The Australian Institute of Sport, Sports Medicine Australia, Australian Physiotherapy Association and the Australasian College of Sport and Exercise Physicians have come together to release a new position statement on concussion. The position statement aims to provide up to date evidence-based information on concussion to help minimize the lasting impacts of recurrent concussion. With recent passings of former AFL and AFLW players due to recurrent concussions (referred to as chronic traumatic encephalopathy or CTE), this position statement has come at a very important time.
What is concussion?
Concussion occurs when a biomechanical force from an object or another person causes the brain to rattle inside the hard casing of the skull. This can sometimes occur from minor knocks where consciousness is maintained or larger knocks where a person loses consciousness. It is important to note that symptoms can vary from person to person. The position statement outlines below the signs and symptoms that everyone should be aware of:
Mandatory signs of concussion (immediate removal and no further play)
Loss of consciousness
Lying motionless for > 5 s
No protective action was taken by the athlete in a fall to the ground, directly observed or on video
Impact seizure or tonic posturing
Confusion, disorientation
Inability to respond appropriately to questions
Memory impairment/amnesia
Balance disturbance or motor incoordination (e.g., ataxia)
Athlete reports significant, new, or progressive concussion symptoms
Dazed, blank/vacant stare or not their normal selves
Behaviour changes atypical of the athlete
Discretionary signs of concussion (immediate removal for further assessment)
Clutching their head
Being slow to get up
Suspected facial fracture
Possible balance disturbance or ataxia
Behaviour changes atypical of the athlete
Other clinical suspicions
Red flag signs of concussion (immediate referral to emergency department)
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
Loss of vision
Visible deformity of the skull
Loss of consciousness
Unusual behavioural change
Double vision
Physiotherapy Involvement in Concussion Management
Physiotherapist are becoming more involved in the assessment and management of concussion with increasing evidence supporting physiotherapist’s role in the rehabilitation from concussion. At the current time it is still required for people with concussion to get medical clearance from a medical practitioner, however, physiotherapists play a key role in guidance through a graded return to sport framework (see link below). Physiotherapists also work with people who suffer from more complex prolonged symptoms and don’t meet the checkpoints of the graded return to sport framework. This includes treatment centred around vestibular oculomotor and neck-based rehabilitation which helps with faster symptom resolution.
So, next time you or someone you know has a head knock, make sure you are aware of the signs and symptoms of concussion and follow a graded return to work framework so that we as a community can reduce the impacts of recurrent concussions!
Written by Matthew Long, Physiotherapist