Tackling Concussions Head On
Danny Frawley’s tragic death following a long history of concussions forced us to confront the importance of protecting athletes’ brains.
In the years since, we’ve seen a heightened frequency of concussions with long-lasting symptoms, with former #1 pick Paddy McCartin retiring (and later returning) due to ongoing concussion symptoms, as well as former first-round draft picks Daniel Venables and Kade Kolodjashnij’s careers being cut short.
Now, following two separate legal actions against the AFL in recent weeks, we must all understand how we can better protect our athlete’s brains.
First, we must understand what a concussion is; how it is diagnosed and treated; and how we can proactively reduce the side effects and healing times of a concussion.
What is a concussion?
A concussion is like a car accident occurring inside your skull. As your brain collides with the hard, bony interior of your skull, the impact stretches the brain momentarily, causing trauma. Because a concussion can affect any region of the brain, a staggering 50% of concussions go unnoticed.
How is a concussion diagnosed?
Due to the subtlety and complexity of concussions, signs and symptoms may be slight and will differ between people and injuries, leaving us with no singular diagnostic test. Recent media has suggested that blood tests and computerised concussion recognition tools, however these do not pick up all concussions.
What are the immediate and long term effects of concussion?
Most symptoms settle after 3-5 days, while the brain takes a further 3 weeks to fully heal. If another concussion occurs immediately, it may be fatal. If another concussion occurs within the recovery time frame, then the recovery period can be drastically increased.
As for our first round draft picks, they suffer from a rarer condition called Post Concussion Syndrome (PCS). Often, those that go on to experience PCS have either had a secondary concussion before the first had fully resolved, or have comorbid conditions that predispose them to a slower recovery.
A lot of media focus has been around the prevalence of Chronic Traumatic Encephalopathy (CTE) amongst retired athletes. CTE is thought to be a neurodegenerative disease due to concussive and subconcussive blows to the head. Frighteningly, it can only be diagnosed after death as it requires examination of the brain. To this date, the jury is still out on the matter as there remains no quality long term study that can support or refute this hypothesis.
How is a concussion treated?
The most important thing to do after a concussion is to see a qualified and competent health professional. Treatment varies depending on what part of the brain is injured, and may include soft tissue work, joint mobilisation, visual rehab exercises, progressive cardiovascular exercise, activity limitations, and nutrition or supplement programs.
Rehabilitation usually takes 2-3 weeks to complete, and during these times, there is a graded return to school/work and sport. However, unless a baseline test is completed prior to a concussion, there is no sure way to know if the brain has fully healed.
The power of baseline testing:
As brains are constantly remodelling and concussions are subtle and complex, only accurate and reproducible testing methods need to be used. For that reason, tests are valid for 1 year for adults and 6 months for children.
A concussion baseline test includes a thorough medical history, baseline symptom score, and testing centred around orientation, memory, concentration, visual tracking, balance, reaction time, grip strength, and neurobehavioral & cognitive assessments.
Only by comparing testing scores of an injured brain to healthy, uninjured brain can we be confident that the brain has fully healed.
How will it affect local sport?
Local sport can expect to see some significant changes in order to protect the health of its athletes. Baseline concussion testing prior to participation, longer mandatory periods of recovery (up to 4 weeks) and clearance from a clinician with specialist concussion training are all imminent in local sport.
With only a matter of weeks left before the start of the AFL season, there is a new sense of urgency around concussions. We have seen a big uptick in athletes across all codes wanting additional protection, with dozens of baseline tests being completed since January.
If you or somebody you know has suffered a concussion, you can find free resources through https://www.strengthsystems.com.au/concussion-management including a specialist designed concussion tracker app for iPhone and android.
Source Links
https://www.abc.net.au/news/2023-02-27/afl-concussion-class-action-planned/102030786
https://www.strengthsystems.com.au/concussion-management
https://completeconcussions.com/
References
McCrory, Paul, Willem Meeuwisse, Jiří Dvorak, Mark Aubry, Julian Bailes, Steven Broglio, Robert C. Cantu et al. “Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.” British journal of sports medicine 51, no. 11 (2017): 838-847.
Images: – these are not images of a real patient.
Submitted by Juy Lumsden – Certified Concussion Clinician.
Principle Physiotherapist Strength Systems
Master of Physiotherapy, Master of High Performance Sport, ASCA Level 2 Associate.
