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Concussion: An Introduction for Young Athletes

A concussion is a serious event, but you can recover fully from such an injury if the brain is given enough time to rest and recuperate.

Each year, U.S. emergency departments treat an estimated 173,285 sport and recreation-related concussions among children and adolescents. Concussion represents 9% of injuries reported in the National Surveillance in US high school sports.

In 2010-11, 19,880 Ontario residents visited an emergency room for a concussion, with children accounting for nearly 38 per cent of those visits. This represents an increase of 60% over the last decade.

Definition of Concussion

A concussion is a complex process affecting the brain caused by traumatic forces either by direct blow to head, face or neck or a blow elsewhere with a transmitted force to head. Rapid development of short term impairment in function occurs.


  • Physical signs: loss of consciousness, amnesia
  • Headache, neck pain, pressure in head
  • Sensitivity to light or noise
  • Nausea or vomiting
  • Dizziness or Blurred vision
  • Balance issues
  • Fatigue, drowsiness, low energy
  • Cognitive impairment: slowed reaction time, difficulty concentrating, difficulty remembering, confusion
  • Behavioural changes: irritability, emotionally labile, sadness, nervous, anxious
  • Feeling slowed down or in a fog, not feeling right
  • Sleep disturbance: drowsiness or insomnia

No loss of consciousness is necessary.  It is a functional injury, no structural damage to the brain. 85-90% of concussed young athletes will recover within 1 to 2 weeks.

Diagnosis of Concussion

  • Often under-recognized, under-diagnosed and under-reported!
  • The most important step in diagnosis and management is reporting the injury to the coach, trainer or parent
  • Evaluation by a physician should occur in the first few days following a concussion

There are many excellent Sport Medicine Physicians in Ottawa to help manage a concussion and assist with safe return to learning and play.

Implications of Concussion

  • Post Concussion Syndrome: risk of prolonged or permanent symptoms such as headache, depression, concentration and learning difficulties if premature return to sport or if a 2nd concussion occurs before full recovery
  • Chronic Traumatic Encephalopathy (CTE): progressive degenerative disease of the brain found in people with a history of repetitive brain trauma
  • Second impact syndrome: although rare, it is not just a “scare tactic”, and most often occurs in athletes under 21 years
  • Catastrophic increase in intracranial pressure causing paralysis, massive brain swelling, herniation, and death

Concussion Management

  • REST! It is the only known effective treatment for concussion
  • Mental Rest (studying, working, reading, art/music)
  • Physical rest (phys-ed class, practice, weights/resistance training, dry-land training)
  • Monitor screen time (computers, video games, TV, texting, smart boards, tablets)
  • It is always unsafe to return to play the same day/game while symptomatic

Concussion Return to Play/Activity Protocol

Rest completely until asymptomatic and return to baseline on IMPACT testing suggests resolution of concussion.

Progress to a step-wise return to play protocol:

  • Day 1: Light Aerobic Exercise
    • Walking or stationary cycling 10-15min
  • Day 2: Increased Intensity Aerobic Exercise
    • Increase resistance on stationary bike, jogging
  • Day 3: Individual sport-specific training with no risk of contact (e.g. skating in hockey, sprint training for field/court sports)
  • Day 4: Sport-specific drills only without body contact, may add light resistance training (simple drills, weights, sit-ups, push-ups)
  • Day 5: Full team practice/scrimmage, non-contact (e.g. “red shirt”) and full participation in drills
  • Day 6: Full participation in practice/scrimmage with contact
  • Day 7: Game play

Athlete should only continue to the next level if asymptomatic at the current level. If post concussive symptoms occur then they should drop back to the previous asymptomatic level and then try to progress again after a day or so. Too rapid of progression will prolong the post concussive course.

To learn more, read the Consensus Statement from the 4th Conference on Concussion in Sport (Zurich).

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