Diagnosing Concussion IS based on Symptoms and Signs


  • Loss of consciousness but not usually
  • Headache
  • Ringing in ears
  • Nausea, vomiting
  • Sensitivity to light
  • Confusion / disorientation
  • Dizziness
  • Tiredness / drowsy
  • Seeing Stars


  • Poor balance and coordination
  • Slow or slurred speech
  • Vacant stare
  • Mood changes – Irritability
  • Delayed response to questions
  • Poor Concentration
  • Decreased playing ability

ONE symptom is all that is required to have a diagnosis of concussion

Be AWARE symptoms may have a delayed onset so continue to monitor athlete late that day and next morning

Concussion Management

-If there is a loss of consciousness activate EMS (Emergency Medical System) immediately, call for an ambulance and assume a possible neck injury.

-Remove the athlete from the current game or practice, even if only mild symptoms due to risk of Second Impact Syndrome. (The athlete if hit again can end up with prolonged symptoms and greater damage)

-If available, a trained professional should medically evaluate the athlete. The SCAT (Sport -Concussion Assessment Tool) Card is a tool used to assess athletes for signs of concussion.

-Do not administer medication

-The athlete should be evaluated by a doctor or a therapist trained in concussion management.

-Do not leave the athlete alone, continue to monitor signs and symptoms for the next several hours.

Return to Play

The athlete must follow a stepwise return to play protocol lasting at least 6 days. If symptoms return during any of the steps the athlete must be re-evaluated by their doctor and go back to the previous step.

Step 1 – No activity, only complete physical and cognitive rest (no activities that require concentration – schoolwork, videogames etc.). Proceed to step 2 only when all symptoms are gone

Step 2 – Light aerobic exercise, such as walking or stationary cycling. Monitor for signs and symptoms. No resistance training or weight lifting.

Step 3 – Sport specific activities and training (just skating, no drills), may add light resistance training

Step 4 – Non-contact training drills, can progress resistance training to heavier weights

Step 5 – Once have medical clearance begin drills with body contact

Step 6 – Game play Only once ALL signs and symptoms have resolved and given clearance by a doctor.

Most Concussions get better in 7-10 days

Predictors of prolonged recovery are: loss of consciousness > 1 minute, greater than 3 symptoms, amnesia after the concussion, frequent concussions

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