Concussion - Fact Sheet
Dr Ryan Kohler explains how to keep
our athletes safe on and off the field from concusion - the mildest
form of traumatic brain injury.
Concussion is a disturbance in the ability of the brain to take in
and process information. The slower function of the brain
represents damage to nerve cells (neurons). The neurons can be
damaged by a direct blow to the head, which causes the brain to
collide with the skull. Indirect impact to the body can transfer an
impulsive force to the brain and have a similar outcome.
The effect varies from athlete to athlete, producing signs that
depend on which part of the brain has been affected. Concussion
signs visible to others at the time of the collision include:
- Loss of consciousness / unresponsiveness
- Upper limb muscle rigidity
- Upper limb spontaneous movement
- Loss of overall body tone
- Loss of control of the neck ("rag doll effect")
- A fit / seizure soon after contacting the surface
- Balance difficulty
- Slow responses
- Vacant stare
- Holding the head
- Facial injury
- Speech slurring.
After the impact injury, the athlete can start to feel unwell as a
group of symptoms start to randomly present themselves. The athlete
may complain of:
- Nausea / vomiting
- Blurred vision
- Memory loss / difficulty
- Not feeling right
- Intolerance of bright light & loud noise
- Sleep difficulty
- Poor attention & concentration
- Sad or irritable or frustrated
- Lethargic, low motivation
- Slow reaction time.
How common is concussion in
1.6 to 3.8 million concussions occur in sport per year in the
United States. Across football codes in Australia, the probability
of concussion is approximately 1 in 10 across all sports.
It is recognised that most concussions get better in seven to 10
days. However, ignoring concussion signs and symptoms or not
recognising them, can result in potentially catastrophic
consequences. Acute brain swelling, traditionally referred to as
"second impact syndrome" is usually fatal. Prolonged symptoms,
recurrent concussion, learning difficulties, and personality
problems have also been reported. A recent study showed how the
recovery time from concussion became longer with each
What should parents, coaches and
administrators do before the season?
Secondary prevention can be explained as effective preparation.
Gathering baseline information on the athlete is able to provide
the first step to effective post concussion treatment.
The important components of concussion screening are:
- Baseline brain function testing with Axon Sports
- Baseline symptom assessment
- Baseline balance testing.
What should parents, coaches and
administrators do at the event?
Use available resources to recognise or suspect concussion. Any
athlete with suspected concussion must be withdrawn from the event
or training immediately. Furthermore, no athlete with concussion or
suspected concussion should return to the same event or practice
that day. ALL athletes with concussion or suspected of concussion
need a formal medical assessment in the soonest possible
Before getting to a medical doctor, be on the lookout for signs of
serious neck or head injury. Protect the athlete's neck and secure
an open airway when the athlete is not responsive.
Urgent hospital referral is necessary for any athlete who has lost
consciousness as a result of a blow to the head or body.
Indications for urgent referral to hospital include:
- Fractured skull
- Penetrating skull trauma
- Loss of consciousness
- Deterioration in conscious state following injury
- Increasing confusion
- Worsening headache post injury
- Persistent vomiting
- Any convulsive movements
- Focal neurological signs
- More than one episode of concussive injury in a match or
- All children with head injuries
- High-risk patients (e.g. hemophilia, anticoagulant use)
- High-risk injury mechanism (e.g. high velocity impact, missile
- Inadequate post injury supervision.
See a medical doctor as soon as
A concussed athlete should see a medical doctor with experience in
managing concussion as soon as possible after the impact. The
medical doctor should see the athlete on a number of occasions,
performing serial assessments. At the first visit, the doctor will
do a full neurological examination and document current
It is recommended that balance testing and computerised brain
function testing be repeated and compared to the baseline test
Recovery from concussion may take longer in younger athletes under
18 years of age, therefore a conservative approach to playing sport
again should be followed in these cases.
How does the athlete get back to
Athletes should only return to high intensity exercise when their
symptoms have gone away and cognitive function has returned to
Once the athlete feels better after about 72 hours, some low
intensity exercise in the form of vision and balance training can
Progression of exercise challenge can occur every 24 hours. If
athletes start to feel unwell during or after exercise, they should
rest for 24 hours and then attempt the same exercise challenge.
Only when an athlete has completed all the stages of exercise
challenge can they obtain written medical clearance from a medical
doctor. The athlete should give this medical clearance to their
Key messages about
- Two to three players in your team this season will have a
- An athlete does not have to lose consciousness to have a
- Suspected concussion? The athlete must stop playing, and not
return to sport or training that day.
- Symptoms can evolve over time - keep monitoring the athlete for
at least 72 hours.
- All athletes with suspected concussion should see a medical
doctor as soon as possible.
References and further information
Sports Concussion Australasia specialises in providing
Concussion Management Systems to organisations, schools and clubs.
for handy information and resources for parents and coaches such as
the new App and wallet card key tag.