The heads up on head injuries

25 Gael concussions last season

Dave Ross, co-ordinator of athletic therapy services, says MRI scans, like this one, are used to examine serious concussions.
Dave Ross, co-ordinator of athletic therapy services, says MRI scans, like this one, are used to examine serious concussions.

Men’s soccer defender Michael Zanetti knows what it’s like to have a concussion. Zanetti suffered his third two weekends ago on the Gaels’ road trip to face the Nipissing Lakers and the Laurentian Voyageurs.

“It was a scramble in our own box, and someone on the other team swung an elbow around and caught me in the back of the head,” Zanetti said, adding that he didn’t realize the extent of his injury until later.

“I felt pretty good after I got back up, and I played until halftime,” he said. “When I tried to go back out after halftime, I felt really nauseous and I wasn’t all there, so I came out of the game.” Chris Gencarelli, men’s soccer head coach, said the delay in recognizing Zanetti’s concussion was unusual.

“Usually, we pick it up right away,” he said. “If it’s after a collision, our trainer’s out there asking people questions and looking for symptoms. We were lucky that Michael knew it was a concussion. It’s definitely a serious injury.” Gencarelli said concussions are to be expected in varsity athletics.

“It’s part of any sport, and I think the athletes recognize that whether it’s a concussion or whether it’s another serious injury, it’s part of being a competitive athlete,” he said. “That’s the unfortunate part of sports.” Zanetti got his second concussion two years ago in his first year with the team, and also suffered one in high school.

Concussions, once rarely talked about, are becoming the focus of more research, debate and discussion. Dave Ross, the co-ordinator of athletic therapy services, said concussions occur quite frequently in Queen’s athletics.

“Last year we had 25 concussions,” he said. “Most of them were very minor, but we’ve got a great number of them.”

Ross said concussions are dangerous because they have the potential to be fatal, and it can be difficult to identify the damage.

“You can die from them,” he said. “When you get a head injury, [you don’t know] if you have any internal bleeds occurring, and when you have bleeds, that can certainly cause death, major bleeding, and major brain damage.”

Ross said concussions can cause problems even if they don’t cause internal bleeding.

“Concussions can have a number of different effects, too: memory loss, [loss of] mental concentration,” he said. “There’s a number of different factors that we may see, especially with repeated concussions. Just because you have a concussion doesn’t mean you’re going to have major problems, but there can be some long-term effects. ”

Ross said the frequent occurrence of concussions in the last few years, particularly in the NHL, have marked significant change in how concussions are treated.

“[There’s been] certainly a lot of review in the last six or seven years, with Eric Lindros and the concussions in professional hockey. They’ve taken a close look at concussions because of the number of concussions they’ve had in the NHL.”

Lindros has suffered eight concussions in his 12-season NHL career, forcing him to miss hundreds of games.

In November of 2001, FIFA and the IIHF, the international governing bodies of soccer and hockey, teamed up with the International Olympic Committee’s Medical Commission to hold the first International Symposium on Concussion in Sport, which featured many of the world’s foremost authorities on concussion treatment.

Three years later, a second international symposium was held in Prague as a follow-up, bringing in a wider range of experts to expand and update their findings.

Ross said the Prague conference revolutionized the way Queen’s deals with concussions suffered by varsity athletes, notably with the move to a universal, two-tiered classification of concussions.

The model the Prague conference proposed defines concussions as either simple or complex for the purposes of treatment and recovery.

Ross said the new model focuses on duration of symptoms, unlike the previous system, which focused more on their occurrence.

“A simple concussion is any concussion that resolves in probably 10 days,” he said. “In the old criteria, if you were knocked out for 15 seconds, we would grade that as Grade III, the most serious concussion.” “What they’re saying [in the new model] is often, someone who’s been knocked out for 15 seconds will recover in a day or two and will be fine. Unconsciousness doesn’t always play a major role in how serious the concussion is.” The conference also proposed that athletes suffering multiple concussions over time could be treated under the complex concussion scheme, even if their symptoms resolve within the seven to 10 days usually associated with simple concussions.

However, what actually constitutes a concussion is somewhat vague. Ross said concussions can generally be defined as hits that affect the brain.

“Basically, concussions are when the brain gets rattled and neurological disturbances occur,” he said.

Ross said magnetic resonance imaging (MRI) and computed tomography (CT) scans are frequently used with serious concussions to check for internal bleeding.

“[MRI and CT scan technology] is certainly being used a lot more, because we have more available,” he said. “They will use those in the hospital, so if we send an athlete down with a head injury, what the MRI will tell you is if you have an internal bleed.”

An article published last month in the scientific journal by researchers from the University of Pittsburgh Medical Centre’s sports medicine concussion program suggested that functional MRI technology could be used to recognize abnormal brain activity caused by concussions, and thus aid doctors and trainers in making decisions about whether an athlete is fit to play.

Richard Rotenberg, a physiotherapist with the men’s hockey team, said there are several ways to recognize an athlete has sustained a concussion.

“Any time you see a violent collision, whether a hit to the head or not, that’s always a sign that you want to take a look at the player when they come back to the bench,” he said. “There are signs and symptoms and tests that you go through, none of which are going to tell you for sure that this person has a concussion, but signs and symptoms that send warning signals.”

It’s a long road to recovery for many athletes. The first step for both simple and complex concussions is to undertake no physical activity at all while symptoms remain.

After that, athletes can progress to light aerobic exercise such as walking or pedaling a stationary bike. If no symptoms occur at this level, they can proceed to sport-specific exercise such as running or skating.

The next level is non-contact training drills, followed by contact training and then game play. However, if symptoms occur at any level, the athlete must drop back to the previous level and try again after a 24-hour period has elapsed.

Rotenberg said the system is deliberately rigid to prevent further injury.

“It’s regimented in the sense that it’s not me making a judgement call, ‘Oh, this guy’s fine, he can go back to play,’” he said. “There are levels of steps that we go through.” Pat Sheahan, the Gaels’ head football coach, said repeated concussions are a large concern for him.

“The problem with any kind of head injury is that the later ones seem to come a lot easier,” he said. “When you have a real severe brain bruise like that, oftentimes it’s the beginning of the end of an athlete’s career in contact sports.”

One of the problems trainers sometimes face is athletes not reporting symptom recurrence. Zanetti said he thinks athletes should be truthful with medical staff, even if it means they’re out for a longer period of time.

“You have to be honest about it with the therapy guys—if you have symptoms, you have to tell them,” he said.

Dave McDowell, women’s soccer head coach, said players don’t always report their symptoms. “I think that’s always a problem with concussions: how honest are the players in terms of telling medical staff and coaches that they have symptoms that may be concussion-like, knowing that they’d have to sit out for a week or whatever it will be?”

McDowell said concussion symptoms can show up significantly after the initial incident and have long-term effects.

“We had a very serious one last year, where one of our captains was elbowed in the face, came off for a couple of minutes, but went back into the game, and wasn’t showing any symptoms of a concussion at that point in time,” he said.

“On the bus, she started showing some symptoms, and she never played again all through the playoffs, and in fact, was still suffering from headaches near the end of the term, almost six months later.”

Right now, McDowell said, one of the team’s players is showing symptoms of a concussion.

“It’s a strange situation, because we’re not sure that it really is a concussion, [but] we have to treat it as a concussion.”

McDowell said the required rest following a concussion can be difficult for athletes.

“The only thing you can do in terms of recovery is rest them,” he said. “I think that’s frustrating for players. With other injuries, you can go out to the stadium, you may be able to bike, and our training staff can do a variety of things. Unfortunately with a concussion, the only thing you can do is rest until the symptoms go away.”

Chris Smith, football defensive back, said the concussion he suffered playing football last summer bothered him for a long time.

“I had to take three weeks off football, so I ended up missing the rest of my summer football league season,” he said. “It’s a really weird feeling. A lot of people, it doesn’t bother them that much, but I really didn’t like feeling like that.”

Smith said he’s not worried about suffering another concussion.

“When it happened, it was a pretty significant hit, so I’m not really worried about it happening again,” he said. “There’s a very high chance that it will happen again, but I don’t think about that while I’m playing.”

James Potter, men’s rugby captain, said he hasn’t yet had a concussion, but he has been concerned about getting one.

“A lot of people don’t know when they actually get a concussion,” he said. “If you break a wrist or sprain an ankle, in a couple weeks, you get better. Guys do that all the time, but if you get a concussion, it lasts for life.”

Rob Lalonde, women’s hockey head coach, said his team experienced a bad concussion last year.

“One of our girls got hit by a bodycheck, really, into the end boards, banged her head against the boards, and then banged her head against the ice when she went down.”

Lalonde said concussions are a major worry for him as a coach.

“[I’m concerned] not just for the girls being out of the lineup, but for their own health and safety. We certainly wouldn’t want to lose a player indefinitely with that type of injury.”

Frequent symptoms of concussions

• Confusion
• Amnesia
• Loss of consciousness
• Headaches
• Balance problems
• Nausea
• Convulsions or seizures
• Slurred speech
• Poor concentration
• Personality changes
• Vacant stares
• Displays of emotions inappropriate to the situation

If any of the above symptoms are spotted, a head injury should be suspected and the player should be removed from the game.

Source: Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport

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