How to diagnose and manage sports-related concussions in primary care

  1. Michael McClarnonFoundation Year 1 Doctor1,
  2. Neil HeronMedical LecturerNIHR Clinical Lecturer23
  1. 1Belfast Health and Social Care Trust, Belfast, Northern Ireland
  2. 2Center for Public Health, Queen’s University Belfast, Belfast
  3. 3School of Medicine, Keele University, Newcastle-under-Lyme, UK
  1. Letter to my Heron N.Heron{at}qub.ac.uk

What do you want to know?

  • Concussion rehabilitation typically lasts at least 20 days for non-elite sports participants, with 24-48 hours of dedicated relative rest followed by a gradual return to work, education, and finally, sport.

  • Non-elite athletes should not return to competitive sport before day 21 following concussion.

  • Recovery from a concussion varies, but for most people, symptoms resolve within two weeks. If symptoms do not improve within four weeks, refer patients to a concussion specialist, eg, a consultant in sports and exercise medicine or a specialist neurologist.

A 20-year-old female amateur soccer player comes to your GB training following a head collision on the pitch two days earlier. She felt unsteady during the confrontation, had a headache ever since, and found it difficult to concentrate.

Sports-related concussion (SRC) is defined as “a complex pathophysiological process affecting the brain, triggered by traumatic biomechanical forces”.123 It is usually caused by direct blows to the head, face, neck, or other parts of the body, with force transmitted to the head. It usually causes a rapid onset of transient neurological dysfunction, including headache or difficulty concentrating (however, in some cases this may be delayed) and is not associated with structural brain injury or pathology on neuroimaging. A study in Canada reported the average annual incidence of a concussion per 87 residents.4

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SRC is relevant to primary care because head injuries and potential SRC are common presentations in events such as rugby tackles or falls from bicycles or horses. Patients are often advised to see their GP for concussion symptoms, and the UK Concussion Guidelines for Non-Elite (Grassroots) Sport recommend that anyone with symptoms after 28 days should seek medical advice from their GP.5 In addition, all concussions …

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