Sport related concussion (SRC)

So many athletic careers have ended because of sport related concussions that the medical profession has become increasingly aware of providing evidence based guidelines to treatment, assessment and recognition of concussion.   Here is a summary of the latest consensus statement on concussion in sport from the 5th international conference on concussion in sport in Berlin in October 2016:

What is a sport related concussion (SRC)?

It is an injury that is caused either by a direct blow to the head, face, neck or elsewhere that the force is transmitted to the head.  The symptoms are usually rapid and can resolve within minutes to hours.  There may be clinical signs such as neurological impairment, there may or may not be loss of consciousness, headaches, dizziness, nausea and vision problems.

How important is the immediate evaluation of an SRC?

The sideline assessment is a rapid screening for a suspected SRC.  The sideline evaluation of cognitive function that tests attention and memory seems to be the most effective.  Testing questions such as time place etc seem to be unreliable as found in current research.  According to the Consensus statement on concussion in sport, the SCAT5 currently represents the most well established instrument available for sideline assessment.  If SRC is suspected, the athlete should be removed from play and evaluated in a distraction free environment rather than on the sideline.

Symptoms and signs of an acute SRC

If the athlete has one or more of the following, an SRC should be suspected:

1. Headache, feeling in a fog, emotional changes
2. Loss of consciousness, amnesia, neurological deficit
3. Balance impairment
4. Behavioural changes (e.g. irritable)
5. Cognitive impairment (e.g. slow reaction time)
6. Sleep/wake disturbance

What should you do if a player has these signs?

1. Remove from play.
2. Have a health care practitioner examine the athlete and rule out cervical spine injury.
3. Evaluate the athlete using a SCAT5 or other assessment tool.
4. Player should not be left alone and serial monitoring should occur over the initial few hours of injury.
5. If an athlete is suspected of having an SRC, they should not be allowed to return to play that day.

Rest and Rehabilitation

A brief period of rest during the acute phase (24—48 hrs) is recommended after injury.  After that, patients can become gradually active while staying below their symptom – exacerbation threshold (any activity that worsens the symptoms).  Closely monitored sub maximal exercise has been show to be safe and beneficial in facilitating recovery.   Rehabilitation may also include cervical spine and vestibular treatment, as well as cognitive behavioural therapy.  There is limited evidence to support the use of pharmacotherapy.

Persistent symptoms

If symptoms persist >10-14 days in adults and >4 weeks in children, a referral is necessary.

The strongest and most consistent predictor of slower recovery from SRC is the severity of the person’s initial symptoms in the first day or initial few days after injury.  Low level of symptoms within the first day after injury seems to be a favourable prognostic indicator.  Children, adolescents and young adults with pre-injury health problems or migrants appear to be at a greater risk of having symptoms for more than 1 month.

Return to sport

Stage 1 – Symptom limited activity

Stage 2 – Light aerobic exercise

Stage 3 – Running or skating drills. No head impact activities.

Stage 4 – Non contact training drills

Stage 5 – Following medical clearance, participate in normal training activities

Stage 6 – Return to sport

Return to school

Stage 1 – Daily activities at home that do not exacerbate symptoms

Stage 2 – School activities

Stage 3-  Return part time to school

Stage 4 – Return full time

What we offer at the Athlete Centre

1. Sideline management/assessment of SRC – we provide event medical coverage to ensure all injuries are managed quickly, safely and effectively.
2. Baseline testing and post injury testing – we use ImPACT computerized testing that has been show to be a valid and reliable tool.  
3. Rehabilitation – we will assess your injury and include if necessary, cervical spine treatment, soft tissue injury management and supervised sub maximal exercise training.
4. Collaboration with your school and other health care practitioners.

Heads up!  Keeping athletes healthy to participate in sport is our main priority.  Contact us if you have any questions!

Consensus statement on concussion in sport – the 5th international conference on concussion in sport.  Berlin, October 2016: http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097699