Concussions

What is a concussion?

A concussion is a type of brain injury. It can change the way the brain functions. Symptoms can affect your body, thoughts, emotions or behaviours.¹ Common signs and symptoms (Parachute) of a concussion² include:

• headaches
• dizziness
• poor balance
• confusion
• nausea and vomiting
• feeling drowsy or having difficulty sleeping
• difficulty thinking clearly and remembering
• being easily upset or angered

Red Flags³

If any of the following signs or symptoms are observed, call 911 and get immediate medical attention.

• neck pain or tenderness
• double vision
• weakness or tingling / burning in arms or legs
• severe or increasing headache
• seizure or convulsion
• loss of consciousness
• deteriorating conscious state
• vomiting
• increasingly restless, agitated or combative
• getting more and more confused

How do you get a concussion?

A concussion can be caused by a direct hit to the head, face, or neck, or from a blow to anywhere on the body that causes the brain to move rapidly back and forth inside the skull.¹ Activities such as getting body-checked, heading a soccer ball, being rear-ended while in a motor vehicle, or experiencing a fall can cause a concussion. You do not have to lose consciousness (be “knocked out”) to have a concussion. Not all head injuries are concussions.

How do you know if you have a concussion?

All individuals suspected of having a concussion should go see their health care provider for a medical assessment as soon as possible.¹ A concussion can’t be seen on an x-ray, MRI or CT scan. Only a medical doctor or nurse practitioner can diagnose a concussion. Any person who has received an impact to the head, face, neck or body should be checked for signs and symptoms of a concussion.^{1, 2} The Concussion Recognition Tool 5 (CRT5, British Journal of Sports Medicine) can be used by anyone, such as a coach, parent, or bystander, to identify a person with a suspected concussion.  Some people will show signs or feel symptoms right away. For others, these can develop over the next 48 hours.

When can you return to school, work, or sport if you have a concussion?

Returning to your regular activities should be done under the supervision of a health care provider. Recovery times are different to each individual. The signs and symptoms of a concussion often last for 10-14 days but may last up to four weeks in children and youth.¹ It’s important to give your brain the time it needs to heal. Rest for the first 24 to 48 hours. That means no TV, computer, reading, work, school, or physical activities. After that, light mental and physical activity can be started, as long as it doesn’t make your symptoms worse. Returning to your regular activities and sports needs to be done carefully and gradually (in steps), to make sure that your symptoms don’t reappear.^1,2 How quickly you can do that depends on the type of symptoms you have and how severe they are.

For school-aged children, Ophea’s (Ontario Physical and Health Education Association) new concussion protocols clearly outline what to do if a concussion is diagnosed and what learning and physical activities are permitted at each stage of recovery.⁶ These protocols have been identified by the Ministry of Education as the minimum standard when it comes to concussion safety for schools.⁷ For more information on managing concussions in schools and school-aged children visit Schools and Daycares.

As an adult with a diagnosed concussion, you should work with a medical professional to understand how to safely return to activities (Parachute) by following a return-to-work, return-to-learn, or return-to-sport strategy.

You should always complete your return to learn/work plan before returning to full sport participation.^1,2 Returning to sport before you’re ready puts you at a high risk of having another concussion, with symptoms that may be increased and last longer.

Concussion safety in Ontario

In March 2018, Ontario passed concussion safety legislation to help protect amateur athletes in sport and in school settings.⁴ Rowan’s Law (Concussion Safety), 2018, makes it mandatory for sports organizations to:

• Ensure that athletes under 26 years of age,* parents of athletes under 18, coaches, team trainers and officials confirm every year that they have reviewed Ontario’s Concussion Awareness Resources (in effect as of July 1, 2019).
• Establish a Concussion Code of Conduct that sets out rules of behaviour to support concussion prevention (in effect as of July 1, 2019).
• Establish a Removal-from-Sport and Return-to-Sport protocol (effective as of January 1, 2021).

* Special Rule: A sport organization that is a university, college of applied arts and technology or other post-secondary institution must not register any athlete regardless of age unless the same requirements are met.

Concussions in sport

Concussions can happen in many sport-related settings so it is important that all organizations take steps to protect their participants. The goals are to reduce the total number of concussions that occur in sports and to reduce the negative effects of concussions on individuals. Creating policies and protocols in the event of a sport-related concussion can help reach these goals. The Ministry of Heritage, Sport, Tourism and Culture Industries provides additional information for sport organizations.

Concussions outside of a sports setting

The information outlined in The Canadian Guidelines on Concussion in Sport² (Parachute) can be applied to children, adolescents and adults who sustain a concussion outside of a sport environment and are returning to activity (i.e., school, work, etc.).² Receiving appropriate diagnosis, and care for concussions and following recommendations for a gradual return to activities is key to helping reduce the negative impact concussions can have.

The Ministry of Heritage, Sport, Tourism and Culture Industries provides additional information on the prevention, identification and management of concussions.

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References:

1. McCrory P., et al. (2017) 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(11), 838-847.
2. Parachute (2017). Canadian Guidelines on Concussion in Sport. Toronto: Parachute.
3. Davis, GA et al. (2017). Concussion Recognition Tool 5. British Journal of Sport Medicine. 51:872. Retrieved from http://bjsm.bmj.com/content/bjsports/51/11/872.full.pdf on September 15, 2020.
4. Ontario Ministry of Heritage, Sport, Tourism and Culture Industries (2020). Rowan’s Law: Concussion safety. Retrieved from https://www.ontario.ca/page/rowans-law-concussion-safety on September 15, 2020.
5. OPHEA (n.d.). Concussions. Retrieved from http://safety.ophea.net/concussions on September 15, 2020.
6. Ontario Physical Education Safety Guidelines. (2018). Concussions. Retrieved from http://safety.ophea.net/concussions on September 20, 2018.
7. Ontario Ministry of Education. (2019). Policy/Program Memorandum 158: School Board policies on Concussion. Retrieved from http://www.edu.gov.on.ca/extra/eng/ppm/ppm-158-jan-2020.pdf on September 16, 2020.

This item was last modified on October 24, 2023