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Recognition of Concussion in Sport

10 Nov 2016
We all have some appreciation of what a concussion is. You may have experienced a concussion yourself playing sport, and most sports fans are familiar with a variety of phrases associated with concussion and its effects. The phrases ‘he/she got knocked out and now has a concussion’ or ‘it was only a small concussion’ are ubiquitous with contact sports. In the past, concussion was considered benign and it’s symptoms transient. However, in recent years there has been increased awareness within the scientific and sporting communities about the potential long-term effects of concussion on brain function.

What is concussion? According to neurologist and brain injury expert Dr Paul McCrory “Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces…”. This quote summarises an important paradigm shift in sports medicine, towards a consensus that concussion is a type of brain injury rather than a temporary loss of brain function.

Think of the brain suspended in fluid (cerebrospinal fluid). If you shake the head the brain will still move, like a yolk in an egg. The harder you shake it the more potential there is for an injury. Unlike a structural brain injury, concussion cannot be detected on imaging. Concussion happens at a cellular level and affects brain function with full resolution of symptoms occurring between seven and 10 days following injury. For a small percentage of people, concussion symptoms can remain for weeks, months and even a year following injury. These individuals may be more susceptible to developing long term problems in brain function. If you are interested in further reading in this area you can look at The Australian Brain Institute's first issue of their magazine which was dedicated to concussion. The issue highlights some prominent case studies of Australian elite athletes with concussion and summarizes the latest concussion research

What can you do as a coach, parent, athlete or health professional? The first step is to recognize and respect concussion. A great resource to know about is the pocket concussion tool, which was developed by concussion experts around the world. This tool helps players, coaches and trainers recognize concussion and justify not returning to play on the day of injury. The pocket concussion tool does not diagnose or assess severity of concussion and is not a substitute for a medical examination. The pocket concussion tool can be accessed via the British Journal of Sports Medicine website (http://bjsm.bmj.com/content/47/5/267.full.pdf)

Concussion-related symptoms may not only involve the brain. Soft tissue injury to the neck and shoulders can occur at the same time as the brain injury. Treatment of these sources of pain and stiffness by a qualified health professional such as a physiotherapist or myotherapist can aid in the management of concussion. Soft tissue therapy plays an important role in this treatment. The key window of time after a concussion (i.e., 7-10 days) is a perfect time to assess balance, strength and treat soft tissue injury or joint dysfunction.

References

McCrory, P et al. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5), 250-258.




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