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What is a Concussion?

Concussions are the most common form of head injury caused by an impact or forceful motion of the head or other part of the body, resulting in rapid movement of the brain within the skull.

 Doctor and Patient

A concussion is a brain injury that can’t be seen on routine X-rays, CT scans or MRIs.

It affects the way a person may think and remember things, and can cause a variety of symptoms.

Any blow to the head, face or neck, or a blow to the body that jars your head, could cause a concussion.

A concussion can happen to anyone. Common causes include falls, motor vehicle crashes, and sports and recreational activities.

A concussion typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.

A concussion causes changes in the way you think and feel. You could have a concussion even if you don’t pass out. It is always a good idea to have your medical doctor or nurse practitioner check you.

It is also important to have someone observe you for a few days after you have injured yourself. Everyone experiences concussions differently and symptoms can take hours or days to develop.

Most people recover in 10 days to 4 weeks, but recovery times can vary. Children and youth typically take longer than adults to recover from a concussion. If a person has had a concussion before, it may take them longer to heal the next time.
Football Injury

Sport Related Concussion (SRC)

A SRC is defined as a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain. Several common features that may be utilized in clinically defining the nature of a concussive head injury as described in the 2016 Berlin Consensus Statement include four main features:

SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.

SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.

SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

Recognize & Respond

The Concussion in Sport Group continues to commit to updating assessment and concussion recognition tools that are freely available.

Concussion Recognition Tool 6

Sport Concussion Assessment Tool 6

Child Sport Concussion Assessment Tool 6

Sport Concussion Office Assessment Tool 6

Child Sport Concussion Office Assessment Tool 6

Suspected Concussion - A Shared Responsibility

If someone experiences an impact to the head, face, neck, or body, and either shows observable signs or reports symptoms of a potential concussion, it's crucial to consider the possibility of a concussion.


In all cases of suspected concussion, the person should stop the activity right away. Continuing increases their risk of more severe, longer-lasting concussion symptoms, as well as increases their risk of other injury. It's essential that anyone suspected of having a concussion receives medical attention from a qualified healthcare professional.


While a formal diagnosis of concussion requires a medical assessment, it's everyone's responsibility to recognize and report suspected cases. This is especially crucial in settings where there might not be immediate access to healthcare professionals.

 Doctor and Patient

Signs & Symptoms

The Body (Physical)

  • Dizziness
  • Headache
  • Sick to the stomach
  • Pressure in the head
  • Balance problems
  • Sensitive to light or noise
  • Blurred vision
  • Nausea or vomiting
  • Ringing in the ears
  • Drowsiness

Person with a headache

Thinking (Cognitive/Mental)

  • Confused
  • Not thinking clearly
  • Feeling slowed down
  • Memory problems
  • Problems concentrating
  • Feeling like “in a fog”

Person thinking

Emotions (Emotional/Behavioural)

  • Irritable
  • Angry
  • Frustrated
  • Nervous or anxious
  • Anxious
  • More emotional
  • Sadness

Person sitting in dark room

Sleep

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Sleeping more than usual
  • Sleeping less than usual

Person looking at clock

Red Flag Symptoms

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

If any of the Red Flag Symptoms are present, call 911 or seek immediate medical care. These may be signs of a more serious injury.

If the person is unconscious DO NOT:

  • Move the person;
  • Remove any equipment, like a helmet or padding, in case of an injury to the spine.

Rest

The first and most important step in recovery from a concussion is to rest for a maximum of 2 days. The Amsterdam Consensus Statement recommends relative rest for only the initial 24 to 48 hours following injury, including limited screen time. Prolonged rest may delay recovery and affect mental health.

Management

Concussion symptoms can be managed by taking breaks and by prioritizing activities to conserve energy. Symptoms can also be managed by supporting quality sleep; naps should be limited to a maximum of 45 minutes per day. Short-term strategies can help manage concussion symptoms. However, these strategies and techniques can slow recovery if used over an extended period of time. A concussion can have a significant impact on physical, cognitive, and emotional functioning. The recovery process involves managing activities in order to not trigger or worsen symptoms—the key is finding the “sweet spot” between doing too much and too little.

Recovery

Aerobic exercise within 2 to 10 days after sport-related concussion has been shown to help with recovery and prevent symptoms from persisting. Thus, progressive increases in exercise intensity are recommended, according to symptom tolerance levels, as long as there’s no risk (that is, head impact, collision or fall). Slight worsening of symptoms with exercise is acceptable as long as the symptoms improve within 1 hour. Caring for a concussion can involve a variety of treatments and a team of health professionals, depending on the symptoms and how a person’s condition improves. Usually, symptoms will go away in 1 to 4 weeks. If you or your child has had a concussion before, or there are other health factors, recovery may take longer. Persistent symptoms should be personalized to the individual and involve a range of licensed health care professionals including occupational therapists, sports therapists, physiotherapists, chiropractors, and psychologists. Prior concussions, a history of headaches, and learning disabilities are all factors which may influence recovery from a concussion and lengthen the recovery period. It is normal to experience symptoms during recovery, and it is normal to feel good one day, and not so good the next. If new or worsening symptoms are experienced at any stage, the person should return to the previous stage until symptoms have improved once again. Wait at least 24 hours before re-attempting the next stage.

Assessments Include:

Conducting a clinical history and physical examination
Ordering diagnostic tests as needed
Referring to medical sub-specialists

Prevention

Concussion prevention is not just a one-time effort; it's an ongoing commitment that operates on multiple levels.

Prevent the concussion from happening. To prevent concussions, it's important for organizations to make changes across different areas. This includes adjusting the environment where activities happen, ensuring proper equipment and training, setting clear rules, and promoting a culture of safety. Considerations like who is most affected by concussions, how concussions occur, and when and where they happen are vital for understanding and addressing the issue.

*Information adapted from: Parachute. (2024). Canadian Guideline on Concussion in Sport. (2nd edition)

Prevent poor outcomes from the concussion. In the event of a concussion, timely recognition, removal from further risk, proper assessment, and management are essential for better outcomes. Establishing evidence-informed concussion policies and protocols can help prevent negative consequences resulting from delays or mismanagement.

*Information adapted from: Parachute. (2024). Canadian Guideline on Concussion in Sport. (2nd edition)

Prevent long-term complications from one or more concussions. By implementing primary and secondary prevention measures, organizations can significantly contribute to the long-term participation and well-being of participants. Establishing policies for better concussion management can reduce the chances of repeated injuries. Sometimes, it's advisable for individuals to consider discontinuing their participation in contact or collision sports, which is a highly individualized decision and there is no criteria to determine the best course of action. While scientific understanding of the long-term consequences of head trauma, such as neurodegenerative diseases and chronic traumatic encephalopathy (CTE), is still evolving, current research indicates that such complications are rare. Currently, there is no evidence suggesting an increased risk of these complications among amateur athletes at this time.

*Information adapted from: Parachute. (2024). Canadian Guideline on Concussion in Sport. (2nd edition)

The best way to prevent concussions is to prevent the incidents that cause concussions! Although not all concussions can be prevented, there are steps you can take to decrease the risk of sustaining one or reducing the severity of a potential concussion.

  • Seatbelts
  • Car and Booster seats
  • Proper training in contact sports
  • Supervision of sport practices and games
  • Sport organizations implementing rules and protocols in contact sports
  • Properly fitted protective sports gear, such as fitted helmets*

*Helmets can prevent serious head injuries. However, helmets are not proven to prevent concussions.

 A man talking with his doctor
Brain scan imaging

Second Impact Syndrome

Second Impact Syndrome (SIS) is associated with brain swelling when an individual experiences a second concussion before the complete recovery from the initial concussion. It is believed that athletes who sustain a concussion and return to their sport early are at a particularly higher risk of sustaining SIS. The management of the condition starts with prompt recognition of a sports-related concussion and protecting the athlete until they recover from the initial injury. The consequences of SIS can cause severe neurological impairment or fatality. Although SIS is an extremely rare condition and there have only been a handful of cases.

Read More About SIS

Learning From Tragedy - Rowan's Law

Rowan’s Law was named after Rowan Stringer, a high school rugby player from Ottawa, who died in the spring of 2013 from a condition known as second impact syndrome. Rowan is believed to have experienced three concussions over six days while playing rugby. She had a concussion but didn’t know her brain needed time to heal. Neither did her parents, teachers, or coaches. Rowan’s Law and Rowan’s Law Day were established to honor her memory and bring awareness to concussions and concussion safety. The last Wednesday of each September has been designated as Rowan’s Law Day to help raise awareness about concussion safety.

Rowan's Law