Concussions are a serious concern in sports, often going unnoticed and leading to worse problems such as prolonged concussion symptoms, increased susceptibility to having another concussion as well as learning and memory difficulties. To address this, a guideline for concussion management in sports was created.
Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport– Amsterdam, October 2022
Recognise: Definition of Sport-Related Concussion
Sport-related concussion is a brain injury from a blow to the head, neck, or body during sports or exercise. Symptoms may appear right away or later, and usually go away within days, but can sometimes last longer.
Reduce: Prevention of Concussion
Studies show mouthguards can significantly reduce concussions in ice hockey, suggesting they should be mandatory for young players. Additionally, limiting contact in youth ice hockey and implementing regular neuromuscular training programs that focus on balance, agility, and sport-specific movements have also been linked to fewer concussions in rugby.
Remove: Sideline Evaluation
If a concussion is suspected, the player should be removed from the game to avoid further injury. Look for signs such as loss of consciousness, seizures, stumbling, confusion, or memory problems. Players exhibiting these signs should not return to a match or training that day, unless evaluated acutely by an experienced health professional.
Rest & Exercise
The best available evidence shows that strict rest until the complete resolution of concussion-related symptoms is not beneficial following a concussion. Relative (not strict) rest, which includes activities of daily living and reduced screen time, is indicated immediately and for up to the first two days after injury. Individuals can return to light-intensity physical activity, such as walking as long as it doesn’t mildly exacerbate symptoms, during the initial 24–48hours following a concussion. Physical activity and cognitive exertion should be stopped if concussion symptom exacerbation is more than mild and brief.
When to refer?
For patients experiencing symptoms beyond 4 weeks, regardless of age, referral to specialists in concussion management is crucial. These persistent symptoms could be pre-existing conditions, concussion-related issues, or a combination of both. Early evaluation by a concussion expert can help determine the cause and guide the most appropriate treatment plan.
Rehabilitation
Rehabilitation can vary among individuals. Some may experience ongoing symptoms such as dizziness, neck pain or headaches which require a more targeted program. In contrast, for those with mild or resolved symptoms, a more general recovery plan can be implemented.
Return-To-Learn
Most athletes (93%) return to school within 10 days with a Return to Learn (RTL) strategy. This strategy minimizes disruptions by encouraging early return to daily activities with minimal symptom increase (less than 2 points on a 0-10 scale for less than an hour). In collaboration with educators, students may receive support including flexible schedules, frequent breaks, reduced screen time, safe physical activity modifications, extra assignment time, pre-printed notes, and adjusted testing.
Return-To-Sports (RTS)
A 6-step return to sport strategy has been developed (Table 2) to guide safe return to sport post-concussion. This process can commence 24 hours post-concussion, with progression through each subsequent step typically taking a minimum of 24 hours. If more than mild exacerbation of symptoms (i.e. more than 2 points on a 0–10 scale) occurs during Steps 1–3, the athlete should stop and attempt to exercise the next day. Athletes experiencing concussion-related symptoms during Steps 4–6 should return to Step 3 to establish full resolution of symptoms with exertion before engaging in at-risk activities. Incremental progression of the cognitive and physical load is recommended, using the magnitude of symptom exacerbation as a guide. Unrestricted return to sport following RTS typically occurs within 1 month of injury in children, adolescents, and adults, with an estimated pooled mean time to RTS of 19.8 days.
