What is Concussion?

The Australian Sports Commission defines concussion as ‘a traumatic brain injury induced by biomechanical forces’ 

How to Recognise Concussion:

The recognition of concussion can be difficult, it is important to know when and how to suspect concussion as appropriate response and management can help prevent further injury or even death.

There are several possible symptoms and signs, they can be subtle and are not only specific to concussion.

Signs & Symptoms:

 The signs of concussion vary and may be difficult to detect, for example athletes may:

• Appear normal but seem vacant, dazed or stunned
• Be disorientated and unable to recall details e.g. time, place, scores etc. 
• Ask repeatedly about what happened
• Have difficulty concentrating and answering specific questions

Loss of consciousness, seizure or balance difficulties are clear signs that an athlete has sustained a significant injury, urgent medical support is critical in these circumstances.

Critical symptoms:

• Neck pain
• Increasing confusion, agitation or irritability
• Repeated vomiting
• Seizure or convulsion
• Weakness or tingling/burning in the arms or legs
• Deteriorating conscious state
• Severe or increasing headache
• Unusual behavioural change
• Double vision

Obvious symptoms:

• Loss of consciousness
• No protective action in fall to ground directly observed or on video
• Seizure or jerky movements after a knock
• Confusion, disorientation
• Memory impairment
• Unsteady on feet or balance problems
• Athlete reports significant, new or progressive concussion symptoms
• Dazed or looking blank/vacant
• Changed behaviour - may be more irritable, agitated, anxious or emotional than normal

Subtle symptoms:

• Headache
• Pressure in the head
• Neck pain
• Nausea or vomiting
• Dizziness
• Blurred vision
• Balance problems
• Sensitivity to light
• Sensitivity to noise
• Feeling slowed down
• Feeling like ‘in a fog’
• Don’t feel right
• Difficulty concentrating
• Difficulty remembering
• Fatigue or low energy
• Confusion
• Drowsiness
• More emotional
• Irritability
• Sadness
• Nervous or anxious
• Trouble falling asleep (if applicable)

What to do for Suspected Concussion:

First-aid principles apply. Neck injuries should be suspected if there is any loss of consciousness, neck pain or a mechanism that could lead to spinal injury. Athletes in this type of situation shouldn’t be moved without guidance from appropriately trained individuals.

To assist the treating health practitioner, it is helpful to note the following details at the time of the injury:

• When: What time did the injury take place?
• How: How did the injury occur? For example, is the injury from a knock to the head by a cricket bat or by the opponent’s shoulder?
• Where: Where on the body was hit? For example, the temple, shoulder or back of head
• What: What occurred next? Including symptoms such as loss of consciousness, convulsions, amnesia, vomiting or confusion 
• Additional useful information: Any further symptoms such as behavioural changes or loss of memory.

Diagnosis of Concussion:

Concussion is often an evolving injury, therefore, signs and symptoms can change or be delayed reflecting the underlying physiological injury status of the brain. There is currently no specific diagnostic test that confirms the presence or otherwise of a concussion. Concussion remains a clinical diagnosis, which is identified based on a person’s history, symptoms and signs on physical examination by a qualified medical practitioner.

How to Manage Concussion:

Any athlete with suspected or confirmed concussion should:

• Remain in the company of a responsible adult
• Not be allowed to drive
• Be advised to avoid alcohol
• Check their medications with their doctor 

Specifically, concussed athletes should avoid:

• Aspirin 
• Anti-Inflammatories (e.g. ibuprofen, diclofenac or naproxen)
• Sleeping tablets
• Sedating pain medications

If diagnosed with concussion, athletes require immediate physical and mental rest, allowing the brain to recover.

To properly rest, time off school or work may be needed. Mental rest may include refraining from playing computer games, reading and watching television.

Mental Health and Concussion:

Long Term Consequences of Concussion:

Under-reporting of Concussion:

Concussion Glossary:

Concussion: 

• Australian Sports Commission: A traumatic brain injury induced by biomechanical forces
• The United States Centres for Disease Control and Prevention description: A concussion is a type of traumatic brain injury - or TBI - caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

Sub-Concussion: 

Term used to describe head impacts that do not cause the person to experience acute symptoms after a hit to the head. Similar terminology: sub-concussive events, episodes, knocks and blows

Repeated Head Trauma (RHT): 

Broad term encompassing concussions and sub-concussions - Includes head impacts that lead to a concussion or mild traumatic brain injury, as well as head trauma that does not cause an individual to experience any subsequent symptoms

Chronic Traumatic Encephalopathy (CTE): 

Brain Injury Australia overview: Chronic traumatic encephalopathy (CTE) is a progressive degenerative neurological disease. Researchers who have found evidence of CTE in brains of retired athletes state that it “results in a progressive decline of memory and cognitive, as well as depression, suicidal behaviour, poor impulse control, aggressiveness, parkinsonism, and, eventually, dementi

Additional Resources: