There’s a lot to know about concussions and their proper management. This page deals in-depth with the most common issues associated with concussions and when athletes can return to play.
What is a concussion?
Information courtesy of: SIRC (Sport Information Resource Centre)
What is a concussion?
A concussion is a common form of brain injury and can be caused by a direct or indirect hit to the head or body. Rapid movement of the head, such as whiplash, can also cause a concussion. In a concussion, there is a change in the brain function, which results in a variety of symptoms. With a concussion, there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal. Your brain still looks fine, but it does not run normally.
What actually happens?
When a person suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull’s bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bony protuberances inside the skull. Such force can also result in a rotational injury in which the brain twists, potentially causing a shearing of the brain nerve fibres. It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself, but how the brain is working. The exact length of this change is unclear. During this time period, the brain does not function normally on a temporary basis and is more vulnerable to a second head injury.
How do concussions occur?
Most concussions in curling occur as a result of falls on the ice either the front or back of the head colliding with the surface.
Who should the athlete-curler tell?
It is extremely important to seek medical advice immediately upon receiving a blow to the head or body that results in signs or symptoms of a concussion. Often, concussions can go untreated (and even unnoticed by others) because few symptoms are visible to casual observers. Many times, the symptoms of a concussion may not be identified until the person recovers to the point where increased exertion causes symptoms to worsen. In many cases, curlers do not even know that they have been concussed.
Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive, and emotional changes. You can never be too careful! Symptoms may actually worsen throughout the day of the injury or even over the next day or two. Without proper management, a concussion can result in permanent problems and seriously affect one’s quality of life.
It is important for any curler who has fallen and hit their head (anywhere on club property for that matter) to tell the club administration and to tell a family member, friend, and teammate if they think they have hurt their head. Because a concussion affects the function of the brain and can result in symptoms such as memory loss or amnesia, it is important that others be aware of the signs and symptoms of concussions to help identify the injury in others. If they think they have hurt their head, they should tell someone immediately.
Youth: It’s very important to congratulate youth curlers at this point for being smart and saying they’ve been hurt. They should be removed from play immediately and medical attention should be sought immediately.
What are the signs and symptoms of a concussion?
Following a concussion, curlers may experience many different signs and symptoms. A symptom is something they will feel, whereas a sign is something others may notice. It is important to remember that some symptoms may appear right away and some may appear later. Just as no two people are the same, no two concussions are the same and so the signs and symptoms may be a little different for everyone. Some may be subtle and may go unnoticed by injured players, as well as their friends and family. Contrary to popular belief, most concussions occur without a loss of consciousness. Symptoms may get worse not just during activity, but later that day and the next.
When should an ambulance be called?
Getting a blow to the head doesn’t necessarily mean an ambulance is needed. If a curler loses consciousness or is dazed and confused, or if a neck or back injury is suspected, erring on the side of caution is the right response. It is better to overreact than to underreact.
How are concussions diagnosed?
With a concussion, there is no visible injury to the structure of the brain; meaning tests like MRI or CT scans usually appear normal. Concussions typically resolve fully with proper rest and management in about a week or two, but concussions that are not diagnosed can lead to long-term and more serious health implications. The first and most important step is to consult a doctor, preferably one familiar with concussion management.
There are many potential factors that may help to inform individual diagnosis, concussion management, and recovery, although many of these are still being researched to find the exact link. For example, severity is probably impacted by a number of factors such as history of previous head injuries, including number of past concussions, length of recovery time, timing between past concussions, age, and style of play. Factors such as this may lead to a different, slower recovery, which is why concussion history should always be monitored. Return to activity while still concussed and symptomatic can lead to an increased risk for another concussion, more intense symptoms, and a prolonged recovery.
Diagnosing a concussion may take several steps. A doctor may ask questions about the concussion and sport history and the most recent injury, and will conduct a neurological exam. This can include checking memory, concentration, vision, coordination, and balance.
The doctor may request further tests including a CT scan or MRI; these tests can be important to assess for other skull or brain injury but they do not inform concussion diagnosis. In the majority of concussions, there will not be any obvious damage found on these tests.
Neuropsychological testing: Sometimes the role of neuropsychological testing is important in identifying subtle cognitive (i.e., memory, concentration) problems caused by the concussion and may at times help to plan return to pre-injury activity. In addition, balance testing may be required. Usually these are arranged by an expert.
When can a youth player return to school?
Sometimes youth who have a concussion may find it hard to concentrate in school and may get a worse headache or feel sick to their stomach if they are in school. They should stay home from school if their symptoms get worse while they are in class. Once they feel better, they can try going back to school at first for half days and if they are okay with that, then they can go back full-time.
When can a player return to the curling ice? — Return To Play
Youth should not return to play until they have completed the Five Steps to Return to Play and have been cleared by their doctor. A concussed player should be removed from activity immediately and should be assessed by a medical doctor. Given that symptoms may worsen later that night and the next day, they should not return to the ice. When children are concussed, their ability to assess their situation may be impaired. Post-concussive symptoms may intensify with an increase in activity, so it is important that return to activity is gradual and monitored/supervised by a medical professional.
A concussion is a serious event, but you can recover fully from such an injury if the brain is given enough time to rest and recuperate. Returning to normal activities, including sport participation is a step-wise process that requires patience, attention, and caution. Each step must take a minimum of one day but could last longer, depending on the player and his or her specific situation.
Concussion Guidelines and Return to Play Policy
The following terms have these meanings in this Policy:
“Association” – Curling Canada;
“Participants” – Coaches, athletes, volunteers, renters, officials and other members.
The Association takes seriously the health and well-being of all curlers and is committed to ensuring the safety of those participating in the sport of curling. The Association recognizes the increased awareness of concussions and their long-term effects and believes that prevention of concussions is paramount to protecting the health and safety of participants.
As part of a responsible risk management plan, the Association recommends that Provincial or Territorial Sport Organization’s (PSOs or TSOs) and Curling Clubs adopt and implement these Guidelines, as well as recommend the following: use of double grippers (when not delivering a stone) and helmets (or other approved head protection) by novice curlers, or curlers who are at high risk of falling. This should include but is not limited to: i) FUNdamental, ii) Learning to Train, and iii) Active for Life.
The Association enacts this Policy as a tool to help manage concussed and possible concussed participants. The Policy provides guidance in identifying common signs and symptoms of concussion, protocol to be followed in the event of a possible concussion, and return to play guidelines should a concussion be diagnosed.
Awareness of the signs and symptoms of concussion and knowledge of how to properly manage a concussion is critical to recovery and helping to ensure the individual is not returning to physical activities too soon, risking further complication.
Please keep in mind that a concussion is a clinical diagnosis that can only be made by a medical doctor. It is imperative that a medical doctor examines someone with a suspected concussion.
During all Association curling events, competitions, and practices, participants will use their best efforts to be aware of incidents that may cause a concussion, such as:
- Head trauma – (blow to the head, face or neck, OR a blow to the body that transmits a force to the head)
Recognize and understand the symptoms that may result from a concussion. These may appear immediately after the injury or within hours or days of the injury and may be different for everyone. Some common signs and symptoms include, but are not limited to:
- Poor concentration
- Sensitivity to light or noise
- Poor appetite
- Decreased memory
- Poor balance
- Slowed reaction time
Identify injured participants or other individuals who have been involved in any of the above incidents and/or exhibit any of the above symptoms.
RESPONSIBILITY OF COACH, ADMINISTRATOR, SUPERVISOR, CHIEF UMPIRE:
If a participant has been identified as having a suspected concussion, the coach, administrator and/or supervisor of that activity will notify all affected parties, including the participant, a parent/guardian (when appropriate) as well as other coaches, administrators and/or supervisors of the suspected concussion. At this point, the individual should not participate in any physical activity until he/she has visited a medical doctor.
If the participant is unconscious:
- Initiate emergency action plan and call 911
- If applicable, contact the child/youth’s parent/guardian to inform them of the injury and their child is being transported to hospital.
- Stay with the individual until Emergency Medical Services arrives.
- Monitor and document any physical, emotional and/or cognitive changes.
- Even if consciousness is regained, he/she needs to be examined by a medical doctor prior to the participant returning to physical activity.
If the Participant is conscious:
- Remove the participant from the activity immediately and;
- Notify the participant’s parent (if the participant is a minor) or someone close to the participant (if the participant is not a minor).
- Have a ride home for the participant arranged.
- Isolate the participant into a dark room or area.
- Reduce external stimulus (noise, other people, etc.).
- Remain with the participant until he or she can be taken home.
- Monitor and document any physical, emotional and/or cognitive changes.
- Encourage the consultation of a physician.
Once the injured participant has been properly attended to, an Incident Report shall be filed with the affiliated Club, Provincial Sport Organization, and the Association within 48 hours. (See Appendix “A”)
Return To Play:
Once the participant’s immediate needs have been met, the participant’s family or the participant should be directed to the following protocol, in accordance with the following guidelines:
- If no concussion is diagnosed: the participant may return to play for the next game, or during the same game according to the Rules of Curling.
- If a concussion is diagnosed: the participant should only return to the activity after following the five steps outlined below and as directed by a physician. (Please note that each step must take a minimum of 24 hours and the length of time needed to complete each step will vary based on the severity of the concussion. The concussed participant should be monitored regularly for the return of any signs and/or symptoms of concussion. If signs and/or symptoms return, consult with the medical doctor):
STEP 1: Complete cognitive and physical rest: Immediately consult a physician. Limit school, work and tasks requiring concentration. Refrain from physical activity until symptoms are gone. Once all symptoms are gone, rest for at least another 24-48 hours and re-consult a physician, preferably one with experience managing concussion. In order to proceed to Step 2, medical clearance is required.
STEP 2: Light aerobic exercise to reintroduce physical activity: 10-15 minutes of low intensity activity like walking or stationary cycling. In order to proceed to Step 3, the concussed participant or parent/guardian if applicable must report back to his/her coach, administrator and/or supervisor that he/she is symptom free.
STEP 3: Sport-specific exercise: 15 minutes of low intensity participation like throwing rocks. The environment should be managed so as to ensure the participant is at minimum risk of falling or colliding with other participants. The participant may also attempt basic balance drills. In order to proceed to Step 4, the concussed participant or parent/guardian if applicable must report back to his/her coach, administrator and/or supervisor that he/she is symptom free.
STEP 4: Activity with no body contact: non-contact practice and non-contact sport specific drills – no activity that involves head impact or other jarring motions. In order to proceed to Step 5, the participant must provide written documentation from a medical doctor to his/her coach, administrator and/or supervisor. The documentation must state that the individual is symptom free and able to return to full participation in physical activity.
STEP 5: Full participation in non-contact sports once cleared by a physician.
This Policy requires the participant to consult with a physician throughout this process AND provide proof of medical clearance before being eligible for Steps 2 and Steps 5 noted above. The Association will comply with all directions provided by the physician, which may supersede this policy.
If a participant is showing signs of concussion and/or has been clinically diagnosed as concussed, the Coach, Administrator and/or Supervisor of that participant shall prevent the participant from curling until the required medical clearance has been provided.
Once the participant has provided medical clearance, the coach, administrator and/or supervisor will be required to forward a copy of the medical clearance letter to the affiliated Club, PSO and to the Association where it shall be attached to the participant’s Incident Report for record keeping purposes.
Failure to abide by any of the guidelines and/or protocols contained within this policy may result in disciplinary action being taken by the Association.