A concussion is a traumatic brain injury- there is no such thing as a minor brain injury.
A player does not have to be “knocked-out” to have a concussion- less than 10% of players actually lose consciousness.
A concussion can result from a blow to head, neck or body. Concussions often occur to players who don’t have or just released the puck, from open-ice hits, unanticipated hits and illegal collisions.
The youth hockey player’s brain is more susceptible to concussion. In addition, the concussion in a young athlete may be harder to diagnosis, takes longer to recover, is more likely to have a recurrence and be associated with serious long-term effects.
Players, coaches, parents and heath care providers should be able to recognize the symptoms and signs of a concussion:
1. If the player is unresponsive- call for help & dial 911
2. If the athlete is not breathing: start CPR
3. Assume a neck injury until proven otherwise
• no neck pain
• no pain, numbness or tingling
• no midline neck tenderness
• normal muscle strength
• normal sensation to light touch
4. If the athlete is conscious & responsive without symptoms or signs of a neck injury…
5. Evaluate the player in the locker room:
• Ask about concussion symptoms (How do you feel?)
• Examine for signs:
• Verify orientation (What day is it? What is the score? Who are we playing?)
• Check immediate memory (Repeat a list of 5 words)
• Test concentration (List the months in reverse order)
• Test balance (have the players stand on both legs, one leg and one foot in front of the other with their eyes closed for 20 seconds)
• Check delayed recall (repeat the previous 5 words after 5-10 minutes)
6. A player with any symptoms or signs, disorientation, impaired memory, concentration, balance or recall has a concussion.
“When in doubt, sit them out”
• Remove immediately from play (training, practice or game
• Inform the player’s parents
• Refer the athlete to a qualified health-care professional
• Medical clearance is required for return to play
7. If any of the signs or symptoms listed below develop or worsen: go to the hospital emergency department or dial 911.
8. An athlete who is symptomatic after a concussion requires complete physical and cognitive rest.
This protocol should not be initiated until after the athlete has been released to participate in the functional return to play protocol by a qualified health care provider. If symptoms appear during a functional test, the test should be stopped and the athlete monitored until symptoms resolve. No further functional testing should be performed that day. Functional testing may resume the following day at the previously asymptomatic level if the athlete remains asymptomatic. If symptoms do not resolve, appropriate medical attention should be obtained.
After each phase of functional testing, the presence of post-concussive symptoms should be assessed and progression to the next phase of functional testing will require the absence of post-concussive symptoms. Each phase requires a minimum of 1 day before progressing to the next phase.
Level 1: Physical and cognitive rest.
Level 2: Light aerobic exercise such as walking or stationary cycling. No resistance training. May read 20% of normal volume. TV ok. No video games.
Level 3: Sport-specific exercises. No resistance training. May read 40% of normal volume. No video games.
Level 4: Non-contact practice. Resistance training ok. May read 60% of normal volume. No video games.
Level 5: Full contact practice. May read 80% of normal volume. Video games ok.
Level 6: Return to unrestricted competition and cognitive activities if medical clearance is provided by a qualified health care provider