Sports Concussions - Part 1
This is part of a multipart series reviewing Sports Concussions and how to return to sport safely. This is not to be used as a replacement for proper Medical Advice and anyone suspected of having a concussion is recommended to consult their Doctor.
Introduction
In Canada, around 45,000 concussions are diagnosed in emergency rooms for athletes aged 5-19 (link). If you play a contact sport, the likelihood of suffering a concussion is around 19% per season (link). Even non-contact sports can still result in concussions (link). So, the idea that if you don’t play a sport like hockey or rugby you aren’t at risk for concussions, is unfortunately false. Anecdotally, one of the worst concussions I experienced with my athletes was with a synchronized swimmer!
Sports-related concussions and their long-term effects on brain health is a complex topic that athletes, parents, and coaches need to be familiar with to ensure they are dealt with properly. Considering that 1 in 2 Canadians know little to nothing about concussions and only 15% can identify the best ways to treat concussion (link), more education is desperately needed. If we return to the 45,000 concussions per year, these are the ones diagnosed by professionals at the hospital. Considering that the majority of concussions go unreported (McCrea et al, 2004), with one study showing 43% of athletes deliberately conceal their symptoms (Torres et al, 2013), the number of concussions suffered each year in Canada is probably many times larger than 45,000. That information is not meant to scare or discourage participation in sport (I myself am a rugby player!), but instead to highlight that concussions are common. As a parent or coach, we must do our due diligence to understand concussions so we can provide the appropriate care if one unfortunately happens.
In Part 1, we will explore the following questions:
What is a concussion, how does it occur, and what are the symptoms?
What are the risk factors for suffering a concussion?
What exactly is a concussion?
The term concussion comes from the Latin word “concussus” or “to shake violently”. It is a type of mild Traumatic Brain Injury, resulting from either direct trauma (i.e., a hit to the head), rapid acceleration-deceleration of the head (i.e., “whiplash”), or a blast injury as seen in theatres of war (read more on the types of TBIs here). The American Academy of Neurology defines concussions as a “clinical syndrome of biomechanically induced alteration of brain function typically affecting memory and orientation, which may involve loss of consciousness” (Giza et al, 2013). Said plainly, when a trauma to the head affects brain function, like impaired memory or dizziness, a concussion likely has been suffered. Often people associate a loss of consciousness as synonymous with a concussion, or as some old school coaches would think, if you didn’t get knocked out you don’t have a concussion. However, it has been shown that 90% of concussions don’t result in a loss of consciousness (Marshall, 2012), so this line of thinking is very dangerous.
What are the symptoms?
Concussions can present with a wide range of symptoms, and in many combinations. Table 1 provides an overview of the most common symptoms. One study which looked at injury data from 192 US high schools across 20 sports, where approximately 15% of all sports-related injuries were concussions, found that the most common symptoms were headaches (94%), dizziness (75%), difficulty concentrating (54%), confusion (44%) and sensitivity to light (35%), with less than 5% losing consciousness (Meehan et al, 2012). It should be noted that the top 3 sports which suffered concussions were boys’ Ice Hockey, Cheerleading, and girls’ Lacrosse. Surprisingly sports like Swimming and Track & Field still sustained concussions (though at much lower rates).
How an athlete reacts immediately post-impact can shed light as to whether a concussion occurred. Often the athlete will show signs of confusion (e.g., going in the wrong direction), or difficulty with balance. This could be a sign of neurological impairment, therefore indicative of a concussion. With that said, this document is not meant to serve as a training manual for how to assess a concussion on the sideline. However, if an athlete is showing any signs or symptoms, or a concussion is otherwise suspected, getting a proper examination by a qualified individual (i.e., Physician, Athletic Therapist etc.) immediately is the recommended course of action. Furthermore, having a current Baseline Concussion testing prior to sustaining a concussion will allow for more effective diagnosis and treatment.
Who is most likely to get a concussion?
It is difficult to pinpoint which sport has the highest incidence of concussions, but in general sports with higher speeds and more physical contact suffer more concussions. In Canada, hockey, rugby and ringette have the highest proportion of brain injuries amongst 5-19 year olds (accounting for 27-44% of all injuries that happen during these sports; link). Boys’ football and girls’ soccer have high rates as well. Player to player contact is the most common cause, where as many as 25% are the result of prohibited activity and 15% caused from the head striking the ground (Mullally, 2017). There is also evidence that females might be at a greater risk for suffering a concussion, possibly due to physiological, cultural and hormonal differences (Dick, 2009). Younger athletes also seem to be more susceptible and may take longer to recover, since their brains are still developing and are less established cognitively (Harmon, 2013).
The following is a list of the biggest risk factors associated with suffering a sports-related concussion (data taken from Harmon, 2013 & Abrahams et al, 2014):
Previous Concussion (2-5.8 times higher risk for sustaining another concussion)
Gender (females have higher risk; lower neck strength, more willing to report injuries)
Age (more susceptible when younger)
Genetics (some genes may be involved with greater nerve damage, though evidence is limited)
Playing Style/Behaviour (aggressive tendencies could increase risk)
Sport (higher speeds, more physical contact)
Unfortunately, there isn’t much we can do to affect these risk factors, and detailed discussions about rules changes and protective equipment are outside the scope of this article. However, adequate education, proper Baseline Testing, appropriate diagnosis and effective treatment plans are the best tools we have to limit any long term consequences.
In Part 2, we will look at what actually happens in the brain to cause a concussion and persistent symptoms (physiology nerds will looove this one lol).
If you enjoyed this article, please share it with an athlete or parent who needs this info.
~Coach Gies