Concussion and Other Head Injuries in Winter Sports

Concussion and Other Head Injuries in Winter Sports

Concussion and Other Head Injuries in Winter Sports
What does the road to recovery look like after sustaining a head injury? Does wearing a helmet protect you from the risk of concussion? Consultant Dan Brooke answers these questions and more in our new blog for National Winter Sport Traumatic Brain Injury (TBI) Awareness Month.
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As this is National Winter Sport Traumatic Brain Injury awareness month, I thought it would be useful to write about concussion, particularly in relation to winter sport. I have mostly experienced concussion in the context of sport – especially rugby and hockey — but it can occur at other times and potentially in all sports. 
At the last Winter Olympics in PyeongChang, concussion was seen in a number of athletes, especially those in skiing or snow-boarding events1,2. A recent article from Canada3 described the incidence of head injuries as between 0.77−3.8÷100,000 ski visits; interestingly most were in beginner to intermediate level skiers. In children, the most common reason for admission to hospital was head injury. In snowboarders, the rate of head injury was 6.5÷100,000 visits. The increase in speed combined with a lack of control was the biggest risk for injury.
Concussion is a very topical and emotive topic in sports, but there is a lot of misinformation and misconceptions out there that I wanted to address.
True or False? #
Concussion is a (minor) traumatic brain injury.
True. This was agreed at the Berlin conference in 2016 to help emphasise the seriousness of the injury. It should be taken seriously but it is something you should be able to recover from if you manage it correctly.
Helmets protect you from concussion. 
False. They may help reduce some force, the risk of serious injury, and protect from soft tissue lacerations, but significant injuries can still occur. F1 Racing Driver Michael Schumacher was wearing his helmet when he suffered his head injury, and it may have saved his life but he still suffered a significant injury. They do help and should be worn but do not offer 100% protection.
You do not have to be knocked out to have a concussion.
True. Other signs are dizziness, confusion, headache, balance problems, up to seizures and loss of consciousness. The symptoms can present up to 48 hours after the injury so be aware.
After a concussion you should have physical and cognitive rest and avoid alcohol.
True. Cognitive rest is really important and involves reducing screen time, work or reading. If you don’t follow this advice it could prolong your symptoms of concussion and delay your recovery.
The good news though, is that most people will recover happily from a concussion. Early diagnosis is key and the best person to see is a  Consultant in Sport, Exercise & Musculoskeletal Medicine.
They assess you by taking a thorough history of your lifestyle, habits and activity levels as well as performing a clinical examination after which they collate all the findings on an internationally recognised document4 used to record concussion tests in athletes. This comprehensive test examines all areas of brain function – from memory, recall, cognition, balance and fine motor skills. 
Most people should rest from all sporting activity after experiencing concussion but can then be guided on a graduated return to their activity or sport with a concussion specialist. If necessary, other healthcare professionals can be brought in to help aid the recovery, such as Physiotherapists, Strength and Conditioning Coaches or Neurologists. 
Although you should recognise a concussion and get seen as soon as possible, there is no reason why in the right hands, you can’t make a full recovery. 
Dr Dan Brooke is a Sport, Exercise and Musculoskeletal Medicine Consultant who specialises in concussion management . He has looked after professional athletes with concussion for many years and helps guide them to a safe return to sport. He supports professional rugby players including international players and those in the England U20 squad, professional hockey players and Olympic athletes. He is the chief medical officer for British Skeleton and has travelled with Team GB as the chief medical officer to the 2017 European Youth Winter Olympics. 
References:
Soligard T, Palmer D, Steffen K, Lopes AD, Grant ME, Kim D, Lee SY, Salmina N, Toresdahl BG, Chang JY, Budgett R, Engebretsen L. Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries. Br J Sports Med. 2019 
Soligard T, Steffen K, Palmer-Green D, Aubry M, Grant ME, Meeuwisse W, Mountjoy M, Budgett R, Engebretsen L. Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med. 2015 Apr;49(7):441 – 7.
Chaze B, McDonald P. Head injuries in winter sports: downhill skiing, snowboarding, sledding, snowmobiling, ice skating and ice hockey. Neurol Clin. 2008 Feb;26(1):325 – 32; xii-xiii.
Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvořák J, Sills AK, Aubry M, Engebretsen L, Loosemore M, Fuller G, Kutcher J, Ellenbogen R, Guskiewicz K, Patricios J, Herring S. The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. Br J Sports Med. 2017 Jun;51(11):848 – 850.
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