A concussion is a mild form of brain injury that causes a temporary disturbance in cells caused by acceleration or deceleration of the brain within the skull.

A concussion is caused by acceleration or deceleration of the brain, following a significant impact to the head or elsewhere on the body.

One common misconception is that someone must be hit in the head to cause a concussion; however, a significant enough hit to the body may cause a whiplash effect and result in enough force to the brain to cause a concussion.

A concussion causes the brain cells to become excited initially, followed by an extreme drop in energy. This may result in any of the following symptoms:

• Loss of consciousness (more than 90% of concussions do not result in loss of consciousness)
• Headache or pressure in the head
• Neck pain or whiplash
• Dizziness or vertigo
• Nausea and/or vomiting
• Blurred or distorted vision
• Balance problems
• Feeling tired, fatigue, slowed down, drowsy or having no energy
• Feeling “foggy” or not thinking clearly
• Not feeling right or feeling off
• More emotional
• Feeling sad, upset or angry
• Nervousness or anxiety
• Sensitivity to light or noise
• Difficulty concentrating
• Difficulty reading or working at a computer
• Difficulty remembering or concentrating
• Confusion
• Difficulty falling asleep
• Sleeping more or sleeping less
• Irritability

Visual signs of a concussion may include:

• Loss of consciousness
• Lying motionless on the field or ice
• Disorientation or inability to respond to questions
• Blank or vacant stare
• Balance, slowed movement, stumbling or incoordination
• Clutching head
• Slow to get up after a hit to the head or body

If you experience any one of these symptoms following a significant impact to the head or body, then you should have a high suspicion of concussion.

When in doubt, sit them out!

Download our free concussion symptoms infographic.

No: however, research demonstrates that reducing contact in younger athletes can decrease the likelihood of concussion. Most concussions happen during a collision when the player isn’t ready for the impending impact. Concussion is an acceleration injury and embracing for impact and stiffening your neck may reduce the force transmitted to the brain. Therefore, having game awareness may help to anticipate hits or impacts, and allow a player to brace accordingly.

Research shows that helmets cannot effectively prevent concussions, but can play an important role in protecting the skull from fractures.

Always tell a parent, teacher, coach and/or friend, if you, a teammate or even an opposing team member may have suffered a concussion. When in doubt, sit them out!

The first 24-48 hours following a concussion are critical due to the potential for a more serious injury that may require immediate medical attention such as a bleed or swelling in the brain. Following the injury, the patient should be monitored for at least 3 hours for any worsening of their condition as this may indicate bleeding or swelling in the brain.

Immediately go to the nearest emergency department if any of the following signs or symptoms are present. These are known as red flags.

• Very drowsy or cannot be woken up
• Vomiting
• Drug or alcohol intoxication at time of injury
• Short-term memory deficits
• Seizure
• Decreasing level of consciousness or awareness
• Fluid or blood coming from the ears, nose, mouth or eyes
• Bruising behind the ears, black eyes or very tender points on the face
• Inability to remember 30 minutes before or after injury
• Unsteadiness standing or walking
• Dangerous mechanism of injury (e.g., struck by a car or falling down stairs)
• Slurring speech
• Weakness or numbness in the arms or legs

It is important that patients receive a proper neurological evaluation and management advice as soon as possible following a concussion as this can significantly impact recovery.

Concussions are difficult to diagnose because symptoms may not be present immediately following an impact, and the symptoms are like those of other common injuries such as whiplash.

Healthcare practitioners and all those involved in concussion care should err on the side of caution. If there is a significant impact and at least one concussion symptom, an athlete should be removed from play and assessed by a licensed healthcare practitioner with training in concussion management. When in doubt, sit them out!

A concussion impacts how the brain functions, and as a result, cannot be detected by MRI or other brain scans. Because symptoms often resolve before full recovery of the brain. Therefore, having a comprehensive, multimodal baseline test done prior to the injury can assist healthcare professionals in making an accurate diagnosis as well as safer return to activity decisions.

Up to 90% of concussion injuries can resolve symptomatically within 7-10 days; however, in some cases, concussion injuries have longer lasting symptoms. If you experience symptoms beyond 4 weeks, this is known as post-concussion syndrome.

Very little is known about what causes post-concussion syndrome. It is currently believed to be due to continued blood flow abnormalities in the brain, continued energy deficits in the brain, psychosomatic disorders, vestibular/ocular issues (integration between visual and balance systems) and/or potential dysfunction in the muscles and joints of your neck that occurred because of the impact.

Risks for prolonged recovery and post-concussion syndrome include:

• History of concussions
• Multiple injuries in close time proximity
• Pre-existing depression or anxiety
• Family or life stressors
• Age (younger children and adolescents generally take longer to recover)
• Misinformation regarding concussions
• Improper management

During the early stages following injury, relative physical and cognitive rest is recommended for 24 to 48 hours; however, these decisions are made on a case-by-case basis.

Following a short period of rest, treatment and rehabilitation may include a gradual increase in mental and physical activity. If symptoms persist beyond 10 days, exercise therapy, manual therapy of the neck, diet and nutritional interventions, and vestibular and visual rehabilitation are proven to be effective treatment and rehabilitation options.

There are currently no over-the-counter or pharmaceutical interventions to speed concussion recovery.

Licensed healthcare practitioners should provide step-by-step processes and graduated stages of recovery to help concussion patients and athletes return to learn, work and/or play.

Our approach to concussion management may include:

• Moderate, symptom-limited activity
• Light cognitive activity
• Half-day of school/work (with restrictions)
• Full day of school/work (with restrictions)
• Buffalo treadmill test (to assess for blood flow abnormalities and readiness to return to exercise)
• Light, non-contact sport specific activity (athletes only)
• Higher intensity, non-contact sport specific activity
• High intensity physical exertion test (a physical exertion assessment which tests various systems and mimics game-like exertion and function) followed by immediate baseline retesting
• Return to full contact and game

This process may vary by individual. We recommend that you schedule an appointment with a licensed healthcare practitioner if you are at risk for concussion or have suffered a concussion.

Click here for the Recovery Stages of Concussion infographic.

A concussion is known as a mild traumatic brain injury (mTBI) and, by itself, is not a fatal injury.

The concern in the initial few hours to days is not the concussion, but rather that there may be a more severe injury than concussion such as a bleed or skull fracture.

Also, there have also been cases where individuals have died from secondary concussions that occurred before full recovery of the first concussion, this is known as Second Impact Syndrome.