Concussions are a growing problem in sport. With mild concussions in soccer and skiing to severe ones in hockey and cyclists- all athletes are susceptible to one. In November 2008, a group of neurological experts met in Zurich to create an international standardized consensus on concussion and its basic treatment. The goals were to define acute simple concussion, address return to play issues, and provide an outline of long-term rehabilitation. In this blog post, we’ll be looking at the extensive definition the Zurich group espoused.

“Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:

1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.

3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.

4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that, in a small percentage of cases, post-concussive symptoms may be prolonged.

5. No abnormality on standard structural neuroimaging studies is seen in concussion.

As we can see, a concussion is a complicated matter. Many people are not aware that CTs and MRIs cannot be used to diagnose this type of trauma. The important thing to remember in field side/court side assessment is that a concussion is a functional injury and not a structural one. A broken arm or torn ankle ligament is a damaged structure and will clearly impair further play. A concussion can have no overt signs until you begin to assess the player’s cognitive and functional capacities.