Welcome to the first post of 2024. We hope you've had a great summer and have found time to be physically active in the sunshine. Did you know our clinic offers management of sport related concussion, in particular with guidance on management of concussion symptoms and the return to competition following competition.
Dr Mel Parnell has been involved in a consensus group to align concussion protocols across different sports at the community level. Previously, each sport provided guidelines for return to play post concussion, with differences between protocols creating confusion, particularly when athletes played across different codes. With ACC at the forefront, medical staff from several sporting disciplines came together to create community concussion guidelines. These new guidelines are published on the ACC website, are easy to follow and well worth the read: Concussion in sport (acc.co.nz).
There are three key principles athletes, parents, coaches and supporters on the sideline can use to know what to do in cases of suspected concussion. It can happen in any sport, and you don't need to be hit on the head or knocked out to be concussed.
Recognise - there is a pocket concussion recognition tool to help identify signs of concussion. The signs and symptoms can be obvious or sometime quite subtle. You may notice:
signs such as lying on the ground not moving, loss of balance, dazed or vacant look
memory impairment if you ask them simple questions on where they are and what the score is
they may report blurry vision, dizziness, confusion, headache or other symptoms
Remove - the player should be removed immediately and not allowed to return - if in doubt, sit it out.
Refer - they should attend a Doctor for an assessment and diagnosis of concussion. This could be a local A&E, local Dr/Medical Centre or the local hospital emergency department
Important things to consider:
early removal/assessment reduces recovery time
female athletes, children and adolescent athletes take longer to recover
if concussion is suspected, the athlete must not return to sport/activity on the same day
Red Flags (require urgent review)
significant neck pain
increasing confusion or irritability
repeated vomiting
weakness or tingling/burning in arms or legs
deteriorating after the injury - increased drowsiness, headache or vomiting
history of bleeding disorder/medications which may result in prolonged bleeding (eg: aspirin/Warfarin)
loss of consciousness or seizures
severe or increasing headache
unusual behaviour (different from normal)
double vision
anyone with inadequate supervision post injury
visible skull deformity
Recover
Typical management includes an element of physical and cognitive rest, usually between 24-48 hours, before a gradual progression of physical and cognitive activity.
This is best guided by a medical practitioner with experience in concussion management (eg: Doctor, physiotherapist, occupational therapist)
return to competitive sport must only occur after a graduated return to play program, and a return to education/work and social activities
Further evaluation by a Doctor should occur in those with prolonged symptoms (greater than 4 weeks)
Return to Sport (see table below)
This should be guided by a medical practitioner with experience in sport related concussion (eg: Doctor, physiotherapist, occupational therapist)
This should be progressed more slowly with children, adolescents and female athletes, and in the majority of cases will occur within 1 month of injury
clearance by a medical doctor is strongly recommended before returning to contact-based and sport specific training (stage 5), or full competition (stage 6)
Before returning to sport specific training (stage 5), the athlete should:
have returned to full capacity/usual work/education
be symptom free and completed up to/including Stage 4
be a minimum 14 days post injury
Before returning to competitive sport/play (stage 6), the athlete should
be symptoms free and completed 7 days at stage 5
be a minimum 21days post injury
have received medical clearance by a Doctor to return to competition
Dr Mel Parnell and Dr Alyse Cameron are skilled in the management of sport related concussion. Athletes will require a referral to be seen, and will be seen in our concussion clinic. Referral can be made by a medical practitioner/allied healthcare once an ACC45 has been lodged. There is no cost/surcharge for these appointments.
Table reference: Concussion in sport (acc.co.nz)
Link to stuff article: Strict stand-down in new national sports concussion guidelines