Concussion Management

By Dr. Steve Keeler, National Team Physician, Swimming Canada

A concussion is a disturbance in neurological function caused by a direct or indirect force to the head. This impairment usually resolves rapidly, however in some cases signs and symptoms may evolve over time after injury. It results in a variety of non-specific signs and/or symptoms (examples below) and most often does not involve loss of consciousness. Concussions should be expected in the presence of any of the following signs and/or symptoms post injury.

 Basic Principles of MANAGEMENT

1. If an athlete sustains a significant impact to the head, face, neck or body and demonstrates any of the visual clues or reports any symptoms of a suspected concussion, it is the responsibility of all stakeholders – athletes, parents, coaches, officials and IST members to report their concerns to medical staff.
2. If concussion is suspected, the athlete must be removed from training/competition and evaluated as soon as possible. Even if the athlete becomes asymptomatic, they should not return to sport on the same day of injury.
3. Athletes suspected of concussion should not be left alone until medically assessed. Serial monitoring may be required as concussive symptoms can evolve over time.
4. More urgent assessment is required if any of the following “Red Flags” occur post injury – worsening headache, repeated vomiting, progressive drowsiness, inability to be awakened, unusual behaviour, seizures, numbness in arms and legs, slurred speech, and neck pain.
5. Athletes require clearance to return to training/competition by a sport medicine physician familiar with the management of concussion. Allied health professionals are often included in this decision. Athletes cannot be cleared to return by coaches or paramedical staff.
6. Complete rest, both physical and cognitive, is recommended in the first 48 hours post concussion.
7. Avoid alcohol, sleeping tablets, ASA, anti-inflammatories and other medications unless medically approved.
8. Swimming is considered a low risk sport, with relatively infrequent occurrence of concussion. At this time, baseline preseason screening is not recommended in swimming athletes.
9. Remember, it is better to be safe. Consult medical staff is concussion is suspected.

Return to Sport

Concussion recovery varies considerably for athletes and is influenced by many factors. A sport medicine practitioner with experience in this area should guide Return to Play (RTP) decisions. Access to a multidisciplinary team may be required. A return to school strategy may be required prior to resumption of sport. Return to school and sport protocols often require an individual plan depending on the athlete and sport. Appendix A and B provide a basic template to guide these decisions. Information on RTP can also be found on both the Child SCAT 5 and Adult SCAT 5.

It is recognized that concussion management and guidelines currently recommended may change over time as medical science evolves. Current management principles are well outlined in the 5th International Conference on Concussion in Sport, Berlin 2016.

Useful Resources

Parachute Canada – A National organization providing educational material on concussion. Recently developed a Canadian guideline on concussion in sport.

Sport Concussion Assessment Tool 5 – A standardized tool for evaluating concussions. Useful for medical and allied healthcare professionals.

Child Sport Concussion Assessment Tool 5 –  A standardized tool for evaluating concussion for ages 5-13 years. Useful for medical and allied healthcare professionals.

Concussion Recognition Tool 5 – Tool to help identify concussion in children, adolescent and adults.

Consensus Statement on Concussion in Sport – From The 5th International Conference on Concussion in Sport held in Berlin, October 2016.