Introduction

Head injuries and concussions can occur in many sports, either in training or during competitions. Because of the potentially grave consequences of injuries to the head, coaches must take certain precautions and should enforce strict safety measures when dealing with them.

The information contained in this section is not designed to train coaches on how to implement a medical treatment, or to offer medical advice in the event of a concussion. Rather, its purpose is to provide some recommendations on how to manage situations involving head injuries in a responsible manner.

It is important to note that there is presently a lack of consensus in the medical community regarding precise grading scales and return to training or competition criteria following concussions.  

What is a concussion?

  A concussion is an injury to the brain that shows itself through a temporary alteration in the mental status of an individual. 

Some common causes of concussions

The situations that may result in head injuries vary greatly from sport to sport, and producing a comprehensive list of possible causes is therefore difficult. However, some common causes include:

• Direct blows to the head, face, or jaw
• Collisions from the blind side, or hits from behind
• Falls or whiplash effect
• Poor quality of protective sport equipment (shock absorption), failure to wear protective equipment designed for the head, or improper adjustment
• The environment (e.g. obstacles near playing surface)
• Significant differences in the skill level, age, or size of athletes involved in activities with physical contacts
• Poor physical condition or strength of neck and upper body musculature

Symptoms

  Symptoms observed in the case of a concussion include headache, dizziness, loss of consciousness, nausea, lethargy, memory loss, confusion or disorientation, vacant stare, lack of focus, ringing in the ears, abnormal speech impairment, balance impairment, problems with sight.

Degrees or grades of concussions

An unconscious athlete or an athlete with significant changes in mental status following a head injury must be transported to the emergency department of the nearest hospital by ambulance. In milder cases when symptoms are not severe, the following guidelines can be used to assess the grade or severity of concussion:

GRADE 1 - No loss of consciousness.  Initial symptoms disappear with rest and are do not reoccur within 15 minutes (symptoms should be reassessed every 5 minutes). After 15 minutes without symptoms, the athlete must be asked to perform a 20-second physical exertion test (e.g. high-intensity run, push-ups or another intense effort). None of the symptoms listed above should be observed following the effort. If this is the first time the athlete has suffered from a concussion, he or she may be authorized to resume training or competition. If the symptoms do return, the athlete must not be allowed to resume the activity, he or she must be seen by a medical doctor the same day, and declared fit before training can resume.

GRADE 2 - Initial symptoms (or some of them) are still present for longer than 15 minutes, or return following the exertion tests. The athlete must not be authorized to resume the activity, and must see a medical doctor the same day.

GRADE 3 - Any loss of consciousness (no matter how brief) is recognized as a Grade 3 concussion. This is a grave situation, and the athlete must see a medical doctor immediately. In a case where the athlete is still unconscious upon the arrival of the charge person, an ambulance should be called, and the Emergency Action Plan should be put into action.

Managing the athlete’s return after a concussion

 Although an athlete may have been given the authorization to return to regular training and competition, this must be done gradually. The athlete must be re-evaluated periodically during the weeks that follow his or her return, to ensure that there are no reoccurring symptoms.

 Below are a series of steps to assist coaches in managing the return to training or to competition of an athlete who has suffered from a concussion. Each step should take at least one day (step 5 applies predominantly to sports that involve body contact).

Step 1:    No activity, complete rest; if no symptoms are observed for one full day, move to Step 2.

Step 2:    General low-intensity continuous exercise, such as walking, jogging, or cycling on a stationary bicycle; if no symptoms are observed, move to Step 3.  

Step 3:    General, low-intensity, sport-specific activity without contact; if no symptoms are observed, move to Step 4.

Step 4:    Low- to moderate-intensity sport-specific training activities without body contact; if no symptoms are observed, move to Step 5.

Step 5:    Regular practice with body contact (no hard impact); if no symptoms are observed, move to Step 6.

Step 6:    Return to regular training and to competition.

If symptoms do reoccur, the athlete must immediately stop any form of activity, and be examined by a medical doctor before resuming training or competition.  It is extremely important for the athlete, the coach, and the medical personnel to be open and frank when evaluating the athlete’s condition. If reoccurring symptoms are not disclosed, the athlete may suffer permanent damage.

Repeated concussions

If an athlete has a history of repeated concussions, he or she should participate in sport activities only when full clearance to do so is obtained from a recognized medical professional.

Note: The previous information is largely based on a brochure produced by Judo Canada, entitled “SAFETY FIRST - WHAT YOU NEED TO KNOW ABOUT CONCUSSIONS.” The Coaching Association of Canada expresses its thanks to Judo Canada and to its Sport Director, Mr. Andrzej Sadej, for permission to adapt this material.