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Concussion Information

Learn how to recognize and respond, concussions can happen to anyone.

What is a Concussion?

A concussion is a mild traumatic brain injury that affects brain function. It is caused by an impact or forceful motion of the head, neck, or body, resulting in rapid movement of the brain within the skull.

 Doctor and Patient
Football tackle

Sport Related Concussion (SRC)

"A SRC is defined as a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain. Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged." Learn more about the ‘12 Rs’ of a SRC.

Recognize

Recognizing the signs and symptoms of a concussion is important because a concussion doesn’t show up on imaging like an X-ray, CT, or MRI scan and there is no objective test, like drawing blood or saliva, that can determine if an individual has a concussion. If someone experiences an impact to the head, face, neck, or body, and either shows observable signs or reports symptoms of a potential concussion, it's crucial to consider the possibility of a concussion.

 Athlete hurt on the field
Referee stopping play

Suspected Concussion

In all cases of suspected concussion, the person should stop the activity right away. Continuing increases their risk of more severe, longer-lasting concussion symptoms, as well as increases their risk of other injury.

Respond

It's essential that anyone suspected of having a concussion be removed from the activity immediately and undergo medical assessment as soon as possible. Depending on the suspected severity of the injury and access to medical services, an initial assessment may be completed by emergency medical professionals or by an onsite licensed healthcare professional, where available. In cases where any red flags are present, emergency medical assessment by emergency medical professionals should take place.

 Doctor and patient

The Body (Physical)

  • Dizziness
  • Headache
  • Sick to the stomach
  • Pressure in the head
  • Balance problems
  • Sensitive to light or noise
  • Blurred vision
  • Nausea or vomiting
  • Ringing in the ears
  • Drowsiness

Person with a headache

Thinking (Cognitive/Mental)

  • Confused
  • Not thinking clearly
  • Feeling slowed down
  • Memory problems
  • Problems concentrating
  • Feeling like “in a fog”

Person thinking

Emotions (Emotional/Behavioural)

  • Irritable
  • Angry
  • Frustrated
  • Nervous or anxious
  • Anxious
  • More emotional
  • Sadness

Person sitting in dark room

Sleep

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Sleeping more than usual
  • Sleeping less than usual

Person looking at clock

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 or seek emergency care immediately.

  • Neck pain or Tenderness
  • Loss of Vision or Double Vision
  • Weakness, Tingling or Burning in Arms/Legs
  • Severe or Increasing Headache
  • Seizure or Convulsion
  • Loss of Consciousness
  • Deteriorating Conscious State
  • Vomiting
  • Increasingly Restless, Agitated or Combative
  • Visible Deformity of the Skull

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

Red Flag Symptoms may be signs of a more serious injury.

Red Flag
Image of clock

Delayed Signs & Symptoms

If an individual is removed from the activity following an impact for cautionary reasons, but there are no observable signs or symptoms of a suspected concussion, then the individual can be returned to the activity but should be monitored for delayed symptoms for up to 48 hours.

Diagnosis

A concussion is diagnosed only by a licensed medical doctor or nurse practitioner. In geographic regions of Canada with limited access to medical doctors and nurse practitioners (i.e., rural, remote or northern communities), a licensed healthcare professional, such as a nurse with pre-arranged access to a medical doctor or nurse practitioner, can facilitate this role.

 Doctor and Patient
Doctor and patient

Medical Assessment

The medical assessment is responsible for determining whether the individual has a diagnosed concussion or not. To provide comprehensive evaluation of individuals with a suspected concussion, the medical assessment must: rule out more serious forms of traumatic brain and spine injuries, rule out medical and neurological conditions that can present with concussion like symptoms, and make the differential diagnosis of concussion based on findings of the clinical history and physical examination and the evidence-based use of adjunctive tests as indicated (e.g., CT scan).

Medical Assessment Letter

Individuals diagnosed with a concussion should receive a Medical Assessment Letter and follow a gradual return to school, work, and sports. Those without a concussion diagnosis should also receive a Medical Assessment Letter and can resume activities without restriction. Since the letter contains personal health information, the individual or their parent/guardian is responsible for providing it to coaches, teachers, or employers.

 Doctor and Patients
Person sleeping in bed

Rest

The first and most important step in recovery from a concussion is to rest for a maximum of 2 days. The Amsterdam Consensus Statement recommends relative rest for only the initial 24 to 48 hours following injury, including limited screen time. Prolonged rest may delay recovery and affect mental health.

Exercise

Returning to light physical activity as tolerated (such as walking) in the initial 48 hours is recommended if there’s no risk of injury. Aerobic exercise within 2 to 10 days after concussion has been shown to help with recovery and prevent symptoms from persisting. Thus, progressive increases in exercise intensity are recommended, according to symptom tolerance levels, as long as there’s no risk (that is, head impact, collision or fall). Slight worsening of symptoms with exercise is acceptable as long as the symptoms improve within 1 hour.

 People walking on sidewalk

Management

Concussion symptoms can be managed by taking breaks and by prioritizing activities to conserve energy. Symptoms can also be managed by supporting quality sleep; naps should be limited to a maximum of 45 minutes per day. Short-term strategies can help manage concussion symptoms. However, these strategies and techniques can slow recovery if used over an extended period of time. A concussion can have a significant impact on physical, cognitive, and emotional functioning. The recovery process involves managing activities in order to not trigger or worsen symptoms—the key is finding the “sweet spot” between doing too much and too little. Caring for a concussion can involve a variety of treatments and a team of health professionals, depending on the symptoms and how a person’s condition improves. Usually, symptoms will go away in 1 to 4 weeks. If you or your child has had a concussion before, or there are other health factors, recovery may take longer. Persistent symptoms should be personalized to the individual and involve a range of licensed health care professionals including occupational therapists, sports therapists, physiotherapists, chiropractors, and psychologists. Prior concussions, a history of headaches, and learning disabilities are all factors which may influence recovery from a concussion and lengthen the recovery period. It is normal to experience symptoms during recovery, and it is normal to feel good one day, and not so good the next. If new or worsening symptoms are experienced at any stage, the person should return to the previous stage until symptoms have improved once again. Wait at least 24 hours before re-attempting the next stage.

Refer

The symptoms of a concussion usually last one to four weeks, but may last longer. If a person has had a concussion before, it may take them longer to heal the next time.

Follow-up with a medical professional if you are worried that the person is not improving or that symptoms are prolonged.

Individuals of all ages who have ongoing (persisting) symptoms for more than 4 weeks should be referred for further evaluation by clinicians that have specialized knowledge in concussion.

Prevention

Although not all concussions can be prevented, there are steps you can take to decrease the risk of sustaining a concussion or reducing the severity of a concussion. It is also not just a one-time effort; it's an ongoing commitment that operates on multiple levels. *Information adapted from: Parachute. (2024). Canadian Guideline on Concussion in Sport. (2nd edition)

Primary Prevention

Prevent the concussion from happening. To prevent concussions, it's important for organizations to make changes across different areas. This includes adjusting the environment where activities happen, ensuring proper equipment and training, setting clear rules, and promoting a culture of safety. Considerations like who is most affected by concussions, how concussions occur, and when and where they happen are vital for understanding and addressing the issue.

Secondary Prevention

Prevent poor outcomes from the concussion. In the event of a concussion, timely recognition, removal from further risk, proper assessment, and management are essential for better outcomes. Establishing evidence-informed concussion policies and protocols can help prevent negative consequences resulting from delays or mismanagement.

Tertiary Prevention

Prevent long-term complications from one or more concussions. Establishing policies for better concussion management can reduce the chances of repeated injuries. Sometimes, it's advisable for individuals to consider discontinuing their participation in contact or collision sports, which is a highly individualized decision and there is no criteria to determine the best course of action. While scientific understanding of the long-term consequences of head trauma, such as neurodegenerative diseases and chronic traumatic encephalopathy (CTE), is still evolving, current research indicates that such complications are rare. Currently, there is no evidence suggesting an increased risk of these complications among amateur athletes at this time.
Brain scan imaging

Second Impact Syndrome

Second Impact Syndrome (SIS) is associated with brain swelling when an individual experiences a second concussion before the complete recovery from the initial concussion. It is believed that athletes who sustain a concussion and return to their sport early are at a particularly higher risk of sustaining SIS. The management of the condition starts with prompt recognition of a sports-related concussion and protecting the athlete until they recover from the initial injury. The consequences of SIS can cause severe neurological impairment or fatality. Although SIS is an extremely rare condition and there have only been a handful of cases.

Learning From Tragedy - Rowan's Law

Rowan’s Law was named after Rowan Stringer, a high school rugby player from Ottawa, who died in the spring of 2013 from a condition known as second impact syndrome. Rowan is believed to have experienced three concussions over six days while playing rugby. She had a concussion but didn’t know her brain needed time to heal. Neither did her parents, teachers, or coaches. Rowan’s Law and Rowan’s Law Day were established to honor her memory and bring awareness to concussions and concussion safety. The last Wednesday of each September has been designated as Rowan’s Law Day to help raise awareness about concussion safety.

Rowan's Law

Disclaimer

The content and resources contained in this site is intended for educational purposes only. It is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health professional for appropriate diagnosis and treatment. The collaborators have made responsible efforts to include accurate and timely information. However the individuals and organizations listed on this website make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.