By Lauren Donley
As community sporting competitions kicked off around the country earlier this year the Australian Sports Commission released its national Concussion Guidelines for Youth and Community Sport. Aimed at anyone involved in junior sport the guidelines provide a clear and consistent framework for managing concussion in children and adolescents aged under 19 years.
The official mantra of the guidelines is: If in doubt, sit them out. This means immediately removing anyone suspected of concussion from play and sitting them out for the rest of the match. The guidelines also point parents, teachers, and coaches to the Concussion Recognition Tool (CRT6) – a free community resource that can assist anyone on the sidelines to identify the key signs and symptoms of concussion.
After identifying a suspected concussion the guidelines advise an initial rest period of 24 to 48 hours followed by a gradual return to sport and other activities such as using screens, reading and learning. This gradual approach centres around two key checkpoints: a return to contact training after a symptom-free period of at least 14 days; and a full return to competitive contact sport after a minimum of 21 days.
What is concussion?
Overwhelmingly concussion tends to be discussed in relation to contact sports (with this article being no exception!). For this reason it may come as a surprise to learn that most concussions are actually caused by other types of trauma such as falls, car accidents and assaults. In fact, a concussion can be caused by any type of impact to the head, or even by a blow to the body that jolts the head back and forth.
At a neurological level concussion occurs when the brain collides with the inside of the skull causing inflammation, damage to brain cells and blood vessels, and chemical changes. Some common symptoms of this damage include confusion, short-term memory loss, headache, dizziness, nausea, vomiting, blurred vision, ringing in the ears and fatigue.
What are the long-term effects?
From a medical standpoint concussion is classified as a type of traumatic brain injury which means it should always be taken seriously. However, the brighter news is that a single or low number of concussions is unlikely to result in permanent damage. Most people recover on their own within several days to a couple of weeks.
For reasons that science is yet to explain, a small number of people go on to develop persistent post-concussion symptoms (PPCS) which can last for weeks or months. Ongoing symptoms can include headaches, sensitivity to light or noise, balance problems, anxiety, and depression. One theory is that these persistent symptoms are due to delayed inflammation in the brain.
In those who experience repeated concussions there’s growing evidence to suggest that cumulative damage can lead to a degenerative brain disease known as chronic traumatic encephalopathy, or CTE for short.
CTE was first identified among boxers in the 1920s at which time it was referred to as ‘punch drunk syndrome’. A century later scientists are still working towards a better understanding of CTE. One reason for the slow progress is that CTE can only be conclusively diagnosed by examining the brain after death. This examination can take months to complete and it’s often a complex decision for individuals and families.
In 2018, the Australian Sports Brain Bank (ASBB) was established to accelerate understanding of CTE and to overcome some of these historical barriers to research. To date, the ASBB has released preliminary findings from the study of 21 donor brains confirming that repeated concussions are linked to the build-up of a naturally occurring protein called tau.
In healthy brains tau provides structural support to brain cells, contributing to efficient transport of substances within cells, and smooth communication between cells. In CTE, tau proteins clump together and spread throughout the brain, leading to cell death and brain shrinkage.
Currently there’s no clear consensus on what level of damage causes this build-up of tau and an eventual progression to CTE. Until research can tell us more the Australian Sports Commission guidelines provide a sensible approach to reducing the likelihood of repeated concussions. A win all round for community sporting clubs and young brains everywhere.
