Concussion: A summary of its management in sport

/ Total Physiotherapy/

The following is a summary of the Australian Rugby Union Concussion Guidance, incorporating the World Rugby Concussion Laws. It highlights the important steps to follow to recover from concussion then return to sport. The information in this summary can easily be adapted to the management of concussion in other sports, not just Rugby Union. If you want a link to the full ARU Concussion Guidance you'll find it at the end of this summary.

This advice applies to any person suffering a concussion or potential head injury. A potential head injury is any injury that has the potential to cause concussion or a more serious head injury. These injuries can be caused by:
1. A direct blow to the head
2. An indirect force transmitted to the head from a blow to another part of the body (e.g.. whiplash)

Recognising Concussion

A player should be suspected of having a head injury or concussion if they have ANY of the following signs, symptoms or fails any of the memory questions.

Signs (what may be seen) 
Dazed, blank or vacant look
Lying motionless on ground / Slow to get up  
Unsteady on feet / Balance problems or falling over / Uncoordinated  
Loss of consciousness or unresponsive  
Confused / Not aware of plays or events  
Grabbing / Clutching of head  
Seizure (fits)  
More emotional / Irritable than normal for that person

Symptoms (players may report)
Headache
Dizziness  
Mental clouding, confusion, or feeling slowed down  
Visual problems  
Nausea or vomiting  
Fatigue  
Drowsiness / Feeling like “in a fog“/ Difficulty concentrating  
“Pressure in head”  
Sensitivity to light or noise 

Memory (questions to ask)  
“What venue are we at today?”  
“Which half is it now?”  
“Who scored last in this game?” 
“What team did you play last week / game?”  
“Did your team win the last game?” 

Any player with signs or symptoms should be taken from the field immediately and can not take any further part in games or activity on that day.

Players with a potential head injury/concussion must be referred to a medical doctor or Emergency Department as soon as possible - even if symptoms have disappeared.

  • It is important the person remains under the care of a responsible adult
  • Must not consume alcohol
  • Must not drive a motor vehicle

If any of these warning signs of a serious head injury present then the player must be taken to the closest Emergency Department or an ambulance called.

  • Severe neck pain
  • deteriorating consciousness
  • increasing confusion/irritability
  • worsening headache
  • vomiting more than once
  • unusual or uncharacteristic behaviour
  • seizure/fitting
  • double vision
  • weakness, tingling or burning down arms or legs

The process if diagnosed with concussion

There are 3 stages of recovery following a concussion before returning to play:

  1. Complete rest
  2. Relative Physical rest
  3. Completing a Graduated Return to Play program

The amount of rest and time required to fulfil return to play requirements is dependent on age.

Children and Adolescents: applies to anyone 18 and under, regardless of team or level they are playing. Children and adolescents take longer to recover and therefore need a longer recovery period. 

The earliest a child or adolescent can return to play after a concussion is 3 weeks. So if the concussion occurs at a Saturday game, the earliest return is in 3 Saturdays time (will miss 2 Saturday games). The recovery will involve:

  • at least 48 hours complete mental and physical rest (the doctor may prescribe more)
  • 2 weeks of recovery and relative physical rest
  • 1 week completing a Graduated Return to Play (GRTP) protocol. Diagram below.

The individual must be symptom free before progressing to the next level of recovery.

Before commencing level 5 of the GRTP (return to contact training), the individual needs to be reviewed by a medical doctor and receive medical clearance to return to contact.

Adults: Applies to anyone 19 years and older. Earliest return to sport is 2 weeks after a concussion. If the concussion occurs at a Saturday game, the earliest return is in 2 Saturdays time (will miss 1 Saturday game). The recovery will involve:

  • at least 24 hours of complete physical and mental rest (the doctor may prescribe more)
  • 1 week of recovery and relative physical rest
  • 1 week completing the GRTP protocol. Diagram below.

The individual must be symptom free before progressing to the next level of recovery.

Before commencing level 5 of the GRTP (return to contact training), the individual needs to be reviewed by a medical doctor and receive medical clearance to return to contact.

The Graduated Return to play protocol

The Graduated Return to play protocol

 

Complex Cases
If any of the following apply the player must see a medical doctor experienced in sports concussion management and follow an individualised management plan:

  • 2 or more concussions in 12 months
  • multiple concussions over playing career
  • concussions occurring with less collision force
  • concussion symptoms lasting longer than expected (i.e. a few days)

Link to the full Australian Rugby Union Concussion Guidance