Any athlete or person suspected of having a concussion should be removed from play or workplace and seek medical evaluation.
Signs to watch for
Problems could arise over the first 24-48 hours. They should not be left alone and must go to a hospital at once if they experience:
• Worsening headache • Repeated vomiting• Weakness or numbness in arms or legs • Drowsiness or inability to be awakened • Unusual behavior or confusion or irritable • Unsteadiness on their feet.• Inability to recognize people or places • Seizures (arms and legs jerk uncontrollably) • Slurred speech
Rest & Rehabilitation
After a concussion, the athlete should have physical rest and relative cognitive rest for a few days to allow their symptoms to improve. In most cases, after no more than a few days of rest, the athlete should gradually increase their daily activity level as long as their symptoms do not worsen.
Once the athlete is able to complete their usual daily activities without concussion-related symptoms, the second step of the return to play/sport progression can be started.
The athlete should not return to play/sport until their concussion-related symptoms have resolved and the athlete has successfully returned to full school/learning activities.
When returning to play/sport, the athlete should follow a step wise, medically managed exercise progression, with increasing amounts of exercise.
Graduated Return to Sport Strategy
Each section contains an exercise step, functional exercise
at each step, and goal of each step
1. Symptom limited activity, Daily activities that do not provoke symptoms. Gradual reintroduction of work/school activities.
2. Light aerobic exercise, Walking or stationary cycling at slow to medium pace. No resistance training. Increase heart rate.
3. Sport-specific exercise, Running or skating drills. No head impact activities. Add movement.
4. Non-contact training drills, Harder training drills, e.g, passing drills. May start progressive resistance training. Exercise, coordination, and increased thinking.
5. Full contact practice, Following medical clearance, participate in normal training activities. Restore confidence and assess functional skills by coaching staff.
6. Return to play/sport, Normal game play.
In this example, it would be typical to have 24 hours (or longer) for each step of the progression. If any symptoms worsen while exercising, the athlete should go back to the previous step. Resistance training should be added only in the later stages (Stage 3 or 4 at the earliest).
Written clearance should be provided by a healthcare professional before return to play/sport as directed by local laws and regulations.
Graduated Return to School Strategy
Concussion may affect the ability to learn at school. The athlete may need to miss a few days of school after a concussion. When going back to school, some athletes may need to go back gradually and may need to have some changes made to their schedule so that concussion symptoms do not get worse. If a particular activity makes symptoms worse, then the athlete should stop that activity and rest until symptoms get better. To make sure that the athlete can get back to school without problems, it is important that the healthcare provider, parents, caregivers and teachers talk to each other so that everyone knows what the plan is for the athlete to go back to school.
Note: If mental activity does not cause any symptoms, the athlete may be able to skip step 2 and return to school part-time before doing school activities at home first.
Graduated Mental Activity Strategy
Each section contains a mental activity and a goal of each step
1. Daily activities that do not give the athlete symptoms Typical activities that the athlete does during the day as long as they do not increase symptoms (e.g. reading, texting, screen time). Start with 5-15 minutes at a time and gradually build up .Gradual return to typical activities.
2. School activities Homework, reading or other cognitive activities outside of the classroom. Increase tolerance to cognitive work.
3. Return to school part-time, Gradual introduction of school work. May need to start with a partial school day or with increased breaks during the day. Increase academic activities.
4. Return to school full-time, Gradually progress school activities until a full day can be tolerated. Return to full academic activities and catch up on missed work.
If the athlete continues to have symptoms with mental activity, some other accommodations that can help with return to school may include:
• Starting school later, only going for half days, or going only to certain classes• No more than one exam/day• More time to finish assignments/tests• Shorter assignments• Quiet room to finish assignments/tests• Repetition/memory cues• Taking lots of breaks during class, homework, tests
• Use of a student helper/tutor• Not going to noisy areas like the cafeteria, assembly halls, sporting events, music class, shop class, etc.• Reassurance from teachers that the child will be supported while getting better
The athlete or person should not go back to sports until they are back to school/learning, without symptoms getting significantly worse and no longer needing any changes to their schedule
References
Sport concussion assessment tool - 5th edition. (2017). British Journal of Sports Medicine, bjsports-2017. https://doi.org/10.1136/bjsports-2017-097506scat5
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Dr. Mike Hadbavny
Chiropractor, Sports Sciences Resident RCCSS(C)
If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria BC. Contact us today.