A concussion occurs when your soft, jelly-like brain shakes inside your hard, bony skull. Our brain is cushioned by layers of liquid inside the skull, but a blow to the head or body can still cause the brain to move. Sometimes it moves forwards, sometimes backwards, sometimes in both directions; it can also move rotationally. (Concussio is a conjugated form of a Latin verb that means "to shake together, to agitate").
Concussion vs TBI
A concussion is a mild traumatic brain injury. "Mild" is one of three categories - the other two are "moderate" and "severe".
Our risk of brain injury increases with each subsequent concussion. That having been said, everyone is different and symptoms and recovery trajectories vary widely from person to person.
Recovery, downtime, rest...
Research and protocols nowadays recommend a "wait and see" / "when in doubt, sit them out" approach.
Second impact syndrome
The death of Rowan Stringer in Ontario due to second impact syndrome garnered national headlines. She was a rugby player who died when she sustained her second concussion in a week. Second impact syndrome occurs when there is a second concussion before the first injury event has healed. Too often, many of our children, youth and adults re-engage too soon and/or too fast after a potential brain injury event.
Not recognizing; hiding symptoms; not reporting
Scott Delaney, Associate Professor at McGill and team physician for the Montreal Alouettes, Montreal Impact, McGill football and men’s and women’s soccer teams, studied 469 university athletes over 12 months. His research revealed that 20 per cent believed they had suffered a concussion, yet 80 per cent of those concussed decided not to consult with a medical professional and chose to continue playing. Delaney created a concussion contract to be signed by athletes, coaches and team therapists before the start of the season. The contract outlines a concussion symptom checklist and protocol as to when athletes are eligible to return to play, which is read and signed, signifying an understanding of the impact of concussions and their long-term effects on physical and mental wellbeing. Also agreed upon is that athletes be removed from play should a concussion be suspected and only return once they are able to function in the classroom at pre-concussion capacity and play and practice symptom-free. (See below in this section for educational resources on this topic.)
Delaney says signing the contract at the beginning of the season sets the tone and removes the pressure and pushback that doctors and therapists are often subjected to when an athlete is suddenly pulled off the field of play after a suspected concussion.
Physical changes in the brain
What many people do not understand is that when a concussion occurs, there are a number of physiological and chemical changes that happen in the brain. Giza and Hovda wrote a literature review published in the Journal of Athletic Training (Jul/Sep 2001, pp. 228-235) titled "The Neurometabolic Cascade of Concussion", and mentioned "abrupt neuronal depolarization, release of excitatory neurotransmitters, ionic shifts, changes in glucose metabolism, altered cerebral blood flow, and impaired axonal function" as primary elements of a concussive brain injury. That's a lot happening that we cannot see. If you want to know more, I am happy to help. There is a lot of information out there.
What to look for
First of all, know that individual responses can be different. Some people have experienced brain trauma from a seemingly innocuous event. Others have big bails and exhibit no apparent consequences. Sometimes, it takes a few days before there is recognition that something is wrong.
Despite the individuality of each injury, there are common themes:
- Can’t recall events prior to or after a hit or fall.
- Appears dazed or stunned
- Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
- Moves clumsily.
- Answers questions slowly.
- Loses consciousness (even briefly).
- Shows mood, behavior, or personality changes.
- Headache or “pressure” in head.
- Nausea or vomiting.
- Balance problems or dizziness, or double or blurry vision.
- Bothered by light or noise.
- Feeling sluggish, hazy, foggy, or groggy.
- Confusion, or concentration or memory problems.
- Just not “feeling right,” or “feeling down”.
Sourced from: Centers for Disease Control and Prevention
Here is another source providing information on mild TBI symptoms.
BVBIAs list of symptoms
I have spoken with people who have experienced one, a few, and/or many concussions and / or brain injuries. Most find it reassuring to see that what they are experiencing is a recognized symptom. For some people, the changes on this list are temporary and they will return to previous levels of functionality. For others, the changes are permanent, and their challenge is to adjust and live with a "new normal".
Education, learning, capacity building
It is true that in recent years, concussions have come online as something to which amateur athletes, coaches, and parents need to pay attention. However, there is still a large gap in between theory and knowledge. Many people's understanding of concussion is old-school, out of date, and not immediately accessible. Let's remedy that!
- Created by a leading UBC researcher, the Concussion Awareness Training Tool takes about a half hour. A child who reads at a grade three level could do it, and I encourage parents to do it with their athletes.
- Concussion 101, A Primer for Kids and Parents is a five minute video and is an entry-level peek.
- The follow-up video, Concussion Management and Return to Learn, talks a bit more about recovery and a step-wise re-engagement plan. (It isn't just for kids; it could also be titled "Return to Work").
- The Centers for Disease Control and Prevention Heads Up page has a plethora of information. It is another fantastic resource for parents, coaches, teachers and child-care providers.
- For pdfs, check out Parachute Canada's Things to Know About Concussions and HealthLink BCs Concussion page.
Get it! Use it! Live it! We have hundreds of these pocket concussion tools to give away. Please contact us and find out how to access some. Please also consider whether we can help you inform your parents, coaches and athletes.
Our brain loves activity, and staying home out of fear isn't a path to health and happiness. We want to help people play hard and play smart. We want to support a lifetime of physical activity. Educating about concussion and supporting a full recovery is our responsibility.