About Concussions

About Concussions

SIRC (Sport Information Resource Centre)

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There is a lot to know about concussions and their proper management. This section deals in depth with the most common issues associated with concussions.

  • What is a concussion?
  • What actually happens?
  • How do concussions occur?
  • Who should the athlete tell?
  • What are the signs and symptoms of a concussion?
  • When should an ambulance be called?
  • How are concussions diagnosed?
  • When can the athlete return to play?
  • Are there different return-to-play guidelines for different sports?
  • What is the role of the coach / instructor in the case of youth athlete’s return to play?
  • How can we prevent concussions?

What is a concussion?
A concussion is a common form of brain injury and can be caused by a direct or indirect hit to the head or body. Rapid movement of the head, such as whiplash, can also cause a concussion. In a concussion, there is a change in the brain function, which results in a variety of symptoms. With a concussion, there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal. Your brain still looks fine, but it does not run normally.

What actually happens?
When a person suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull’s bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bony protuberances inside the skull. Such force can also result in a rotational injury in which the brain twists, potentially causing a shearing of the brain nerve fibres. It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself, but how the brain is working. The exact length of this change is unclear. During this time period, the brain does not function normally on a temporary basis and is more vulnerable to a second head injury.

How do concussions occur?
Most concussions in curling occur as a result of falls on the ice either the front or back of the head colliding with the surface.

Who should the athlete-curler tell?
It is extremely important to seek medical advice immediately upon receiving a blow to the head or body that results in signs or symptoms of a concussion. Often, concussions can go untreated (and even unnoticed by others) because few symptoms are visible to casual observers. Many times, the symptoms of a concussion may not be identified until the person recovers to the point where increased exertion causes symptoms to worsen. In many cases, curlers do not even know that they have been concussed.

Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive, and emotional changes. You can never be too careful! Symptoms may actually worsen throughout the day of the injury or even over the next day or two. Without proper management, a concussion can result in permanent problems and seriously affect one’s quality of life.

It is important for any curler who has fallen and hit their head (anywhere on club property for that matter) to tell the club administration and to tell a family member, friend, and teammate if they think they have hurt their head. Because a concussion affects the function of the brain and can result in symptoms such as memory loss or amnesia, it is important that others be aware of the signs and symptoms of concussions to help identify the injury in others. If they think they have hurt their head, they should tell someone immediately.

Youth: It’s very important to congratulate youth curlers at this point for being smart and saying they’ve been hurt. They should be removed from play immediately and medical attention should be sought immediately.

What are the signs and symptoms of a concussion?
Following a concussion, curlers may experience many different signs and symptoms. A symptom is something they will feel, whereas a sign is something others may notice. It is important to remember that some symptoms may appear right away and some may appear later. Just as no two people are the same, no two concussions are the same and so the signs and symptoms may be a little different for everyone. Some may be subtle and may go unnoticed by injured players, as well as their friends and family. Contrary to popular belief, most concussions occur without a loss of consciousness. Symptoms may get worse not just during activity, but later that day and the next.

When should an ambulance be called?
Getting a blow to the head doesn’t necessarily mean an ambulance is needed. If a curler loses consciousness or is dazed and confused, or if a neck or back injury is suspected, erring on the side of caution is the right response. It is better to overreact than to underreact.

How are concussions diagnosed?
With a concussion, there is no visible injury to the structure of the brain; meaning tests like MRI or CT scans usually appear normal. Concussions typically resolve fully with proper rest and management in about a week or two, but concussions that are not diagnosed can lead to long-term and more serious health implications. The first and most important step is to consult a doctor, preferably one familiar with concussion management.

There are many potential factors that may help to inform individual diagnosis, concussion management, and recovery, although many of these are still being researched to find the exact link. For example, severity is probably impacted by a number of factors such as history of previous head injuries, including number of past concussions, length of recovery time, timing between past concussions, age, and style of play. Factors such as this may lead to a different, slower recovery, which is why concussion history should always be monitored. Return to activity while still concussed and symptomatic can lead to an increased risk for another concussion, more intense symptoms, and a prolonged recovery.

Diagnosing a concussion may take several steps. A doctor may ask questions about the concussion and sport history and the most recent injury, and will conduct a neurological exam. This can include checking memory, concentration, vision, coordination, and balance.

The doctor may request further tests including a CT scan or MRI; these tests can be important to assess for other skull or brain injury but they do not inform concussion diagnosis. In the majority of concussions, there will not be any obvious damage found on these tests.

Neuropsychological testing: Sometimes the role of neuropsychological testing is important in identifying subtle cognitive (i.e., memory, concentration) problems caused by the concussion and may at times help to plan return to pre-injury activity. In addition, balance testing may be required. Usually these are arranged by an expert.

When can a youth player return to school?
Sometimes youth who have a concussion may find it hard to concentrate in school and may get a worse headache or feel sick to their stomach if they are in school. They should stay home from school if their symptoms get worse while they are in class. Once they feel better, they can try going back to school at first for half days and if they are okay with that, then they can go back full-time.

When can a player return to the curling ice? — Return To Play
Youth should not return to play until they have completed the Five Steps to Return to Play and have been cleared by their doctor. A concussed player should be removed from activity immediately and should be assessed by a medical doctor. Given that symptoms may worsen later that night and the next day, they should not return to the ice. When children are concussed, their ability to assess their situation may be impaired. Post-concussive symptoms may intensify with an increase in activity, so it is important that return to activity is gradual and monitored/supervised by a medical professional.

 A concussion is a serious event, but you can recover fully from such an injury if the brain is given enough time to rest and recuperate. Returning to normal activities, including sport participation is a step-wise process that requires patience, attention, and caution. Each step must take a minimum of one day but could last longer, depending on the player and his or her specific situation.