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What is a Sport-Related Concussion?
According to the Concussion in Sport Group’s 5th international conference, held in Berlin in October 2016, the current definition of an SRC involves the following four criteria:
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A direct or indirect trauma anywhere on the body with a force transmitted to the head;
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Rapid (seconds to minutes) or delayed (minute to hours) symptom presentation, typically with spontaneous resolution;
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Negative standard neuroimaging (computerized tomography (CT) or magnetic resonance imaging (MRI)), reflecting a functional rather than structural injury;
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With or without loss of consciousness, with stepwise resolution of symptoms.
What is Post-Concussion Syndrome?
While the majority of SRCs are resolved within 2–3 weeks, symptoms may persist for months. This clinical scenario is most aptly termed post-concussion syndrome (PCS). Common signs and symptoms include:
| Physical Signs |
Mental Signs |
Headache
Ringing in the Ears
Nausea/Vomiting
Fatigue
Drowsiness
Blurry Vision
Balance Problems
Trouble Sleeping
Light Sensitivity
Noise Sensitivity |
Difficulty Concentrating
Difficulty Remembering
Low Energy
Confusion
Drowsiness
Emotional
Irritability
Sadness
Nervousness
Anxious/Anxiety |
Treatment
Once an athlete is suspected of having an SRC, they are removed from play and precluded from returning to play for the remainder of the day. “When in doubt, sit them out!” The initial diagnosis is made by a medical provider, usually sideline-based certified athletic trainers (ATCs), and is largely driven by clinical signs and symptom endorsement. Diagnosis is helped further by enlisting someone familiar with the player’s baseline personality and affect in order to judge deviations from baseline. The general consensus on treatment is that athletes should rest for 1–2 days, both mentally and physically, to minimize energy demands to the brain and allow post-concussive symptoms to resolve. Athletes should take a more active approach to recovery, gradually increasing their physical and cognitive activity level as much as possible without experiencing recurrent symptoms. A Return to Play (RTP) protocol is implemented following return to neurologic baseline. It is suggested that this occur after completing a Return to Learn (RTL) protocol, which is the resumption of classroom learning with tolerable or resolved symptoms.
Return to Learn (RTL)
- Implementing appropriate instructional strategies
- Collaboration between ATCs, parent, other medical providers, counselor/DSS, admin and teachers important when identifying and implementing instructional supports
- Recommendations should be based on clinical evaluation and student-reported symptoms
- Teacher feedback is very helpful in determining which strategies are most appropriate and effective
- Progressive RTL Protocol
- Phase 1: Cognitive and physical rest at home
- Phase 2: Light cognitive activity at home
- Phase 3: Maximum instructional modifications/supports, limited school attendance
- Phase 4: Moderate instructional modifications/supports, limited school attendance
- Phase 5: Minimal instructional modifications/supports, full school attendance
- Phase 6: No instructional modifications/supports, full school attendance, full academic load
Return to Participation (RTP)
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Stage 1: Activity limited by symptoms; introduction of daily activities (physical & cognitive) that do not provoke symptoms.
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Stage 2: Light aerobic exercise of low intensity; elevation of heart rate above baseline activity with actions such as walking or cycling at a leisurely pace.
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Stage 3: Exercise specific to sport; begin sport-specific movement such as running; contact strictly avoided.
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Stage 4: Training without contact; resume drills with continued strict avoidance on contact with the goal of resuming coordination.
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Stage 5: Resumed full contact practice; participate in practice drills including contact. Close monitoring is suggested.
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Stage 6: Full return to play; resume normal participation in the sport
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