What is a sports related concussion (SRC)?
“Sports-related concussion is a traumatic brain injury induced by biomechanical forces”¹. Certain common features are used to clinically diagnose this condition and include include¹:
- A direct blow to the head, face, neck or elsewhere on the body that leads to a force being transmitted through the head.
- Quick onset of short-lived impaired neurological function that resolves spontaneously. In some cases, signs and symptoms may develop over a few minutes or hours.
- SRC may result in neuropathological changes leading to functional disturbances in brain function rather than structural changes. This means that scans won’t show any changes to the brain.
- Signs and symptoms that may or may not involve loss of consciousness.
- Resolution of the signs and symptoms of a concussion usually resolve sequentially but sometimes symptoms may be prolonged.
The clinical signs and symptoms must also not be linked to drug, alcohol, or medication use, other injuries (neck or vestibular system) or other comorbidities (eg, psychological factors or coexisting medical conditions)¹.
What happens after an SRC?
Sport-related concussions don’t typically last longer than four weeks and usually resolve completely by three months². They can lead to various symptoms and can be divided into six categories⁴:
- Vestibular (balance and visual control system). Symptoms can include dizziness and imbalance.
- Ocular – symptoms include abnormal movements of the eye or changes in the eye’s ability to focus.
- Cognitive – symptoms include feeling “foggy”, difficulty concentrating, memory impairment, confusion and a sensation of being slowed down.
- Headache/Migraine.
- Anxiety/Mood – symptoms can include anxiety, agitation, feeling tearful and irritability.
- Fatigue – symptoms can include difficulty falling asleep, drowsiness and low levels of energy.
Other symptoms and effects of concussion
SRC can also lead to musculoskeletal symptoms including:
(a) A sore, stiff neck³.
(b) Cervicogenic headaches (headaches caused by stiff joints and tight muscles in the neck)³.
Sometimes concussions can lead to something called post-concussion syndrome. This presents with similar symptoms to the concussion and is ultimately a prolonged concussion. It is especially common for prolonged symptoms to be present in adolescents³.
How is an SRC and Post-concussion Syndrome diagnosed?
An SRC and post-concussion syndrome are usually diagnosed by a doctor using specific questionnaires and tests. Physiotherapists trained in vestibular rehabilitation can also assess it, but it is better to have it assessed by a sports-physician.
A post-concussion syndrome is diagnosed when the following criteria are met¹:
- A history of traumatic brain injury or concussion;
- PLUS at least three or more of the following:
○ Headache
○ Dizziness
○ Fatigue
○ Irritability
○ Insomnia
○ Concentration or memory disturbance
○ Intolerance to stress, alcohol or emotion
How is sports-related concussion treated?
Depending on the severity of the concussion, recommendations will be given regarding how long the person should stop sport and how much time should be taken off from school or work. Other than rest, the person is usually referred to physiotherapy for treatment. Depending on the person’s symptoms, physiotherapy may include the following:
- Treatment of neck stiffness and pain;
- Treatment of headaches that are being caused by the neck;
- Vestibular rehabilitation to address the following things: dizziness, nausea, balance problems and eye movement dysfunction. This is particularly important in people who play a sport(s).
It is very important to remember that a concussion is an injury to the brain. Unfortunately, because we can’t physically see that the brain is injured, concussions are not always taken seriously. Long-term problems including cognitive impairments and degenerative conditions of the brain can occur if concussions are not managed properly, especially when there has been more than one concussion¹.
- McCrory P, Feddermann-Demont N, Dvořák J, Cassidy JD, McIntosh A, Vos PE, Echemendia RJ, Meeuwisse W, Tarnutzer AA. What is the definition of sports-related concussion: a systematic review. British journal of sports medicine. 2017 Jun 1;51(11):877-87.
- Biagianti B, Stocchetti N, Brambilla P, Van Vleet T. Brain dysfunction underlying prolonged post-concussive syndrome: A systematic review. Journal of affective disorders. 2020 Feb 1;262:71-6.
- Wong CK, Ziaks L, Vargas S, DeMattos T, Brown C. Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International journal of sports physical therapy. 2021;16(1):12.
- Kim K, Priefer R. Evaluation of current post-concussion protocols. Biomedicine & Pharmacotherapy. 2020 Sep 1;129:110406.