Concussion Management


Concussion… thanks to Sydney Crosby the hockey world is now listening. However, as health care providers and parents our primary concern isn’t the 8 million dollar athlete that understands the risks and is compensated for it. The concern is our sons and daughters playing sport either recreationally or competitively that inadvertently sustain a concussion. These kids/young adults if managed poorly may suffer indefinitely. These risks increase substantially if the athlete is cleared to return to play before they are fully recovered. The Shift Concussion Management Program has identified and addressed the failures of most commonly used strategies and is constantly evolving with the most up to date research. Shift Concussions is affiliated with, a not for profit organization founded by Keith Primeau and Kerry Goulet and a portion of all proceeds generated by the program go towards funding concussion research.

You can learn more about our Concussion management Clinicians by visiting the "Chiropractors" tab, under "About Us".


What is a concussion?

The working definition used today for concussion is “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (developed by the consensus panel at the 3rd International Conference on Concussion in Sport that was held in Zurich, 2008). Put simply, a concussion changes the way our brain functions – causes it to work less optimally. It 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. A Concussion may or may not involve loss of consciousness (loss of consciousness is not a diagnostic requirement). In fact, less than 20% of concussions result in a loss of consciousness.


What are the symptoms of a concussion?

Some common symptoms often reported with concussive injuries include:

  • Headache
  • Dizziness
  • Neck pain
  • Nausea or Vomiting
  • Loss of balance
  • Poor coordination
  • Trouble focusing on objects or words
  • Poor concentration
  • Feeling “foggy”
  • Confusion
  • Amnesia, or poor memory
  • “Flashing lights”
  • Blurred or double vision
  • Seeing “stars”
  • Irritability or emotional changes
  • Ringing in ears
  • Slow to follow direction
  • Decreased playing ability
  • Easily distracted
  • Vacant stare
  • Drowsiness/fatigue
  • Difficulty falling asleep
  • Feeling “off” or not like oneself
  • How do I know if my son/daughter has sustained a concussion?

Check for symptoms listed previously
Concussions can be difficult to properly recognize given the wide range of symptoms & individual responses. Symptoms such as headache and dizziness are common yet can also occur in a variety of other sport-related issues (eg. dehydration, heat-related illness). To complicate things further, the appearance of symptoms may be delayed for several minutes or even hours after the initial injury.

A useful rule of thumb to convey to athletes, parents, or coaches: If a player presents with one of the symptoms listed previously and has the mechanism of a head injury, treat it as a concussion. It is important to realize that the mechanism of injury may be subtler and not as obvious as a “big hit”. An athlete that is not acting normally, having difficulty remembering plays or following instructions may have sustained an injury several hours previously. There should be absolutely NO return to play on the same day as the injury regardless of the level of athletic performance.

Parents, coaches, and trainers should be taught that a symptom scale/checklist is a good method for identifying symptoms that may be indicative of concussion. For the team coach or trainer who knows the athlete well, it may be obvious that the athlete is struggling with simple questions and/or is acting unusual or different. Other cases are less apparent. Sideline concussion evaluations, which assess orientation, concentration, and memory, help to determine how well the athlete’s brain is working. The Pocket Concussion Recognition Tool is a valuable sideline assessment tool that can be used to evaluate the domains above, however it is not designed to take the place of a more comprehensive evaluation by a medical professional.


What could happen if my child returns to play too early?

There is the potential that your child could sustain another concussion. This second concussion may occur easier than the initial concussion and may be more severe. There is a still a lot to learn on the long term effects of multiple concussions.

Refer to ‘Second Impact Syndrome’ listed below.

What is the recovery time-frame after a concussion?

Some seem to recover quickly and others do not
The majority (80-90%) of concussion-related symptoms are thought to resolve in a short (7-10 day) period; however in some, symptoms may persist beyond 10 days:

Children & adolescents
Players suffering from multiple concussions in a close timeframe
Persistent headache (>60 hrs) or high symptom load
Athletes with history of migraine, depression, ADHD, learning disabilities or sleep disorders
Why some athletes seem to recover quickly and others do not remains unclear. Even when symptoms resolve quickly it is advisable that a proper gradual return-to-play protocol be carried out. The whole recovery process therefore may take upwards of 3-4 weeks to prevent premature return to sport.


Once my child is symptom free, how does the return-to-play process work?

Athletes recovering from a concussion should not skip to 100% exertion from 0%.
Once symptom free, it is recommended that each athlete undergo a graduated program of exercise testing. Similar to weight training, athletes recovering from a concussion should not skip to 100% exertion from 0% in a short time frame. Physical exertion testing is important not only for physical re-conditioning, but to guard against symptom relapse and help prevent premature return-to-sport. It is well known that concussive symptoms can be aggravated with exercise and even though you may feel well, running, jumping, or stick handling are things that may cause your symptoms to return.

The return-to-play process is gradual. The first stage typically involves light cycling or jogging to elevate your heart rate a moderate amount. If no symptoms are aggravated either during or for 24 hours after this exercise session, you may progress to a more difficult workout routine. Eventually you may advance to on-field or on-ice practice and finally full game play (with proper medical clearance). The whole process could take anywhere from 5 days to 2 weeks depending on your specific situation or the stipulations of your governing sport organization. At any time if your symptoms return, you must return to a lower level exertion (or complete rest) depending on the advice of your health professional.

What is post-concussion Syndrome?

Post-concussion syndrome is a diagnostic term used when symptoms persist for several weeks and sometimes months after the injury. If your symptoms persist beyond 3-4 weeks it is important that you undergo proper medical assessment (ideally re-assessment) in order to receive the right education and management strategies for your condition.

What do I do if I suspect that my child has had a concussion?

Contact our Shift Certified Clinic and we can walk you through the best course of action. It is important to have your child assessed as soon as possible. Patients should visit their family doctor/walk-in clinic/emergency room for an assessment. After visiting a medical doctor you should then be assessed at our Shift Certified Concussion Management Clinic. We will do our very best to have your child assessed as soon as possible.

Is baseline testing covered by my extended health care?

Yes, If you have extended health coverage for Chiropractic Care.

Is post-concussion testing and treatment covered by my extended health care?

Your child’s first visit post-concussion should be with your family doctor/walk-in clinic/emergency room as it is important to co-manage your child’s case. This visit is covered by OHIP. Your second visit should be with a certified concussion management clinic like ours. All assessments and any required physical therapy afterwards may be covered under extended health coverage. Our clinic leaders are Doctors of Chiropractic, so you should check into your Chiropractic coverage. If physical therapy is recommended, all techniques will be billed under ‘Chiropractic’.

Is concussion testing, assessment or treatment covered by OHIP?

Visits with your family Doctor will be covered under OHIP. These visits will differ from your visits to a concussion clinic like ours, which is not covered under OHIP. Your extended health care coverage may cover visits to a concussion clinic like ours.

What is second impact syndrome?

A serious consequence of head trauma
Second Impact Syndrome is a rare, but serious consequence of head trauma which results in rapid swelling of the brain – potentially leading to severe disability or death. Controversy exists as to whether second impact syndrome is a product of cumulative head trauma (when an athlete sustains a concussion while still suffering the effects of a previous concussion), or if it is simply a product of a single, mild traumatic brain injury.

Regardless of its cause, second impact syndrome is a severe consequence of head injury in young athletes. There should be absolutely NO return to play while an athlete is displaying signs and symptoms of a concussion, regardless of the level of competition.

What is best way to protect my child against concussion?

Proper coaching, quality equipment and good sport-related techniques may help reduce your child’s incidence of a concussion. Proper management post-concussion may also help reduce the incidence and severity of any subsequent concussions.

Hockey is expensive, what is this going to cost me?

*Covered under extended health care under ‘Chiropractic’

Baseline Testing:

One Athlete – $60.00 per player

Full team – $50.00 per player

Association rates (all teams) – $40.00 per player

Post-Concussion FEES:

Comprehensive Post Concussion Assessment with any recommended treatment for initial visit- $120.00

Post-concussion treatment (when recommended for completion within clinic) per visit – $70.00

Basic concussion treatment – $40.00 (inquire within for more information on what this refers to)

Exertional testing before return-to-play – $70.00

What does baseline testing consist of?

Baseline testing will consist of medical history, a neurocognitive computerized test and a physical exam.

What should I expect when I bring my child in for a concussion assessment?

We will begin with a medical history and description of injury. Depending on how your child is feeling on their assessment day, we may perform a computerized neurocognitive exam. We will also complete a very thorough physical, orthopaedic and neurological examination. If your child has had the computerized testing done within the past year we will compare our new results with your baseline scores.

Who will be assessing my child?

Our clinic’s Doctors of Chiropractic will be assessing your child and implementing a physical rehabilitation program if necessary. Our clinic currently has two Doctors of Chiropractic that are certified in Concussion Management, and have attended 8 years of undergraduate and professional education. We offer a very large range of physical therapy treatments and techniques to suit your child’s specific requirements as well as parent/child preferences.