How to manage concussion?

Any athlete with suspected or confirmed concussion should:

• remain in the company of a responsible adult
• not be allowed to drive
• be advised to avoid alcohol
• have their medications reviewed.

Specifically, concussed athletes should avoid:

• aspirin
• anti-inflammatories (such as ibuprofen, diclofenac or naproxen),
• sleeping tablets
• sedating pain medications.

If the athlete is diagnosed with concussion, immediate management is physical and cognitive rest. This may include time off school or work, and relative rest from cognitive activity. Having rested for 24 – 48 hours after sustaining a concussion, the athlete can begin light intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms.

Children and adolescents

Sport-related concussions are common in children and adolescents aged 18 years or younger. For this age group, a more conservative approach to diagnosis and management is recommended This is because this age group:

• has a slower rate of recovery from concussion
• has unique physical, cognitive and emotional differences
• is more vulnerable to concussion, due to factors including decreased myelination, poor cervical musculature, and (possibly) increased head to neck ratio
• the role of cerebral blood flow alterations in the pathophysiology of concussion may be more significant

The concussion-and-brain-health-position-statement-2023.pdf requires those aged 18 or under to be symptom free for 14 days prior to medical clearance to return to contact or high-risk activity. To be clear, that is not 14 days from the time of concussion. It is 14 days from when the athlete becomes symptom-free. This recommendation allows for the individual case variability in symptom duration. It ensures that the most vulnerable individuals have demonstrated a clear capacity to perform all normal activities of daily living, including non-contact exercise, without symptoms, before they return to the field of play.

Return to learn

‘Return to learn’ is about the athlete’s gradual return to their usual program at school or work.

A graded return to learn and return to sport should occur concurrently. Activities that do no exacerbate symptoms should be introduced first and may be related to either their return to school or sport.

Physiotherapists can use the RETURN-TO-LEARN.pdf to communicate to teachers the requirements for a concussed child or adolescent.

Return to sport

‘Return to sport’ is about the athlete’s gradual return to full sporting activity and a physiotherapist is well placed to guide this process.

Having rested for 24 – 48 hours after sustaining a concussion, the patient can begin light intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms.

Physiotherapists can use these Graded Return to Sport Frameworks to inform their Return to sport patient programs.

• GRADED-RETURN-TO-SPORT-FRAMEWORK-COMMUNITY-AND-YOUTH.pdf
• Graded Return to Sport Framework in the Advanced Care Setting