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:
- 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 moderate intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms. Concussive symptoms usually resolve in 10 – 14 days.
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
Return to learn
‘Return to learn’ is about the athlete’s gradual return to their usual program at school or work.
‘Return to learn’ should take priority over ‘Return to sport’. School programs may need to include more regular breaks, rests and increased time to complete tasks.
Medical practitioners can use the Return to Learn Care Plan 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.
Having rested for 24 – 48 hours after sustaining a concussion, the patient can begin moderate intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms. Concussive symptoms usually resolve in 10 - 14 days, after which the athlete can begin a staged return to sport.
Athletes returning to sport should follow these steps and spend at least 24 hours at each level:
Begin with light aerobic activity (at an intensity that can easily be maintained whilst having a conversation) until symptom-free
Basic sport-specific drills which are non-contact and with no head impact
More complex sport-specific without contact, including resistance training
Full contact practice following medical review
Normal competitive sporting activity
Athletes should only progress to the next level when they have completed 24 hours at the current level without recurrence of symptoms. If symptoms recur or worsen, athletes should step down to the previous level and complete at least 24 hours symptom free at that level..
Medical practitioners can use these Return to sport protocols to inform their Return to sport patient programs.