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Concussion Education Resource
These guidelines are for general informational purposes only. They are not intended to and do not constitute any medical advice and do not contain any medical diagnoses, symptom assessments or medical opinions.
WHAT IS A CONCUSSION?
A concussion is a brain injury that can’t be seen on x-rays, CT or MRI scans. It affects the way an individual thinks and can cause a variety of symptoms.
WHAT CAUSES A CONCUSSION?
Any blow to the head, face or neck, or somewhere else on the body that causes a sudden jarring of the head may cause a concussion. Examples include falling on the ice, colliding with the boards or another skater, landing awkwardly from a jump, tripping, etc.
WHEN SHOULD I SUSPECT A CONCUSSION?
A concussion should be suspected in any individual who sustains a significant impact to the head, face, neck, or body and reports ANY symptoms or demonstrates ANY visual signs of a concussion. A concussion should also be suspected if an individual reports ANY concussion symptoms to one of their peers, parents, teachers, or coaches or if anyone witnesses an individual exhibiting ANY of the visual signs of concussion. Some individuals will develop symptoms immediately while others will develop delayed symptoms (beginning 2448 hours after the injury).
WHAT ARE THE SYMPTOMS OF A CONCUSSION?
A person does not need to be knocked out (lose consciousness) to have had a concussion. Common symptoms include:
| ‣ Headaches or head pressure | ‣ Easily upset or angered |
| ‣ Dizziness or disorientation | ‣ Sadness |
| ‣ Nausea and vomiting | ‣ Nervousness or anxiety |
| ‣ Blurred or fuzzy vision | ‣ Feeling more emotional |
| ‣ Sensitivity to light or sound | ‣ Sleeping more or sleeping less |
| ‣ Balance problems | ‣ Having a hard time falling asleep |
| ‣ Poor focus, concentration and retention | ‣ Difficulty working on a computer |
| ‣ Appearing dazed or drowsy | ‣ Difficulty reading |
| ‣ Feeling slowed down or fatigued | ‣ Difficulty learning new information |
WHAT ARE THE VISUAL SIGNS OF A CONCUSSION?
Visual signs of a concussion may include:
| ‣ Lying motionless on the ice or ground | ‣ Blank or vacant stare |
| ‣ Slow to get up after a direct or indirect hit to the head |
‣ Balance, gait difficulties, motor incoordination, stumbling, slow labored movements |
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‣ Disorientation or confusion or inability to respond appropriately to questions |
‣ Facial injury after head trauma ‣ Clutching head
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WHAT SHOULD I DO IF I SUSPECT A CONCUSSION?
If an individual is suspected of sustaining a concussion, they should be immediately removed from skating/office training or coaching. Any individual who is suspected of having sustained a concussion must not be allowed to return to skating, off-ice training, or coaching that day, even if they say they are feeling better.
It is important that ALL individuals with a suspected concussion undergo a medical assessment by a medical doctor or nurse practitioner, as soon as possible. It is also important that ALL individuals with a suspected concussion receive written medical clearance from a medical doctor or nurse practitioner before returning to any kind of sport / physical activities.
WHEN CAN THE INDIVIDUAL RETURN TO LEARN/SCHOOL/COACHING AND SPORTS?
It is important that all individuals diagnosed with a concussion follow a stepwise return to learn/school/coaching and sports-related / physical activities that includes the following Return-to-learn/School/coaching and Skate Canada Return-to-Sport Strategies. It is important that individuals return to full-time school activities before progressing to stage 5 and 6 of the Return-to-Sport Strategy.
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1
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Daily activities at home that do not give the individual symptoms. |
Typical activities during the day as long as they do not increase symptoms (i.e. reading, texting, screen time). Start at 5-15 minutes at a time and gradually build up. |
Gradual return to typical activities.
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2
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Learn / School / Coaching activities.
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Learn / School: Homework, reading or other cognitive activities outside of the classroom. Coaching: Reading or other cognitive activities off the ice. |
Increase tolerance to cognitive work.
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3
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Return to Learn / School / Coaching part-time.
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Learn / School: Gradual introduction of schoolwork. May need to start with a partial learn/school day or with increased breaks during the day. Coaching: gradual return to work – may need to start with a partial work day and should remain off the ice. |
Increase academic/coaching activities.
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4
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Return to Learn / School / Coaching full-time.
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Learn / School: Gradually progress Coaching: Gradual progress to coaching, first remaining off the ice, then progressing to on - ice; Should start progression from stage 2 to 6 of the Skate Canada Specific Return to Sport Strategy for coaches as tolerated. |
Return to full academic activities and catch up on missed schoolwork
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McCrory et al. (2017). Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.
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1
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Symptom-limiting activity.
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Daily activities that do not provoke symptoms.
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Gradual re-introduction of work/school activities.
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2
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Light aerobic activity.
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Cardio-vascular testing if available to establish the basic heart rate (HR), where the symptoms appear. If not possible: • Medium pace walking without symptoms (HR 100-130) • Light intensity stationary cycling or jogging for 15-20 minutes at subsymptom threshold intensity • No resistance training
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Increase heart rate. Regain normal heart rate variability.
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3
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Sport-specific exercise.
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Running or skating drills. No head impact activities. Off-ice warm-up: • sub-maximal with agility exercises. On-Ice intervals: • stroking, then turns (no twizzles) • 5 x 3 minutes program parts without jumps or spins at 60-70% max heart rate (around 140), and rest until back to 50-55% max HR (around 80-100) Off-ice training (gym): • under 80% of 1 maximal repetition (MR) • No jumps, avoid exercises with head below hips • Core, proprioception, stabilization & flexibility exercises
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Add movement No jumps, no spinning. Try to plan ice session with less skaters on the ice.
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4
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Non-contact training drills.
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Warm up: • Off-ice double jumps without symptoms (start with 5-10 reps) • Agility with intervals, 8 x 30sec. On-Ice training: 1- Full programs with single jumps; no spins; 80-90% max HR (165-180) Rest until back to 50-55% max HR (around 80-100) Single and double jumps outside programs No spins If tolerated: 2- Complete programs with single and double jumps, but no spins Mastered triple jumps outside programs No spins If tolerated: 3- Add more difficult triple jumps 4- No spins Off ice training (gym): • No more than 80% of 1 MR (maximal resistance) • Add exercises with external resistance • Avoid jumps in training if jumps being done during same day on-ice training
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Exercise, coordination and increased thinking. Avoid repetitive falls. Avoid session with a lot of skaters.
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5
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Full contact practice.
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Following medical clearance Warm-up: Same as previous to injury On-ice training: 1. Complete/full programs with all jumps but no spins Spins outside programs If tolerated: 2. Progress to full programs Off-ice training (gym): • Pre-injury strength & conditioning • Limit jumping depending on how much was done on ice |
Restore confidence and assess functional skills by coaching staff.
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6 |
Return to sport |
Normal training, no restrictions. |
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1
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Symptom-limiting activity
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Daily activities that do not provoke symptoms
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Gradual re-introduction of work/school activities |
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2
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Light aerobic activity
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Cardio-vascular testing if available to establish the basic HR where the symptoms appear If not possible: • Medium pace walking without symptoms (HR 100-130) • Light intensity stationary cycling or jogging for 15-20 minutes at subsymptom threshold intensity • No resistance training
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Increase heart rate. Regain normal heart rate variability.
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3
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Sport-specific exercise.
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Running or skating drills. No head impact activities. Off-ice warm-up: • Sub-maximal with agility exercises. On-Ice intervals: • Stroking, then turns (no twizzles, no lifts) • 5 x 3 minutes program parts without jumps, lifts, or spins at 60-70% max heart rate (around 140), and rest until back to 50-55% max HR (around 80100) Off-ice training (gym): • Under 80% of 1 maximal repetition (MR) • No jumps or lifts, avoid exercises with head below hips • Core, proprioception, stabilization & flexibility exercises |
Add movement No jumps, no lifts, no spinning. Try to plan ice session with less skaters on the ice.
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4
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Non-contact training drills.
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Warm up: • Off-ice double jumps without symptoms (start with 5-10 reps) • Agility with intervals, 8 x 30sec. • Off-ice lifts On-Ice training: 1- Full programs with single jumps (including side by side jumps); no spins; 80-90% max HR (165-180) Rest until back to 50-55% max HR (around 80-100) Single and double jumps outside programs Lifts outside of program No throw jumps No Death Spiral No spins If tolerated: 2- Complete programs with single and double jumps (including side by side) and lifts, but no spins Mastered triple jumps and throw jumps outside programs No spins No Death Spirals If tolerated: 3- Complete programs with lifts, triple side by side and double throws, no spin Death spirals and triple throws outside programs No spins Off ice training (gym): • No more than 80% of 1 MR (maximal resistance); • Add exercises with external resistance • Avoid jumps in training if jumps being done during same day on-ice training |
Exercise, coordination and increased thinking. Avoid repetitive falls. Avoid session with a lot of skaters.
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5
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Full contact practice.
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Following medical clearance Warm-up: Same as previous to injury On-ice training: 1. Complete/full programs with all jumps, throws and death spirals, but no spins Spins outside programs If tolerated: 2. Progress to full programs Off-ice training (gym): • Pre-injury Strength & Conditioning • Limit jumping depending on how much was done on ice |
Restore confidence and assess functional skills by coaching staff.
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6 |
Return to sport. |
Normal game play |
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1
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Symptom-limiting activity.
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Daily activities that do not provoke symptoms.
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Gradual re-introduction of work/school activities. |
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2
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Light aerobic activity.
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Cardio-vascular testing if available to establish the basic heart rate (HR), where the symptoms appear. If not possible: • Medium pace walking without symptoms (HR 100-130) • Light intensity stationary cycling or jogging for 15-20 minutes at subsymptom threshold intensity • No resistance training |
Increase heart rate. Regain normal heart rate variability.
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3
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Sport-specific exercise
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Running or skating drills. No head impact activities. On-Ice intervals: • Stroking, then turns (no twizzles) • 5 x 3 minutes at 60-70% max heart rate (around 140), and rest until back to 50-55% max HR (around 80-100) Off-ice training (gym): • Under 80% of 1 maximal repetition (MR) • No exercises with head below hips • Core, proprioception, stabilization & flexibility exercises |
Add movement. No jumps, no spinning.
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4
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Non-contact training drills.
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On-Ice intervals: • Stroking then turns; 80-90% max HR (165-180) • Rest until back to 50-55% max HR (around 80-100) • Single and double jumps • No spins If tolerated: • Mastered triple jumps outside programs • No spins If tolerated: • Add more difficult triple jumps Off ice training (gym): • No more than 80% of 1 MR (maximal resistance); • Add exercises with external resistance
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Exercise, coordination and increased thinking. Avoid repetitive falls.
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5
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Full contact practice.
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Following medical clearance Warm-up: Same as previous to injury On-ice training: • Jumps • Reintroduce spins If tolerated: • Progress to full coaching session physically Off-ice training (gym): • Pre-injury Strength & Conditioning • Limit jumping depending on how much was done on ice |
Restore confidence.
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| 6 | Return to sport | Normal training, no restrictions |
HOW LONG WILL IT TAKE FOR THE INDIVIDUAL TO RECOVER?
Most individuals who sustain a concussion will make a complete recovery within 1-2 weeks while most youth will recover within 1-4 weeks. Approximately 15-30% of patients will experience persistent symptoms (>2 weeks for adults; >4 weeks for youth) that may require additional medical assessment and management.
HOW CAN I HELP PREVENT CONCUSSIONS AND THEIR CONSEQUENCES?
Concussion prevention, recognition and management require individuals to follow the rules and regulations of their sport, respect other skaters, coaches and trainers, avoid head contact, and report suspected concussions.
TO LEARN MORE ABOUT CONCUSSIONS PLEASE VISIT:
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