Concussion is one of the most common — and most misunderstood — injuries in sport. In Quebec, thousands of athletes across hockey, football, soccer, and alpine skiing experience the consequences of an unrecognized or poorly managed head injury each year. This educational guide explains what a sports concussion is, how to recognize it, and how to safely return to play.
What Is a Sports Concussion?
A concussion is a mild traumatic brain injury caused by a direct blow to the head or an indirect force to the body that creates an acceleration-deceleration movement of the brain within the skull. It temporarily disrupts normal brain function without necessarily causing structural damage visible on MRI or CT scan.
Contrary to popular belief, loss of consciousness is not required to diagnose a concussion. The vast majority of concussions occur without the athlete blacking out. What matters is the presence of characteristic symptoms following a head or body impact.
In Quebec, the most commonly affected sports include:
- Ice hockey — body checking, board impacts, puck contact
- Football — tackling, repetitive helmet-to-helmet collisions
- Soccer — aerial duels, heading, falls
- Alpine skiing and snowboarding — high-speed falls
- Rugby, martial arts, basketball — direct contact to the skull
Symptoms and Warning Signs
Immediate Symptoms
An athlete who has sustained a head impact may present one or more of the following symptoms within minutes or hours:
- Headache or pressure in the head
- Nausea or vomiting
- Dizziness or balance problems
- Blurred or double vision
- Sensitivity to light (photophobia) or noise (phonophobia)
- Confusion, fogginess, or feeling "not right"
- Slowed reaction time or slurred speech
- Loss of consciousness (even briefly)
- Amnesia surrounding the event
Delayed Symptoms
In the hours and days that follow, additional symptoms may develop:
- Sleep disturbances (sleeping too much or too little)
- Difficulty concentrating or remembering
- Irritability, anxiety, or mood swings
- Fatigue
- Feelings of sadness or depression
- Symptom worsening with physical or cognitive exertion
Red Flags — Medical Emergency
The following signs require an immediate call to 911 or an emergency room visit:
- Progressively worsening headache
- Repeated vomiting
- Seizures
- Prolonged loss of consciousness (more than 1 minute)
- Weakness or numbness in a limb
- Difficulty speaking or understanding
- Unequal pupil sizes
Diagnosis — The Role of the Sports Medicine Physician
There is no blood test or standard imaging that confirms a concussion. The diagnosis is clinical: it is based on the history of trauma, neurological examination, and symptom assessment.
In sports medicine, the global reference tool is the SCAT6 (Sport Concussion Assessment Tool, 6th edition), a standardized evaluation that includes:
- Symptom checklist (22 items scored 0 to 6)
- Orientation and immediate memory test (Maddocks questions)
- Cognitive testing (concentration, delayed memory)
- Neurological examination (vision, coordination, reflexes)
- Balance assessment (BESS — Balance Error Scoring System)
The sports medicine physician can also compare results to a pre-season baseline assessment — an increasingly common practice in organized sports programs. Supplemental imaging (CT scan, MRI) may be ordered to rule out structural injury in the presence of red-flag neurological signs.
Return-to-Play Protocol
The core principle is clear: no same-day return to play. The athlete must be symptom-free at rest before beginning any graduated return to activity.
The protocol recommended by the Concussion in Sport Group (CISG) and adopted by Hockey Canada, Football Canada, and the International Olympic Committee involves 6 graduated steps:
- Symptomatic rest — avoid anything that worsens symptoms (sport, intense cognitive activity, screens)
- Light aerobic exercise — walking, stationary cycling at low intensity, no resistance
- Sport-specific exercise — skating without contact, running, sport-specific movements without head impact
- Non-contact training drills — technical training, resistance exercises, team drills
- Full-contact training — after written medical clearance
- Full return to competition
Each step should last a minimum of 24 hours. If symptoms return, the athlete must go back one step and consult a physician. Step 5 (contact training) requires written medical clearance.
For children and adolescents, the protocol is more conservative: steps are longer and monitoring is closer, as the developing brain is more vulnerable to repeated concussions.
Return to School and Work
Cognitive rest is as important as physical rest. Sustained intellectual effort (extended reading, exams, screen-based work) can aggravate symptoms and delay recovery.
A graduated return to learn protocol runs parallel to the return-to-play steps:
- Rest at home, limited cognitive activity
- Progressive return to school (short days, frequent breaks)
- Part-time schooling with accommodations (no exams)
- Full-time schooling without accommodations
- Full return including exams and sport
Parents and teachers play a key role in monitoring school-related symptoms. Open communication with the school is essential to temporarily adapt the workload.
When to See a Sports Medicine Doctor
Seek prompt evaluation from a sports medicine physician in the following situations:
- Symptoms persisting more than 24–48 hours after the impact
- Difficulty returning to daily activities
- The athlete is a child or teenager
- Concussion follows a recent previous concussion
- Significant cognitive or emotional symptoms (concentration difficulties, irritability, anxiety)
- Before authorizing return to contact play — medical clearance is mandatory
At Clinique Sport Santé Laurentides, Dr. Sébastien Labrecque-Sauvé evaluates and supports athletes through concussion management, from initial diagnosis to safe return-to-play clearance.
Prevention in Sport
While no measure can completely eliminate the risk of concussion, several strategies significantly reduce incidence and severity:
Proper Equipment
- Wearing a certified, properly fitted helmet (hockey, football, skiing, cycling)
- Regular inspection and replacement of damaged equipment
- Mouthguard use in hockey and contact sports
Rules and Sports Culture
- Enforcing rules that prohibit head contact
- Coaching education on concussion recognition and management
- Promoting a sports culture that does not encourage athletes to "play through" a head injury
- Systematic reporting of any suspected impact, even in the absence of immediate symptoms
Physical Preparation
- Cervical muscle strengthening (neck muscles absorb part of the impact energy)
- Safe checking technique training (hockey)
- Controlled fall training (martial arts, skiing)
Frequently Asked Questions About Concussion
How long does a sports concussion last?
Most concussions resolve within 7 to 14 days in adults. In children and teenagers, recovery may take 2 to 4 weeks or longer. Approximately 10 to 15% of cases develop into post-concussion syndrome with symptoms persisting beyond 4 weeks, requiring specialized multidisciplinary management.
Can an athlete return to play the same day as a concussion?
No. International guidelines from the Concussion in Sport Group are clear: no same-day return to play. The athlete must be symptom-free at rest and complete a medically supervised graduated return-to-play protocol before resuming contact sport.
Does a helmet prevent concussions?
Helmets significantly reduce the risk of skull fractures and hematomas, but do not fully prevent concussions. A concussion is caused by the movement of the brain within the skull (acceleration-deceleration), a phenomenon that current helmets cannot entirely prevent. It remains essential to wear a certified, properly fitted helmet at all times.
What is post-concussion syndrome?
Post-concussion syndrome refers to the persistence of symptoms (headaches, fatigue, cognitive difficulties, sleep disturbances, mood changes) beyond 4 weeks after a concussion. It affects approximately 10 to 15% of concussed individuals and requires thorough medical evaluation and multidisciplinary care involving sports medicine, neuropsychology, and vestibular physiotherapy.
How many concussions are too many?
There is no established "safe" number of concussions. Each concussion is taken seriously, and the risk of long-term consequences increases with repeated head injuries — especially when the interval between concussions is short (second impact syndrome). The decision to retire from contact sport after multiple concussions is an individualized clinical discussion with a sports medicine physician.
Did you sustain a head impact or do you need an athlete evaluated? Dr. Sébastien Labrecque-Sauvé, sports medicine physician in the Laurentians, can guide you from initial diagnosis to safe return-to-play clearance.
Book an Appointment