In Hong Kong and elsewhere, athletes of all sports are at a risk for concussion.
This week I have observed a couple head or collision injuries while playing and watching sports. I have observed that many event staff, coaches, parents and players are not sure of what to do when one occurs. Collisions, clashes of heads and falls can cause head and neck injuries. One of the most serious injuries that can happen is a concussion. Some of the most recent events where concussions have occurred can be observed below:
Does your HK league or facility have a plan when a concussion occurs?
What is a Concussion?
Concussion is considered a brain injury. A concussion is defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”. (From à McCrory P, Meeuwisse W, Aubry M, et al.. Consensus statement on concussion in sport—the 4th International Conference on Concussion in Sport, held in Zurich, November 2012. Clin J Sport Med. 2013;23:89–117.)
A concussion is defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”
The consensus statement goes further and gives 5 main criteria that defines a Concussion:
- Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘‘impulsive’ force transmitted to the head.
- Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.
- Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
- Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged
What happens to the Brain when a Concussion occurs?
This video from the NCAA has an excellent summary of what happens to the nervous system and brain when a concussion has occurred.
I am a Coach/ Player/Organizer and I have seen an event that may have caused a head injury/concussion.
What should I do?
After observing a head injury (excluding or ruling out a spinal injury), it all starts with a side line assessment. All organizers, coaches or captains should familiarize themselves with the POCKET CONCUSSION RECOGNITION TOOL (CRT). The pocket CRT has all the basic questions needed to suspect a concussion. If a concussion is suspected, the player is referred to a health professional such as a physician or Chiropractor, for diagnosis and guidance as well as return to play decisions. This form, seen below, is the most basic way to know the signs and symptoms of a concussion and to perform a brief assessment.
“All organizers, coaches or captains should familiarize themselves with the POCKET CONCUSSION RECOGNITION TOOL (CRT)”
Click here for the pocket concussion recognition tool
“If a concussion is suspected, the player is referred to a health professional such as a Physician or Chiropractor, for diagnosis and advice for return to play. “
Other things to watch out for:
- Symptoms—somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional symptoms (eg, lability);
- Physical signs (eg, loss of consciousness (LOC), amnesia);
- Behavioural changes (eg, irritability);
- Cognitive impairment (eg, slowed reaction times);
- Sleep disturbance (eg, insomnia).
Remember, if you are not sure if you, or your player has sustained a concussion, it is best to be cautious and remove them/yourself from play. A player with suspected concussion should not be allowed to return to play on the day of injury. A detailed assessment should be provided for the injured athletes as soon as possible
“If you are in doubt, sit them out!”- CDC
Once the player is removed, what next?
The SCAT3 and/or other sideline assessment tools should be completed by a licensed healthcare provider in as quickly as possible. A full physical, compete with an neurological assessment should also be completed. Also, don’t leave your friend or player alone. Help them home and check on them over the first few hours following their head injury. Monitoring the signs and symptoms is essential over the initial few hours following a suspected concussion.
“Monitoring the signs and symptoms is essential over the initial few hours following a suspected concussion.”
Ordering advanced imaging (CT/CAT/MR/MRI) may be required to rule out any fractures, bleeding on the brain or significant damage. Research has shown that brain CT or MRI contributes “little to concussion evaluation” . If a patient is going through prolonged or worsening, signs and symptoms, imaging may be required.
A concussion has been ruled out by my doctor, yet I still experience neck and headaches, what could be the problem?
Other soft tissue conditions may be contributing to your neck and headaches. The “whiplash” type mechanism of a head injury can cause injury to the soft tissues: muscles, tendons, joints, bones and nerves. Chiropractors can help determine if you have a concussion as well as other soft tissue injury.
Does your school / football / basketball / boxing / jiu-jitsu / rugby league have a concussion plan in place?
Chiropractors can help educate your students, parents, athletes and members on what to do in case of a suspected concussion. I am able to provide presentations on signs, symptoms and management for concussions in Hong Kong and Asia. Do not hesitate to contact me if you have questions on education or treatment of concussions.
Play safe!