Concussion 101

By: Jacquie Van Ierssel PT, PhD(c), FCAMPT, SPC Diploma

What is a Concussion? What's the Best Way to Manage it?

What is a Concussion?

A concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces (McCrory et al., 2013). It may be caused by a direct blow to the head, or an indirect force imparted elsewhere in the body. Loss of consciousness is not necessary for a diagnosis of concussion.

Helmets Don’t Prevent Concussion

Technology has advanced in development of helmets as an essential piece of protective equipment to prevent skull fractures in contact sports. However, how much padding can protect the brain from sloshing around inside the cranium when struck by a rotational force? According to American Academy of Neurology, football helmets only reduce the risk of traumatic brain injury by 20%. Enforcing rules, respect in sport, decreased head contact, and policy changes are much more effective tools in preventing concussion.

Concussions Cannot be Diagnosed by CT or MRI

One of the greatest challenges we face is that concussion is an invisible injury that is often under-reported or misdiagnosed. Standard structural neuroimaging appears normal following concussion, and does not help in diagnosing the injury.  

Most Concussions Resolve in Less than 4 Weeks

80-90% of athletes experience full recovery within the 7–10 days following a concussion. Recovery time for children and adolescents is about 3 weeks. Athletes with a history of previous concussions, increased number of symptoms following each concussion, and increased time to recovery following each subsequent concussion may take longer to recover. Think of this early stage as a “window of opportunity” to allow the brain to heal. Symptoms that persist beyond 4 weeks may meet the diagnostic criteria for post-concussion syndrome.

Management of Persistent Symptoms

Post-concussion syndrome is best managed by a multidisciplinary approach. For national guidelines, view the Guidelines for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms.

Return to Learn

It is widely agreed that student athletes should return to the classroom and all social activities before returning to play. Both cognitive and physical rest are the cornerstone of concussion management, so often a few days rest from school is indicated. A gradual reintroduction of cognitive activities is recommended with frequent breaks and modifications to learning expectations and environment as needed. For a step-wise Return to Learn protocol, see the CATT online training tool.

Return to Play

No athlete suspected of sustaining a concussion should return to play the same day. Once an athlete is symptom free, they should follow a stepwise exercise protocol to RTP, waiting 24 hours between steps. If symptoms return, the athlete should return to the previous step until they are again symptom-free. For more details, see the Zürich RTP protocol.