Understanding Concussions

Concussions are mild traumatic brain injuries frequently encountered by athletes during sports activities. The severity of a concussion can vary greatly, ranging from a mild "bell-ringer" to a blow that causes a loss of consciousness lasting over five minutes. Coaches, trainers, therapists, and physicians involved in athletic contests must possess knowledge about various types of concussions and appropriate treatment approaches. Inadequate care can have severe and sometimes lifelong consequences. In Canada alone, approximately 200,000 concussions occur each year, often resulting in significant and long-lasting cognitive impairments. Impaired cognitive functions may include information processing speed, problem-solving, planning, and memory. These impairments can worsen with repeated concussions.

Treatment of Concussions

To manage a concussion, a thorough evaluation of the athlete's injury history, neurological screening, and examination of the cervical vertebrae and musculature are necessary. Several scales are used to grade concussions, with the Glasgow Coma Scale being the most widely employed. This scale evaluates eye opening, motor responses, and verbal responses and assigns numerical values accordingly. The alert/verbal/painful/unresponsive (AVPU) method, adopted by the American College of Surgeons Committee on Trauma, assesses an athlete's level of consciousness by evaluating their response to verbal or painful stimuli and their pupil size and reaction. Evaluating pupil size and response to light is crucial as raised intracranial pressure can cause pupillary dilation and sluggish response.

A renowned physiotherapy clinic in Whitby utilizes the complete concussion management protocol, which involves conducting a baseline test to assess an athlete's brain function in a healthy state. This baseline data is invaluable in identifying any residual deficits and gauging brain recovery levels, enabling safer decisions regarding the athlete's return to sports activities after a concussion.

Classification of Concussions

Although various concussion grading systems and return-to-play guidelines exist in medical literature, only three have gained widespread acceptance: Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe). Despite the lack of universal agreement on the definition and grading of concussions, all medical professionals concur that athletes experiencing post-concussion signs or symptoms, whether at rest or with exertion, should not return to contact or collision sports. Recognizing the significance of past concussions and the possibility that athletes may have overlooked some of their previous concussions, maintaining a detailed concussion history is essential.

Signs and Symptoms of Concussion

A player may experience a concussion without losing consciousness. If any of the following symptoms or issues arise, a head injury should be suspected, and appropriate management should be implemented:

  • Cognitive features: confusion; amnesia; unawareness of time, date, place, period, opposition, or game score; loss of consciousness.
  • Typical symptoms: dizziness; headache; unsteadiness or loss of balance; feeling dazed, stunned, or "dinged"; seeing stars or flashing lights; ringing in the ears; double vision; nausea.
  • Physical signs: impaired conscious state or loss of consciousness; poor coordination or balance; impact seizure or concussive convulsion; loss of balance or gait unsteadiness; slow to follow directions or answer questions; easily distracted or poor concentration; inappropriate emotions such as laughing or crying; vomiting; glassy-eyed or vacant stare; slurred speech; personality changes; inappropriate playing behavior, such as running in the wrong direction; significantly reduced playing ability.
  • Other symptoms such as sleepiness, sleep disturbance, or a subjective feeling of slowness and fatigue may also occur.


Recognizing the seriousness of brain injuries and their potential long-term effects is of utmost importance. Athletes and coaches should prioritize preventive measures like wearing appropriate protective gear, employing proper techniques, and avoiding contact or collisions that could lead to head trauma. Additionally, educational and awareness campaigns targeting athletes, coaches, parents, and healthcare professionals can help reduce the incidence of brain injuries and promote appropriate management when they do occur. While there is still much to learn about brain injuries, ongoing research and advocacy can ensure better protection and support for athletes in their pursuit of athletic excellence.