Concussion in Sport – Facts
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.
Here are some facts about concussion in sport you should know……
13.4 concussions per 1000 hours played Rugby union (1). In Rugby, concussion injury rates are high for both ball carrier and tackler (2).
There are 6 concussions per 1000 hours played in AFL (3,4).
Concussion is also common in sports such as basketball (5) and netball (6).
Incidence of concussion and games missed is on the rise, likely due to improved recognition and early care. For example, concussion without loss of consciousness is more likely to be recognised, and more players are now more likely to be removed from play and assessed.
Concussion increases risk of further musculoskeletal injury (7,8).
Concussion is the most common injury requiring hospitalisation. Concussion is about 1 in 8 injuries in community Australian Rules Football. (Australian Institute of Health and Welfare).
There is a higher incidence of anxiety and depression in those with persistent symptoms following concussion (9).
Adverse mental health and sleep has been found in former rugby players with higher numbers of previous concussions (10).
Concussion is linked to worsening mental health, including depression (11,12).
Slowed reaction times are common after concussion 13 and can lead to increased risk of further head impacts (14,15).
Vestibular-ocular changes can occur in over half of sport related concussions (16).
Vestibular-ocular dysfunction (17), mental health (9) and sleep quality (18) is associated with prolonged recovery and should be included in baseline screening.
Concussion and repeated head impacts are associated with increased risk of developing Chronic Traumatic Encephalography (CTE) (19).
Females are more susceptible to concussion and suffer worse symptoms (20).
Multimodal baseline screens help with interpretation of post-concussion assessments (21).
Early interventions combining vestibular, ocular and neck treatment and sub-threshold exercises improve outcomes with earlier return to play (22–24).
Associate Professor James McLoughlin, Co-Director, Your Brain Health
References
1. Union, R. F. England Professional Rugby Injury Surveillance Project. 2014-15 Season Report. Preprint at (2016).
2. West, S. W. et al. It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys’ Rugby. Clin. J. Sport Med. (2023) doi:10.1097/JSM.0000000000001118.
3. Orchard, J., Seward, H. & Orchard, J. J. AFL Injury Survey 2014. , Victoria, Australia: AFL Doctors Association, AFL … (2014).
4. League, A. F. AFL Injury Survey 2015. Melbourne, Victoria, Australia: AFL Doctors Association (2015).
5. Patel, B. H. et al. Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018. Orthop J Sports Med 7, 2325967119854199 (2019).
6. Downs, C., Snodgrass, S. J., Weerasekara, I., Valkenborghs, S. R. & Callister, R. Injuries in Netball-A Systematic Review. Sports Med Open 7, 3 (2021).
7. Howell, D. R., Lynall, R. C., Buckley, T. A. & Herman, D. C. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med. 48, 1097–1115 (2018).
8. McPherson, A. L., Nagai, T., Webster, K. E. & Hewett, T. E. Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis. Am. J. Sports Med. 47, 1754–1762 (2019).
9. Sheldrake, E. et al. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front. Neurol. 13, 850590 (2022).
10. Hind, K., Konerth, N., Entwistle, I., Hume, P. & Theadom, A. Mental health and wellbeing of retired elite and amateur rugby players and non-contact athletes and associations with sports-related concussion: the UK …. Sports Med. (2021).
11. Rice, S. M. et al. Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. Sports Med. 48, 447–465 (2018).
12. Gornall, A., Takagi, M., Morawakage, T., Liu, X. & Anderson, V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br. J. Sports Med. 55, 1048–1058 (2021).
13. Eckner, J. T., Kutcher, J. S., Broglio, S. P. & Richardson, J. K. Effect of sport-related concussion on clinically measured simple reaction time. Br. J. Sports Med. 48, 112–118 (2014).
14. Harpham, J. A., Mihalik, J. P., Littleton, A. C., Frank, B. S. & Guskiewicz, K. M. The effect of visual and sensory performance on head impact biomechanics in college football players. Ann. Biomed. Eng. 42, 1–10 (2014).
15. Mihalik, J. P. et al. Collision type and player anticipation affect head impact severity among youth ice hockey players. Pediatrics 125, e1394-401 (2010).
16. Kaae, C., Cadigan, K., Lai, K. & Theis, J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 50, 279–296 (2022).
17. Whitney, S. L. et al. Association of acute vestibular/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj. 34, 840–845 (2020).
18. Magliato, S. N. et al. Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms. J. Child Neurol. 08830738231170721 (2023).
19. Daneshvar, D. H. et al. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat. Commun. 14, 3470 (2023).
20. McGroarty, N. K., Brown, S. M., & Mulcahey, M. K. (2020). Sport-Related Concussion in Female Athletes: A Systematic Review. Orthopaedic Journal of Sports Medicine, 8(7), 2325967120932306.
21. Resch, J. E. et al. The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ Open Sport & Exercise Medicine 2, e000012 (2016).
22. Reid, S. A., Farbenblum, J. & McLeod, S. Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis? Br. J. Sports Med. 56, 292–298 (2022).
23. Leddy, J. J., Haider, M. N., Ellis, M. & Willer, B. S. Exercise is Medicine for Concussion. Curr. Sports Med. Rep. 17, 262–270 (2018).
24. Hutchison, M. G. et al. Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care. PLoS One 17, e0276336 (2022).
Sports injury in Australia, Australian rules football. (2023). Retrieved 4 September 2023, from https://www.aihw.gov.au/reports/sports-injury/sports-injury-in-australia/contents/featured-sports/australian-rules-football.