Persistent symptoms

Many people will experience symptoms after a concussion beyond 4 weeks. These are ‘persistent symptoms’ that will require help from health professionals. Up to 25% of people still experience symptoms at 3 months(Polinder et al. 2018), and with those who attend hospital after concussion, nearly 12% of children and 31% of adults experience symptoms beyond 3 months, with more than 50% still report some symptoms at 12 months(Machamer et al. 2022).

We estimate that 36,000 people in Australia

90,000 people in the UK

And 470,000 people in the US will experience persistent symptoms each year!

Academic Performance in schools.

1 in 5 children will suffer a concussion by the age of 10.

• A history of concussion in the past 12 months was significantly associated with a higher risk of poor academic standing during the same period.
• Young people hospitalized with concussion had 30% higher risk of not reaching the national minimum standards for numeracy, 40% higher risk for reading.
• In years 3-9, hospitalisation with concussion leads to 64% higher risk of not completing year 11 and 75% not completing year 12.(Lystad et al. 2022)
• Concussion leads to an increased risk of mental health issues with to a 2-fold higher risk of suicide. (Fralick et al. 2019; Ledoux et al. 2022)
• Children who have previously suffered a concussion are four times more likely to sustain another concussion (Fitzgerald et al. 2022)
• Concussion results in a 65% increase in lower limb injury for up to one-year post-concussion (Avedesian, Covassin, and Dufek 2020)
• There is increasing interest in the role in concussion recovery and sporting performance too.

What about employment?

• Concussion is associated with reduced income. For those who attend emergency, 17% were still not working at 12months, however this improved if support is provided within the first 3 months (Gaudette et al. 2022)

Avedesian, Jason M., Tracey Covassin, and Janet S. Dufek. 2020. “The Influence of Sport-Related Concussion on Lower Extremity Injury Risk: A Review of Current Return-to-Play Practices and Clinical Implications.” International Journal of Exercise Science 13 (3): 873–89.

Daneshvar, Daniel H., Evan S. Nair, Zachary H. Baucom, Abigail Rasch, Bobak Abdolmohammadi, Madeline Uretsky, Nicole Saltiel, et al. 2023. “Leveraging Football Accelerometer Data to Quantify Associations between Repetitive Head Impacts and Chronic Traumatic Encephalopathy in Males.” Nature Communications 14 (1): 3470.

Fitzgerald, Melinda, Jennie Ponsford, Natasha A. Lannin, Terence J. O’Brien, Peter Cameron, D. James Cooper, Nick Rushworth, and Belinda Gabbe. 2022. “AUS-TBI: The Australian Health Informatics Approach to Predict Outcomes and Monitor Intervention Efficacy after Moderate-to-Severe Traumatic Brain Injury.” Neurotrauma Reports 3 (1): 217–23.

Fralick, Michael, Eric Sy, Adiba Hassan, Matthew J. Burke, Elizabeth Mostofsky, and Todd Karsies. 2019. “Association of Concussion With the Risk of Suicide: A Systematic Review and Meta-Analysis.” JAMA Neurology 76 (2): 144–51.

Gaudette, Étienne, Seth A. Seabury, Nancy Temkin, Jason Barber, Anthony M. DiGiorgio, Amy J. Markowitz, Geoffrey T. Manley, and TRACK-TBI Investigators. 2022. “Employment and Economic Outcomes of Participants with Mild Traumatic Brain Injury in the TRACK-TBI Study.” JAMA Network Open 5 (6): e2219444.

Ledoux, Andrée-Anne, Richard J. Webster, Anna E. Clarke, Deshayne B. Fell, Braden D. Knight, William Gardner, Paula Cloutier, Clare Gray, Meltem Tuna, and Roger Zemek. 2022. “Risk of Mental Health Problems in Children and Youths Following Concussion.” JAMA Network Open 5 (3): e221235.

Lystad, R., A. McMaugh, G. Herkes, G. Browne, T. Badgery-Parker, C. Cameron, and R. Mitchell. 2022. “The Impact of Concussion on School Performance in Australian Children: A Population-Based Matched Cohort Study.” Journal of Science and Medicine in Sport / Sports Medicine Australia 25 (November): S36–37.

Machamer, Joan, Nancy Temkin, Sureyya Dikmen, Lindsay D. Nelson, Jason Barber, Phillip Hwang, Kim Boase, et al. 2022. “Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study.” Journal of Neurotrauma 39 (5–6): 358–70.

Polinder, Suzanne, Maryse C. Cnossen, Ruben G. L. Real, Amra Covic, Anastasia Gorbunova, Daphne C. Voormolen, Christina L. Master, Juanita A. Haagsma, Ramon Diaz-Arrastia, and Nicole von Steinbuechel. 2018. “A Multidimensional Approach to Post-Concussion Symptoms in Mild Traumatic Brain Injury.” Frontiers in Neurology 9 (December): 1113.

How common is concussion in football?

While the most frequent injuries in football involve the lower limbs, concussions and other head injuries, though less common, remain a significant concern. Head and neck injuries are rank as the 5th most common type of injury, making up about 5% of all football injuries. Specifically, concussions occur at a rate of approximately 0.5 per 1000 match hours, with an even lower incidence during training sessions.

How do head injuries occur?

Head injuries often happen during aerial challenges. Collisions involving head-to-head contact, elbow-to-head, knee-to-head, foot-to-head, and head-to-ground impacts are the primary culprits.

Are some positions more likely to sustain a concussion?

Yes, defenders are most prone to concussions (33%), followed by midfielders (30%), forwards (24%), and goalkeepers (13%). These injuries are most common in the final and initial 30 minutes of a match, particularly in midfield areas where collisions and aerial duels are frequent.

Is there a difference between the male and female game?

Indeed, studies show that head and neck injuries occur more frequently in female players compared to their male counterparts (17% vs. 14%).

What are the impacts of concussion on football players?

Growing concerns have emerged following studies indicating that former professional footballers are 3.5 times more likely to die from neurodegenerative diseases than the general population. Conditions like dementia, Parkinson’s, motor neuron disease, and Chronic Traumatic Encephalopathy (CTE) are linked to repeated head impacts.

One of the lesser-reported impacts of a concussion is that athletes are reported to have a 2.5 times greater risk of sustaining a subsequent musculoskeletal injury following an initial concussion.

What about concussion substitutes?

The International Football Association Board (IFAB) approved the trial of permanent concussion substitutes in 2021. This measure was implemented in the Premier League and Women’s Super League, with FIFA initially trialling it in international competitions such as the FIFA Club World Cup™.

What else are authorities doing to protect players?

Authorities are continuously working to safeguard players. In 2021, new heading guidelines were introduced by The FA, Premier League, EFL, the PFA and the LMA, recommending that a maximum of 10 higher-force headers are carried out in any training week. In May 2024, the FA have begun phasing out deliberate heading in matches for all grassroots youth football from U7 to U11.

How can Your Brain Health help?

Your Brain Health is dedicated to promoting effective concussion management strategies within the football community. Through education, such as the online Level 1 course “Concussion – Are You Ready?”, players, coaches, and officials can learn to protect themselves and others, ensuring the long-term health and safety of everyone involved in the sport.

Together, by staying informed and proactive, we can ensure that football continues to be a source of joy, unity, and safety for all. Enjoy the matches, support your teams, and let’s keep our players safe on the road to glory at Euro 2024!

How common is concussion in cricket?

Concussions in cricket are less frequent than injuries to the hamstring, lumbar spine, and trunk. However, they still occur. Data indicates an annual concussion incidence of 0.9 per 100 players, or 2.3 males and 2.0 females per 1000 days in the elite game.

In England, during the 2023 domestic season, there were 17 reported concussions, each resulting in an average of 10 days lost per concussion.

How do head impacts occur in cricket?

The primary cause of head impacts in cricket is batters being struck by the ball from fast bowlers, accounting for 67% of such incidents. Other causes include close fielders being hit by the ball, collisions with other players or the boundary fence, the head striking the ground, and wicketkeepers being hit by the bat!

Is there a difference in Men’s and Women’s cricket?

Yes, there is a difference. In elite cricket, concussion rates are 0.4 per 1000 player hours for men and 0.5 for women. Interestingly, 53% of head impacts in women’s matches result in concussions, compared to 32% in men’s matches.

What is the impact of concussion in cricket?

Post-concussion, symptoms like balance issues, impaired concentration, and vision problems can affect performance relating to cricket. Repeated head impacts and concussions are linked to chronic traumatic encephalopathy (CTE), though there are no known cases in cricketers so far.

In 2021, Derbyshire wicketkeeper Harvey Hossein retired from cricket following a series of concussions.

What are the concussion protocols in cricket?

In 2019, the International Cricket Council (ICC) mandated concussion protocols, requiring players to pass a series of assessments before continuing play.

What about concussion substitutes?

Since August 2019, the ICC has allowed concussion substitutes in Test matches. If a player is diagnosed with a concussion, they can be replaced by another player who can fully participate.

Marnus Labuschagne became the first concussion substitute in the history of international cricket, replacing Steve Smith during the Lord’s test of the 2019 Ashes series. He went on to score 59 in the fourth innings to help Australia salvage a draw.

What are the helmet regulations?

Modern cricket helmets are designed to offer enhanced protection but cannot eliminate concussion risk entirely. Helmets must comply with the British Standard BS7928:2013, a mandate from the ICC to improve player safety. The introduction of neck guards has also been developed which have now been mandated by both Cricket Australia and the ECB.

What are the guidelines at an amateur club or school?

While elite teams have trained medical staff to manage head impacts, concussions also occur at the community level. In Australia, 28% of cricket-related hospital admissions were as a result head injuries.

Research indicates that players often lack awareness about guidelines, testing, and helmet regulations, highlighting the need for ongoing education. Australian Guidelines now recommend clubs and schools appoint a concussion officer to manage concussions.

How can Your Brain Health help?

Your Brain Health offers education on concussion, including the online Level 1 course “Concussion – Are You Ready?” This 45-minute course is designed for those at elevated risk of concussion or who wish to become designated concussion officers.

Baseline screening

We have removed time and cost limitations by designing fast and cost-effective multimodal screens that focus on key measures monitored and compared at an individual level to inform best care following a concussion.

Education

We have developed a world class programme of three critical courses for anyone involved in concussion management. From parents and teachers through to medical practitioners wanting evidence-based updates. Knowing the most up to date developments saves lives.

Support

We facilitate support by providing opportunities for global networking within our custom designed online community of experts. Knowledge around concussion continues to evolve rapidly from the fields of neurology, vestibular, musculoskeletal and sports rehabilitation. Collaboration and sharing are key to innovation and best practice moving forward.

Technology

We are at leading the way in the selective use of the very best technological advances. From specific software, apps, virtual reality, eye-tracking, balance, movement, heart rate and cognitive testing devices, we know what people need and when.

Biopsychosocial Model:

The paper emphasizes a holistic approach to concussion management.

Beyond physical aspects, consider psychosocial factors (e.g., mental health, social support).

Personalized care is crucial.

Education and Prevention:

From athletes, to coaches, to parents improving education in this area is essential.

The paper underscores the authority of licensed medical professionals in decision-making.

Preventive measures, such as proper technique and equipment, play a vital role.

Assessment Advances:

The assessment process has evolved, including an update on the optimal value of baseline screening measures.

A comprehensive evaluation includes symptom assessment, cognitive testing, balance assessment, vestibular-ocular and mental health screening.

Athletic trainers should be proficient in these areas.

Prognostic Recovery Indicators:

Factors affecting recovery post-concussion are explored.

Initial symptom severity, early care seeking, and other individual characteristics influence outcomes.

Monitoring these indicators can inform key management decisions.

Mental Health Considerations:

Pre- and post-injury mental health are critical.

Screening for mental health conditions is recommended.

Establish referral networks for athletes with mental health needs.

Return to Academics:

Returning to school after a concussion requires careful planning.

Individualized support, academic adjustments, and communication with educators are essential.

Monitor academic progress during recovery.

Physical Activity and Rehabilitation:

Early controlled aerobic exercise benefits recovery.

Targeted rehabilitation interventions address persistent symptoms, including vestibular and cervicovestibular rehab protocols.

Gradual return to physical activity is part of the process.

Return to Sport:

Updated return-to-sport guidelines emphasize a stepwise approach.

Clinically directed aerobic exercise is part of treatment.

Individualized decisions consider the athlete’s well-being.

Knowledge around concussion and brain injury recovery and rehabilitation is making promising progress; however, challenges remain in driving progress and innovation in clinical practice.

Every field of clinical practice faces the challenges of keeping up to date with the latest clinical evidence and implementation of a change in practice usually takes a frustratingly long time! Concussion research and practice is also further challenged by the complex nature of brain impairments that involve many clinical specialities from the areas of neurology, neuropsychology, sport, and vestibular clinical practice, just to name a few. If rehabilitation is to progress, these clinical specialities will need to communicate and collaborate effectively. That is no easy task, with differences in terminology, experience, locations, and expertise making collaborative work very challenging.

At Your Brain Health, we take concussion in sport very seriously.

As one of the most common injuries in contact sport, it is also potentially one of the most devastating to long term health and quality of life. Your Brain Health has put together this list of facts on concussion you should know following the advice released from the Australian Sports Commission, partly addressing the recommendations from the Australia Parliament Senate inquiry into concussion and repeated head trauma contact sports.

Your Brain Health offers many services to help sporting clubs including education, multimodal baseline screening and clinical support.

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