Given the Pacioretty-Chara concussion discussion in the NHL, and it being so soon after the Crosby concussion, a quick overview of concussion injuries and rehabilitation is in order.

A concussion is when a direct blow to the head, neck or elsewhere on the body results in a force being transmitted to the head. This force causes the rapid onset of impaired neurological function. This impairment is generally short-lived and will resolve spontaneously.

With a concussion, there is a range of symptoms and their severity. At times, the patient may not even lose consciousness. Imaging studies would appear normal given that structural changes haven’t occurred yet. At this time, no reliable system of severity has been established. It is judged on a case-by-case basis. The loss of consciousness and post-concussion amnesia do not indicate the severity of the concussion.

If someone is suspected of having a concussion, first check that there are no more serious injuries. The individual can not be left unattended and should be supervised by medical personnel for several hours. Immediately after the concussion, the use of pain medications or alcohol can not be tolerated since they would mask any changes in symptoms that may be of clinical importance. The person should be checked every 2-4 hours for the first 24 hours; even waking them up at night to ensure no change in their mental state has occurred.

Once the first 24 hours have gone by and the individual appears normal, a return to play protocol (RTP) can be followed to ensure the individual’s eventual return to normal activity with minimal risk of re-injury.

The RTP used by McGill University is as follows:

1. 24 hrs of complete rest- mental and physical, with all neurological scans indicating normal activity.

2. Light aerobic activity with all scans indicating normal activity.

3. Sport specific drills with all the scans indicating normal activity.

4. Non-contact drills with no signs or symptoms.

5. A full contact practice

6. Finally return to play.

All of these must last at least 24 hours with no signs or symptoms of neurological impairment. If there is, the individual must regress back one level and wait at that level for at least 24 hours a second time before trying the next stage again.

It is important to realize that 90% of concussions resolve with minimal consequence in less than 10 days however symptoms post-concussion can last for months or years afterwards. I would strongly encourage you to download and print the pocket SCAT2 that can be carried in your wallet here. ). A newer scan, not available for free but considered easier to administer, is available here.