An Australian Senate Inquiry is currently examining what more can be done to address the risks of concussion and repeated head trauma in contact sports. Submissions to the Inquiry have compared the Australian sporting industry’s response to concussion as analogous to the way big tobacco treats risks associated with smoking.
The sporting industry has been accused of failing to adequately evolve in response to the growing body of scientific research linking concussions to detrimental and long-term impacts on brain function and activity, including neurodegenerative diseases. To date, submissions to the Inquiry have called for research funding, greater education, the establishment of a national concussion registry, and consistent evidence-based guidelines to protect athletes from lifelong injury and impairment.
With an estimated 170,000 cases every year, concussion is the most common form of traumatic brain injury in Australia and is by no means limited to elite athletes. In this blog, we talk to SportsCare’s Principal Physiotherapist and resident concussion expert, Kylie Kook, about how to recognise the warning signs of concussion, the importance of proper concussion management, and how a physiotherapist can effectively and responsibly aid in managing concussion symptoms.
What are the typical causes and signs of a concussion?
A concussion is caused by an acceleration/deceleration of the brain following a significant impact on the head or body that causes the brain to move inside the skull.
While the majority of cases at the SportsCare Concussion Clinic are the result of high-impact contact sports like rugby, AFL and roller derby, Kylie notes that concussions can also be caused by falls and other accidents.
“We see concussions from falls off bikes (both road and mountain bikes), horses, play equipment and more recently, e-scooters”, says Kylie.
“It’s also important to remember that motor vehicle accidents also result in a large number of concussions, often these can be missed or put down to whiplash,” she adds.
Any form of a jolt to the head or body can result in a concussion.
“It’s important that all head knocks, suspected and known concussions be taken seriously and investigated and managed appropriately,” warns Kylie.
Symptoms may show up instantly after the incident, or minutes or even hours later. It is crucial to monitor for the following symptoms following a head injury, as they could indicate a concussion:
- balance problems
- nausea and vomiting
- fainting and unconsciousness
- vision changes and sensitivity to light and sound
- signs of memory loss or confusion.
- Not feeling right
The link between repeated exposure to head injuries and neurodegenerative disease
An Australian Senate Inquiry has recently been established in response to rising public concern about the risks associated with repeated head injuries in sports. For Kylie, the recent widespread public attention to the issue is long overdue.
“I think the whole world is standing up and paying attention now which is important.”
“Prioritising brain health over all other aspects of sport needs to be a priority,” says Kylie.
“We need to continue to adopt new practices and challenge the old attitudes to do what was “fine in my day”,” she says.
“Sporting organisations need to be up to date with the latest research and be committed to promptly changing the way they do things as new information and research come to light.
“Educating from a grassroots level up is vital, ensuring that at all levels, all players, coaches, trainers, and team management have access to education on the latest and best concussion recognition and management.
“Adopting mandatory baseline testing in all semi-contact and contact sports would be a great place to start and then having strict protocols to follow would encourage the safest adoption of sport and the safest return to sport,” says Kylie.
The role of physiotherapy in concussion management
Physiotherapists work with all aspects of the body, including the brain. SportsCare Canberra is officially recognised by Complete Concussion Management (CCMI), a global network of recognised clinics offering standardised, evidence-based concussion care to those impacted by, or at risk of, concussion.
SportCare’s CCMI practitioners collaborate with primary care physicians to co-manage concussions, helping patients and athletes safely return to learn, work and play.
“CCMI provides our clinical staff with the most up-to-date, evidence-based knowledge and training.
“This ensures that all our concussion clients are getting the best possible care, hot off the research press,” says Kylie.
Through collaboration between trained healthcare practitioners, educated coaches and trainers, and informed parents and athletes, CCMI educates and empowers those involved in sports to recognise concussions and take the necessary steps to help athletes recover and safely return to sport.
“It’s paramount to have evidence-based practice systems in place and to keep evaluating and improving the systems.
“The patients we see also go onto the CCM database (deidentified of course) and so by collecting data on the patients, we are able to contribute to continuing research and data in the concussion world and help to keep shaping the best management system,” explains Kylie.
“We are constantly updating and evolving the concussion program based on advances and increased understanding in the concussion world,” she adds.
What’s involved in a typical concussion management journey?
Ideally, those involved in activities with a high risk of concussion visit the SportsCare Concussion Clinic annually to undertake multimodal baseline testing, a battery of physical and cognitive tests that measure baseline healthy brain function before the start of the sporting season and prior to the injury. Baseline testing is, however, only the start of the concussion rehabilitation journey.
“In the event of a concussion, we endeavour to see people in the first 5 days to redo their baseline and use the results of these tests to guide and form an individualised plan for return to cognitive and physical activity and then ultimately a safe return to sport,” explains Kylie.
While most people recover without major medical treatment and are symptom-free within 10 days of sustaining an injury, there is a small percentage who develop post-concussion syndrome and require longer-term rehabilitation.
Longer-term symptoms can include memory and concentration problems, mood swings, and even personality changes.
“In more serious concussion cases, the individual generally has the best prognosis if they are seen within 6 days of being concussed and if rehab commences straight away,” says Kylie.
While the rehabilitation journey for post-concussion syndrome is often longer than in acute cases, the prognosis can still be positive. An individualised rehabilitation program will be developed based on the individual’s particular presenting symptoms and dysfunctions, often involving treatment by a multidisciplinary team of healthcare practitioners.