Detection and Protection

Erin Riley

Where we stand when it comes to diagnosing and reducing concussions in hockey

Across Canada, local and national media outlets continue to report on an ever-growing conversation about concussions – what the latest research tells us, emerging guidelines, and the creation of stricter policies in different sports and organizations. The increased awareness has opened conversations within communities like the GTHL, with people asking newly informed questions about how concussions affect those closest to them.

Experts in pediatric concussion and rehabilitation from the Concussion Centre at Holland Bloorview Kids Rehabilitation Hospital have made great gains in this field since signing a partnership with the GTHL in 2015. Holland Bloorview research has found that awareness of signs and symptoms of concussion among hockey coaches and trainers has increased. They also note an increase in reported concussions leading to follow-up and medical clearance during the same time frame.

Tools for recognition and diagnosis

On the bench, there may be no visible signs or reports of symptoms by a player who appears to have taken a significant blow to the body or head. That can be the trouble of recognizing concussions, making for a tough decision in a game.

“Recognizing concussions is a team effort,” says Dr. Nick Reed, clinician scientist at Holland Bloorview and co-director of the Concussion Centre. “Players, families, trainers and coaches must be knowledgeable in the signs and symptoms of concussions, and understand that they may or may not appear right away.”

“Everyone has a role in speaking up if there is any suspicion of concussion, and the first immediate step is to take that player out of play right away. Remember: when in doubt, sit them out.

Signs or symptoms can be delayed or present immediately. If a player looks and reports feeling fine after a hit, Dr. Reed’s advice is to monitor the player for 48 hours. The important message is to seek immediate attention from a physician as soon as one or more symptoms appear.

While there are many tools and tests that can help diagnose and size-up other serious brain injuries, there currently are no validated medical imaging scans or lab tests to diagnose a concussion. To diagnose and treat a concussion, doctors and clinicians must first depend on players to let them know how they feel. Input from coaches, trainers, parents and teammates is also valuable to understand how a player looked at the time of the incident and any changes since then.

Important first steps 

Once a child has been diagnosed with a concussion by a physician, and other serious brain injuries have been ruled out, Dr. Reed says that physical and mental rest in the first 24 to 48 hours is essential to recovery. This can prove difficult for young people as staying at home does not always guarantee rest – screen time and simply being in a noisy environment continues to stimulate the brain.

;After the initial rest period, it’s important to gradually increase physical and mental activity. One method, known as the symptom-tolerance approach, encourages kids to try safe activities in gradual increments that don’t worsen symptoms. Receiving follow-up care from a healthcare team can support players and families in preventing persistent concussion symptoms and optimize recovery progress through safe reintegration of activity.

Safe return to play 

Best practices and guidelines from national and international consensus currently state that it is appropriate to return to sport following a concussion provided each of the following criteria are met:

  • Symptoms have resolved
  • Full return to school schedule and workload
  • A return-to-play protocol has been completed successfully
  • Medical clearance to return to full game play has been given

For most youth, symptoms resolve within one month after a concussion. Dr. Reed adds that while many people successfully resume playing sports, there needs to be more research in this area of pediatric concussion so that we have a more accurate picture of the safety of youth returning to sport.

Focus on respect

Dr. Reed’s best advice is to keep emphasizing to players that respect for themselves and others is the top priority while on the ice, rather than the “win at all cost” mentality.

“We still see cheers for the big hits rather than for the nice pass or goal,” Dr. Reed said. “But if we shift the culture to respecting your own brain and your teammates’ brain first and foremost, we can make significant strides in reducing risk of concussions.”

* The GTHL and the Concussion Centre at Holland Bloorview Kids Rehabilitation Hospital are in the midst of a five-year partnership that began in 2015. Learn more at

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