Analysis: here’s why good concussion management is essential in sport at all levels

By Enda Whyte and Siobhán O’Connor, DCU

(1) How does concussion happen in sport?

It happens when forces are applied to the brain either directly (e.g. a “blow” to the head) or indirectly (transmitted to the brain from elsewhere in the body such as a strong shoulder charge). This causes the brain to shake forward and backwards or to rotate within the skull and leads to an injury which primarily affects the function of the brain.

(2) What happens when someone is concussed?

A series of events are triggered after the injury. Blood flow to the brain can decrease by as much as 50%, causing an “energy crisis”. The “shaking” of the brain stretches nerves, disrupting normal impulse transmission. Cells within the brain have to work harder to maintain normal function, compounding the energy crisis. This is why symptoms develop over time and worsen when a greater demand is put on the brain, for example when reading or concentrating.

From RTÉ Radio 1’s Today show, Dr Siobhan O’Connor on her DCU team’s report into young GAA players and concussion

(3) How do I know if someone has sustained a concussion?

There is no single test (yet) to detect concussion so it is based upon the signs and symptoms that an athlete displays. An athlete may appear slow getting back up, unsteady on their feet or hold their head. The athlete may feel sick, dizzy, tired, have a headache and difficulty remembering or focussing. It is important to know that an athlete does not have to lose consciousness to be concussed. The Concussion in Sport group developed a useful recognition tool to assist athletes, parents and coaches.

(4) What should I do if I think an athlete is concussed?

He/she should not continue to play and should be monitored for at least one to two hours. He/she should be assessed by a doctor, certified athletic therapist or a specially trained physio.

Serious injuries (such as a brain haemorrhage or spinal injury) can present in a similar way to a concussion so it is important to watch out for the following symptoms: severe or increasing headache, double vision, loss of consciousness or increased drowsiness, vomiting, weakness or tingling/burning in the arms or legs, neck pain or tenderness, becoming increasingly restless, agitated or combative or developing seizures. If you notice these symptoms and a medical professional is not present, the athlete should be brought to hospital right away.

From RTÉ Radio 1’s Drivetime, concussion in sport specialist Dr Barry O’Driscoll on the links between football and dementia

Advice in the case of a suspected concussion includes resting for the first 24 hours approximately, not driving until medically cleared, avoiding alcohol and prescription or non-prescription drugs without medical supervision (specifically sleeping tablets and aspirin, anti-inflammatories or stronger painkillers) and not returning to sport until medically cleared.

(5) If the athlete says they’re OK to continue, should they be allowed?

Although concussion awareness is good in adolescent Gaelic games athletes and nearly all athletes would not want their teammates to continue playing, almost two thirds admitted to playing with a suspected concussion, particularly if it was in an important game. It is imperative that the decision to continue play is not left up to the athlete as their ability to think clearly can be affected by a concussion. If an athlete, particularly an adolescent, sustains another concussion before they have recovered from the first, it may lead to a condition called second impact syndrome, which can be fatal. Although this is very rare, it led to the tragic death of Ben Robinson in 2011. Also, continuing may prolong an athlete’s recovery from concussion and can increase the likelihood of sustaining other injuries.

(6) Can concussions resolve by themselves?

Although the majority of concussions will resolve with a structured approach to returning to work, school and sport, no two recoveries are the same and some athletes will have prolonged symptoms. Adolescents and children or people who have a history of concussion, motion sickness, migraines, vertigo or ADHD can take longer to recover. Therefore, the return to play guidelines for different sports are exactly that, guidelines.

From RTÉ Radio 1’s Drivetime, the GAA Medical, Science and Welfare Committee’s Dick Clerkin and former Tyrone All-Ireland football winner Diarmuid McNulty on the GAA guidelines on concussion

(7) Can you get treatment for concussion?

Yes, particularly for those with persistent symptoms. Treatment is based upon the individual clinical presentation. Some athletes benefit greatly from rehabilitation targeted at the inner ear, eyes, neck and migraines, or from specific medication. A good diet and regular sleep patterns are also important to assist recovery. Gradual increases in aerobic exercise (after an initial 24 to 48 hours) can be very beneficial under the guidance of your doctor, certified athletic therapist or a specially trained physio.  

(8) When can I return to sport?

The energy crisis in the brain following concussion is like a car stuck in second gear: things may be fine when it’s going slowly but problems become more apparent when you speed up. Therefore, it is really important that the sport specific, gradual return to sport protocol is completed under guidance from a healthcare professional. This consists of a number of stages which can only be progressed after a minimum of 24 hours if symptoms aren’t reproduced. It has been found that even if athletes feel better in 7-10 days, other signs take up to 4 weeks to clear. Although some adult sports guidelines technically allow return to play in 7 days, this should be seen as the absolute minimum rather than a target.

(9) Will there be long-term effects?

If managed properly most people will recover without any long lasting effects. A small number of athletes can develop post-concussion syndrome with persistent symptoms. These athletes often respond well to targeted treatment. There have also been links with repeated concussions and degenerative brain conditions such as chronic traumatic encephalopathy as highlighted in the film Concussion. Although it is difficult to prove a direct cause and effect, it emphasises the importance of good concussion management in sports.

Dr Enda Whyte is an Assistant Professor in Athletic Therapy and Training at the School of Health and Human Performance at DCU. Dr Siobhán O’Connor is an Assistant Professor in Athletic Therapy and Training at the School of Health and Human Performance at DCU. She is a former Irish Research Council awardee.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ