Concussion & Return to Sport
Concussion and Return to Sport
What is a Concussion?
A concussion is a brain injury that is associated with usually short-lived, transient deterioration of brain function. A concussion is a functional injury, rather than a structural one.
What Causes Concussion?
Concussions can occur from a direct blow to the head or body. A hard skull casing protects our brains, so when the head or body encounters an impact, the softer brain bounces up against the hard skull wall, injuring it. You can think of it as a bruise. We aren’t exactly sure of what is going on inside the brain during a concussion, but p signals in the brain get mixed up, delayed and a bit lost due to a change in normal chemical signalling between neurons (brain cells).
Retrieved from https://giphy.com/gifs/brain-concussion-NhXhI7kHCwxRC on 01/07/2020
What are the Concussion Symptoms?
Symptoms of concussion vary widely, so it is essential to take brain injuries like concussion seriously so that everyone can get the best care possible and avoid any complications. When in doubt, get checked out by a qualified professional. Sometimes this is available pitchside, or you might need to visit your GP or the emergency room, depending on the severity of your symptoms. If you have any critical symptoms, or loss of consciousness – call an ambulance.
(Australian Sports Commission, 2020)
How is Concussion Diagnosed?
When a concussion occurs, there is no structural change in the brain, so there aren’t any scans that we can do to detect a concussion. A scan like a head x-ray, CT or MRI might be needed to rule out other types of brain problems, including bruising, swelling, bleeding, and skull/neck fracture (Denay & Martin, 2020).
New research for diagnosing concussion centres around cutting edge imaging techniques, which detect changes in brain cell chemical and electrical functioning (Chong & Schwedt, 2018). There are also new tests to detect protein abnormalities in the brain, indicating damage (Schwab, Tator & Hazrati, 2019). Research in animals also suggests that disruption to the function of the blood-brain barrier may occur in concussion (Johnson et al., 2018). All of this research is very early and isn’t recommended for medical use just yet because the reliability and accuracy of the tests still require validation.
You Have A Concussion. What Should You Do Next?
If you have sustained a head injury, you should be immediately removed from play and assessed. A pitchside or emergency room health professional will use a series of questions, clinical tests and observations to decide if you have a concussion or not, or another injury. Depending on the severity of your symptoms, further tests might be needed, which you can only get at a hospital. It’s important not to skip this bit, even if you feel alright. Concussion symptoms can lag by an hour or more, so rest and thorough testing are critical (Olson, Ellis, Selci & Russell, 2020). Continuing to play with a concussion is the most influential factor we know that prolongs concussion symptoms and slows recovery (Elbin et al., 2017).
If your symptoms are deemed minor, your pitchside professional can assess and diagnose you. You will probably also be referred to your GP if this is the case. If there is no pitchside professional available, or your pitchside person doesn’t have concussion specific assessment training, you should visit an emergency room just in case. Depending on the severity, an ambulance is advisable to transport you there without moving your neck.
Immediate after-care for a concussion is essential. The vital do’s and don’ts can save you a lot of trouble in the long run.
The other thing to remember is that if pain relief medication is needed, avoid anti-inflammatories in the first 48-72 hours (Ghosh et al., 2019). Common over the counter anti-inflammatory medications in Australia are:
- Nurofen, Advil, Bugesic (ibuprofen)
- Voltaren, Dinac, Fenac (diclofenac)
- Celebrex (celoxib)
- Naprogesic, Naprosyn, Aleve (naproxen)
What are the Concussion Treatment Options?
Generally, concussion treatment is rest followed by a steady reintroduction to a healthy life. With a bit of knowledge, this transition may usually be home-based with a bit of common sense. You will need to see your GP or trained health professional for clearance before returning to your sport.
Concussion symptoms usually deteriorate when we are tired, or your brain has had too much stimulation. In the early stages, simple things like going for a walk, watching TV or scrolling on your phone can be enough to tax your brain into being tired. Slowly, things should improve, and you’ll need fewer rest periods throughout the day. Once you can get through the day, you can then return to school or work in small doses, progressing back to full time.
If you are having difficulty in getting over the fatigue and symptoms from a concussion, you can do what is called concussion rehabilitation. This rehab consists of a variety of training types based on the symptoms you’re experiencing. The main areas of brain function related to concussion symptoms are body pain, thinking, emotional, behavioural, consciousness and sleep disturbance (BMJ, 2016). Tailored rehabilitation reflects your unique cluster of symptoms. This rehab might include a thorough education program to understand your concussion, balance retraining, vision retraining and strict guidelines for a return to different types of exercise.
The recommended and typical course of recovery from a concussion is below. You can expect 2-3 days of symptoms, and then a steady return to work, school or uni over the next two weeks. After that, you can begin your return to sport testing, which can occur in as little as five days for adults and ten days for children.
This delayed course of action is to protect your brain from long-term memory, emotional, thinking and movement difficulties called ”post-concussion syndrome” (Leddy, Baker & Willer, 2016). Staying away from high-risk head impact activities like tackling, heading a ball or accidentally getting hit again reduce the risk of something called ”second-impact syndrome. There is some evidence to suggest that a second concussion injury after the first one hasn’t finished healing can lead to brain bleeding with long term damage, and can be fatal, although this is a hotly debated topic (McLendon, Kralik, Grayson & Golomb, 2016).
(BMJ Publishing Group, 2016)
For more information, get in contact with your GP or PhysioWorks physiotherapist who can advise you on your best course of action. Guidance is essential for a concussion because every brain and brain injury is very different!
Original Article by Isabelle Kelly
Author Unknown. Date Unknown. Brain Concussion GIF. Retrieved from https://giphy.com/gifs/brain-concussion-NhXhI7kHCwxRC on the 01/06/2020
Australian Sports Commission. (2020). Medical Practitioners: Signs and Symptoms: Concussion in Sport Australia. Retrieved from https://concussioninsport.gov.au/medical_practitioners#signs_and_symptoms on the 03/06/2020
BMJ Publishing Group. (2016). Managing recovery from concussion (infographic). BMJ 355:i5629 https://doi.org/10.1136/bmj.i5629
Chong & Schwedt. (2018). Research Imaging of Brain Structure and Function After Concussion. Headache, the Journal of Head and Face Pain. 58(6); 827-835 https://doi.org/10.1111/head.13269
Denay K.L., Martin E.R. (2020) Concussion Diagnostic Imaging Options. In: Patel D. (eds) Concussion Management for Primary Care. Springer, Cham
Elbin, D’Amico’Amico, McLeod, Covassin & Anderson. (2017). Concussion: Predicting Recovery. Return to Play in Football. p723-735.
Ghosh, Kolade, Shontz, Rosenthal, Zuckerman, Bosco & Virk. (2019). Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Their Effect on Musculoskeletal Soft-Tissue Healing. JBJS Reviews 7(12); e4 doi:10.2106/JBJS.RVW.19.00055
Johnson, Weber, Xiao, Cullen, Meaney, Stewart, & Smith. (2018). Mechanical disruption of the blood-brain barrier following experimental concussion. Acta neuropathologica, 135(5), 711-726.
Leddy, Baker & Willer. (2016). Active Rehabilitation of Concussion and Post-Concussion Syndrome. Phys Med Rehabil Clin N Am 27; 437–454. http://dx.doi.org/10.1016/j.pmr.2015.12.003
Makdisi, Davis, McCrory. (2014). Updated guidance for the management of sports-related concussion in general practice. Australian Family Physician 43(3) p94-99
McLendon, Kralik, Grayson & Golomb. (2019). The Controversial Second-Impact Syndrome: A Review of the LIterature. Pediatric Neurology. 62; 9-17 https://doi.org/10.1016/j.pediatrneurol.2016.03.009
Olson, Ellis, Selci & Russell. (2020). Delayed Symptom Onset Following Pediatric Sport-Related Concussion. Frontiers in Neurology. 11(220) https://doi.org/10.3389/fneur.2020.00220
Ontario Neurotrauma Foundation. (2019). Concussion Do’s’s and Don’ts’ts: The First Few Days of Recovery. Retrieved from http://concussionsontario.org/wp-content/uploads/2020/01/ONF-DoDonts-Tearaway-EN-Nov2019-WEB.pdf on the 03/06/2020
Schwab, Tator & Hazrati. (2019). DNA damage as a marker of brain damage in individuals with history of concussions. Laboratory Investigation. 99(7), 1008
FAQs about Sports Injuries
Sports Injury Management
You probably already know that a sports injury can not only affect your performance, but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary greatly to how we treat you this year. The good news is that you can benefit significantly from our knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving or other problems will develop.
Ice or Heat?
We normally recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, heat packs can be used. We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to specifically discuss your situation.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the bandage will also help to support the injury as the new scar tissue is laid down. This should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain what to do next.
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is very helpful, especially for ankle or hand injuries. Think where your injury is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain drugs can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you do return to sport - we'll detect and help you to correct any biomechanical faults that may be affecting your technique or predisposing you to injury
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally there are four main reasons why you develop arthritis:
- Previous injury that was inappropriately treated (eg old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, simply ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, they'll also refer you elsewhere if that's what's best for you. Think about it. you could be suffering needlessly from a sports injury. Please use our advice to guide you out of pain quicker . and for a lot longer.
If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Acute Sports Injury Clinic
The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.
How to Best Care for Your Sports Injury?
There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.
Why Use an Acute Sports Injury Clinic?
Your Acute Sports Injury Assessment Consultation allows us to provide you with:
- A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
- Early acute sports injury care, professional advice and education. What to do this week?
- Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
- Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
- Immediate supply of walking boots, braces and rental crutches if needed.
- Low-cost professional service.
Who is a Sports Physiotherapist?
Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.
What is Sports Physiotherapy?
Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit. Sports physiotherapists help athletes recover from sporting injuries, and provide education and resources to prevent problems.
Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.
Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, skilled assessment and diagnosis of sports injuries, and use effective 'hands-on' management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most of PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.
Sports Physiotherapy BrisbaneUltimately, your safe return to sport will be determined by your sports physiotherapist, doctor or surgeon. They will take into consideration your tissue healing and how well you have progressed in your rehabilitation. Returning to sport too early can delay healing and prolong recovery and pain. Your physiotherapist will aim to speed up the process via some hands-on treatment techniques, exercises, electrical modalities, plus most importantly, strength and agility exercises to replicate your sport. Sometimes bracing or taping may allow an early return to sport. As a general rule, most soft tissue injuries and bone injuries will take at least six weeks for scar tissue to mature or your bone to strengthen. Therefore, caution is required and is best discussed with your sports physiotherapist, doctor and coach.
FAQsCommon Physiotherapy Treatment Techniques What is Pain? Physiotherapy & Exercise What Causes Post-Exercise Muscular Pain? What are the Best Core Exercises? Barefoot Running: Your MUST READ Guide to the Pro's and Con's. Can Kinesiology Taping Reduce Your Swelling and Bruising? Heat Packs. Why does heat feel so good? How Can You Prevent a Future Leg Injury? How Do You Improve Your Balance? How Does an Exercise Ball Help Back Pain? Post-Operative Physiotherapy Rotator Cuff: What is it? Sports Injury? What to do? When? What are Common Adolescent / Children Leg Injuries? What are the Early Warning Signs of an Injury? What are the Signs of an Unsupportive Pillow? What is a TENS Machine? What is Chronic Pain? What is Nerve Pain? What is Sports Physiotherapy? What to expect when you visit PhysioWorks? What's the Benefit of Stretching Exercises? When is the Best Time for a Pre-Event Massage? Why do your Joints Click? Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
Why Do Physiotherapists Prescribe You Exercises?The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose. Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.
What Exercises Should You Do?Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person. You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.
What Happens When You Stop Exercises?Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage. It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs. The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.
Would You Stop Your Daily Prescription Drugs?Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not! Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional. So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.
Olympic InjuriesThe Olympic games are the pinnacle of an athlete's career, where the fastest, strongest and elite compete for the podium finish. But just like you and me, they too suffer injuries, both career-ending and career limiting. How do they recover? In the 2008 Beijing Olympic games, out of the 9572 athletes, 1055 injuries were reported with the most common place of injury at the knee. The table below shows a grasp of the injuries sustained by athletes at the 2008 Olympic games and 2010 Winter Olympic games. Let's focus on the summer sports for the purpose of this article. If you guessed soccer, taekwondo, field hockey, handball and weightlifting as your top 5, you win the GOLD! Source: Scientific American, 2012
What're the Safest Olympics Sports?For the risk adverse, you top 5 sports to get you to and from the Olympics are Sailing, Canoeing/Kayaking, Rowing, Synchronised swimming and diving. Having said that, I've seen all of those sportsmen and women with injuries at PhysioWorks! But the injury is not necessarily the end of your Olympic aspirations. You can see from the chart above that most athletes were able to recover and compete.
How Do Olympians Recover So Quickly?When you’re at the elite level, you generally have an overabundance of medical assistance. You are closely monitored in terms of your daily health and any “niggles” are seen to immediately - not to mention the multiple physiotherapy sessions they can have in one day! Furthermore, they have access to state of the art medical technology which can assist diagnosis and speed up recovery. So what would be a 6-week injury for the local athlete (“Elite”) could potentially be under 4 weeks for the Olympian. They are also well in-sync with their bodies and consistently perform the recovery tasks mentioned below to ensure they are ready for their events and speed up their recovery.
What Do Olympians Do to Recover Quicker?As mentioned earlier, a considerable portion of the Olympic athlete's recovery can be attributed to their access to medical assistance. The athlete does the training, has a natural talent, but there is also a proactive and readily available medical team behind them ensuring they stay at the top. We cannot undermine the athlete’s proactivity in performing their own recovery - regular stretching, not ignoring “niggles”, performing rehabilitation and “prehab” as prescribed. These are done so consistently but also with technical precision - not accepting poor quality.
How Do Olympians Prevent Injuries Between Events?Competing at the Olympics isn’t a one-off event. More often than not, each sport has heats followed by a final series - sometimes even on the same day! To ensure the athletes are in their finest form to compete, they implement all the tricks of the trade - most of which we have access to! Compression gear, physiotherapy, massages, stretching, foam rollers, adequate nutrition and active recovery. Active recovery is often overlooked by the local sporting athlete but can so easily be the difference between being 80% and 100% recovered for your event. This can be done by a simple warm down jog/walk, stretching, pool recovery (water walking, light swimming) and nutrition. As the name suggests, the warm down is the opposite to the warm-up, we aim to gradually lower the heart rate and body temperature following physical activity. Simultaneously, it removes waste products created during exercise, including the dreaded Lactic Acid - which can cause cramping and tightness in muscles if it is not effectively removed. Inevitably, the tightness and soreness in muscles restricts movement and can limit the athlete's ability to perform at their top level.
What Does PhysioWorks offer that the Olympic Athletes have access to?At Physioworks, we believe that every athlete whether competing in 5th-grade rugby or premier grade netball should have access to the same medical team services that elite athletes do. A team approach, with you at the centre, ensures your recovery from injury or event is undertaken effectively and efficiently. By offering access to physiotherapists, dietitians, massage therapists, exercise physiologists, hand therapists, acupuncturists etc as well as supplying products to potentially speed your recovery (protective equipment, compression garments, Tens machines and many other products), we are giving our patients every opportunity to ensure their quick and safe recovery. Of course, there is the body’s natural healing ability but, if we can place it in the optimal healing environment, you too can heal like an Olympian. GO AUSTRALIA!!
Private Health Insurance Rebates
PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.
However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.
HICAPS - Instant Health Fund Claims
Most health funds are members of the HICAPS instant claims system. Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.
Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.
- All Private Health Insurance Funds including BUPA, Medibank Private, HCF
- For a full list of Hicaps instant claim funds see here: Hicaps Funds
- HCF More for Muscles Program
PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:
- Australia Post; Coles Myer; Woolworths
- Department of Veterans' Affairs
- CTP & Sports Insurers