The Athletes' Guide to Concussion: Part 3

Welcome back to the final part of our concussion guide! In this part, we’re breaking down what to do immediately after a concussion occurs — from recognizing red flags and making sideline decisions, to understanding when it’s safe to return to play. Looking out for symptoms and responding quickly can make all the difference in recovery outcomes and long-term health.

Watch the video or read below to learn about concussion management and how physiotherapy supports safe recovery and return to sport!

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Sideline Management of a Concussion

• Do NOT return to play the day of the injury

• Monitor for a few hours after injury

  • Avoid use of medication to prevent masking of symptoms

  • Do not sleep for at least 3 hours following - monitor for decline, but no need to wake up throughout the night

• Address first-aid issues first and rule out serious medical conditions

  • Neck, neurological, severe brain injury, fractures, etc.

• Licensed healthcare provider/physician can assess the potential concussion using the SCAT-6

  • Not required

• If ANY signs or symptoms are present, concussion should be suspected until proven otherwise

  • Recovery time is SHORTER and symptoms are LESS significant in those removed from play

  • Note: many concussion symptoms overlap with other causes

• No two concussions are the same: history of concussion does not dictate what a second concussion will look or feel like

• WHEN IN DOUBT, SIT THEM OUT

Red Flags 2-3 Hours After Impact -> Refer to Emergency Room

• Severe or worsening headache

• Seizures

• Weakness in a limb

• Vomiting

• Decreasing alertness

• Changes in vision

• Tingling or numbness

• Difficulty speaking or understanding speech

• Difficulty swallowing

• Difficulty writing or reading

• Loss of fine motor skills - tremors

• Loss of coordination

• Loss of balance/unsteady

• Decreasing level of consciousness >2hrs after injury

• Fluid leaking from ears. bruising behind ears, 2 black eyes

• Inability to remember more than 30 minutes before the injury

SCAT6: Sport Concussion Assessment Tool - 6th Edition

• Used with ages 13+, 12 and younger use Child SCAT6

• More effective with baseline testing but not required

• Not to be used by itself to rule in/out concussion

• Concussion may still exist if SCAT6 is normal

• Results normalize 3-5 days post injury, so should not be used to determine return to play

Short Term Recovery

• Brain energy levels recover in 22-30 days (physiological recovery)

  • Symptoms may resolve before this

  • About 85% of concussed high school athletes have no symptoms by 21 days

• No symptoms does not mean there has been physiological recovery

  • May lead to early return to play, returning before brain energy levels recover = increased chance of greater brain injury and prolonged recovery

• Symptoms alone are a poor indicator of recovery

When Can I Return to Play?

• Normalization of objective testing

  • Balance, reaction time, cognitive ability, memory, visual processing, physical capacity, etc.

  • Assessed by licensed healthcare practitioner (ex. Physiotherapist)

• Done by comparing post-concussive test results to baseline measures and/or symptom provocation during testing

  
  

What is PCS?

• Symptoms that persist beyond 14 days in adults and 30 days in children that are no longer a result of the functional disturbance to the brain. They can be from a variety of other systems in our body that are dysfunctional following a concussion:

  • Blood flow abnormalities during exertion/physical activity

  • Eye movements/reflexes

  • Neck

  • Metabolic/hormonal/inflammatory

  • Psychological

Role of Physiotherapy

• Education on various potential causes of symptoms and symptom management

  • Talk about use of sunglasses, blue light, screen protectors, etc

• Determine causes of continued, persistent symptoms

  • Exertional testing

  • Neck, vision, vestibular system testing

• Guide return to school/work and play

• Provide exercises to improve symptoms

  • Physical/cardiovascular symptoms

  • Neck exercises

  • Vision training

  • Balance training

  • Etc...

• Rule out causes of symptoms that would warrant a referral back to your doctor (i.e fracture, spinal cord injury, etc)

• Get you safely back to sport!

What is the plan moving forward?

• We will continually reassess symptoms to individualize the treatment moving forward

• 3 appointments following the assessment will test various causes of concussive symptoms:

  • 1. Buffalo Concussion Treadmill test – assess the body’s response to a gradual increase of physical demand through a graded walking treadmill test

  • 2. Vestibular/Ocular-Motor Screening (VOMS) – assess if there are any abnormal findings or provocation of symptoms with eye movements / reflexes

  • 3. Neck Screening – review range of motion, joint mobility, muscle tone, etc in the neck to see if any symptoms could be caused from the neck joints or musculature

• If return to contact sport is the goal, we will clear for contact through the ‘Chicago Blackhawks Concussion Test’ which will put you through interval type physical testing to maximally exert your cardiovascular system

3 Things to Reduce Risk of Sustaining a Concussion

1. Be an aware, skilled player

2. Optimize your endurance

3. Advocate for and adhere to rules of the game

3 Things to Optimize Recovery and Management of a Concussion

1. Seek Help as Soon as Possible: best predictor for shortest recovery = seeing licensed healthcare provider for an assessment as soon as possible (<3 days), do NOT return to play

2. Be a Positive Change in Sport Culture: don't use terms like "getting your bell rung", take head injury seriously and support teammates going through concussion recovery

3. Stay Educated and Aware: recognize wide variety of concussion signs/symptoms, educate teammates

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That wraps up our three-part Concussion Guide series! The key takeaway is that timely assessment and proper care lead to better outcomes. Concussions are serious, but with the right plan and professional guidance, athletes can return to school, work, and sport safely and confidently.

If you suspect you have a concussion, click below to book an appointment to help you recover fully and get back to performing at your best!

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