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Use your head when it comes to concussion

Concussion is a mild traumatic brain injury that occurs when the brain is shaken or jolted inside the skull.

It is estimated that more than 180,000 concussions are experienced in Australia each year and around 30 percent of those with concussion will go on to experience ongoing, debilitating symptoms that affect their health, lifestyle, and work.

In the past, concussion was seen as a relatively harmless, short-term injury. However, with growing understanding and awareness about its short and long-term impacts, we are now seeing improved recognition and management of the condition.

In this month’s blog, we take a closer look at the causes, symptoms and management of concussion.

What is concussion?

A concussion is a short-term brain injury resulting from a force to the head, neck or body that causes the brain to move within the skull and results in chemical changes and damage to brain cells.

It can be caused by:

  • Falls – particularly common in older adults and young children.
  • Sports-related injuries – common in contact sports, such as Australia Rules Football (AFL), boxing, rugby, soccer, and touch football; as well as cycling, wheeled motor sports, and equestrian.
  • Transport accidents – from head hitting the steering wheel, dashboard, or window etc.
  • Violence and assault – including domestic violence.
  • Blast injury or other occupational hazards

According to statistics from the Australian Institute of Health and Welfare, the majority of concussion presentations to hospitals were a result of a fall (51%), followed by transport accidents (24%), and assault (11%), with one in five (or 22%) of all hospitalised concussion cases having occurred while participating in sport or physical activity.

Source: AIHW National Hospital Morbidity Database - Number of concussion hospitalisations, by cause and sex, Australia, 2021–22

What is concussion?

A concussion is a short-term brain injury resulting from a force to the head, neck or body that causes the brain to move within the skull and results in chemical changes and damage to brain cells.

It can be caused by:

  • Falls – particularly common in older adults and young children.
  • Sports-related injuries – common in contact sports, such as Australia Rules Football (AFL), boxing, rugby, soccer, and touch football; as well as cycling, wheeled motor sports, and equestrian.
  • Transport accidents – from head hitting the steering wheel, dashboard, or window etc.
  • Violence and assault – including domestic violence.
  • Blast injury or other occupational hazards

According to statistics from the Australian Institute of Health and Welfare, the majority of concussion presentations to hospitals were a result of a fall (51%), followed by transport accidents (24%), and assault (11%), with one in five (or 22%) of all hospitalised concussion cases having occurred while participating in sport or physical activity.

Signs and Symptoms

In the past, concussion was seen as a relatively harmless, short-term injury that was associated with fast recovery, under-reporting and a lack of understanding about potential long-term impacts.

In fact, in previous generations, it was often thought that if you weren’t knocked out cold, then you weren’t concussed! However, we now know that concussion can occur without a complete loss of consciousness and symptoms can vary greatly.

Some symptoms may show up immediately, while others may present in the days, weeks, or even months following a knock to the body or head.

The most common symptoms include:

  • Headache or pressure in the head
  • Dizziness or balance problems
  • Nausea or vomiting
  • Sensitivity to light or noise
  • Confusion or memory problems
  • Fatigue or drowsiness
  • Blurred vision or ringing in the ears
  • Mood changes, such as irritability, anxiety, or depression

The Australian CTE Biobank and Macquarie University, in partnership with Sydney FC, have developed this useful ‘Big 5’ initiative to help those involved with sport better identify concussion following a head knock during games.

 It encourages people to look out for:

  1. Slump – lying motionless, unconscious or knocked out.
  2. Sway – appearing wobbly, unsteady or falling over.
  3. Slow – walking slowly, wandering or delayed movements.
  4. Stun – confused, appearing stunned or behaving unusually.
  5. Slur – slurred speech, slow speech, or responding poorly.

Some concussion symptoms can indicate a more severe and life-threatening brain injury, so it’s important to seek emergency care if you experience any of the following symptoms:

  • Neck pain or tenderness
  • Seizure or convulsion
  • Double vision
  • Loss of consciousness
  • Weakness or burning/tingling in more than one arm or in the legs
  • Deteriorating conscious state
  • Vomiting
  • Severe or increasing headache
  • Increasingly restless, agitated or combative
  • Visible deformity of the skull

While most people will recover fully within a couple of weeks, children can take a little longer to recover from a concussion and there may be some people who experience ongoing symptoms for weeks or months after the initial injury.

Long-term impacts of concussion

With a better understanding and more research into concussion these days, there is also growing evidence to suggest that repeated impacts to the head, neck or body can result in a number of debilitating long-term conditions

This includes:

  • Chronic Traumatic Encephalopathy (CTE) – a degenerative brain disease that affects thinking, mood and behaviour, and interferes with day-to-day life.
  • Cognitive impairment – causing problems with memory, attention, and executive function.
  • Mood disorders – including depression and anxiety.

These can result in people who have had repeated head impacts, even without concussion.

In recent years, we’ve also seen a number of high-profile sports people having to retire early from their professional careers as a result of ongoing issues from repeated concussion, including Australian cricketer, Will Pucovski; AFL players Nathan Murphy and Angus Brayshaw; and NRL players Dale Finucane, Boyd Cordner, Jake Friend and Andrew Davey.

Prevention

While head injuries can’t always be prevented, there are ways to reduce your risk, including:

  • Wear a seat belt whenever you’re travelling in a car.
  • Secure your children in age-appropriate safety seats – check with your State Government for more information.
  • Reduce the risk of falls – avoid standing on unstable surfaces, remove or secure small area rugs, improve lighting, and install handrails.
  • Follow the rules of your sport – many sports have banned certain tackles or developed techniques and rules to reduce head injuries at all levels of play.
  • Take time to recover from injuries – don’t return to work or school too quickly, or rush back to playing sports before you are fully recovered.
  • Exercise regularly – to strengthen your leg and core muscles to improve your balance.

Treatment

While treatment and management of concussion will depend on its severity, it is important for anyone with concussion to rest for the first 24-48 hours, in order to give your brain a chance to heal.

It is also suggested that you:

  • Don’t drive or operate heavy machinery
  • Don’t drink alcohol
  • Limit screen time
  • Take time off work or school
  • Continue to do gentle exercise, such as walking
  • Get assessed by a doctor, to ensure there is no bleeding, fluid or pressure on the brain, or any spinal injury.

Even if you are feeling fine and normal after a concussion, you will need to avoid participating in sports and rigorous activities for a few weeks and should only return to these after you’ve been given the ok by your doctor.

Returning to activities too soon can put you at risk of additional injuries that exacerbate any existing inflammation and lead to a longer recovery and ongoing long-term impacts.

If you have any concerns or show any signs and symptoms of concussion, make an appointment with your GP as soon as possible. Bookings at Illawarra Medical Centre can be made online (insert link) or by contacting us on (08) 9208 6400.

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