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Injury Prevention

Brain Concussion

Patria Hume explains the signs and symptoms and treatment of


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Concussion is a form of brain injury caused by a temporary disturbance in the

way the brain works. Concussion can occur following a sudden violent
movement of the head, for example when the head hits the ground after
falling off the bars. Most damage is caused by rotation and acceleration (e.g.
a spinning of the head caused by a blow to the side of the head). The brain
accelerates and decelerates inside the skull and can become bruised by
colliding with the inside of the skull. Concussion may occur with or without
loss of consciousness. Concussions commonly occur in falls.

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Concussion Signs


After the initial injury, the way the brain functions is disrupted. It is important
to realise that the symptoms of concussion may not appear immediately. The
normal electro-chemical balance within the brain goes 'haywire'. This happens
in a cascade and is the reason that a gymnast can appear lucid directly after a
head injury but become increasingly confused after a couple of minutes. It
takes energy (from the oxygen and fuels carried in the blood) to pump the
chemicals back into their proper balance within the brain. What makes things
especially tough on the brain cells is that when a concussion occurs, the blood
flow to the brain decreases so that excessive bleeding into the brain does not
occur. So at the time the brain cells are crying out for extra energy to allow
them to return to their normal state, the amount of energy getting through to
them is lower than normal. While the brain cells are in this energy-starved
state they are particularly susceptible to any further injury. Many of the cells
that would recover if the brain were allowed enough time to heal will die if the
brain is further injured while in this vulnerable state.

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A concussed gymnast may show some of the following signs:

A vacant stare
Slow responses (e.g. slow to answer questions or follow instructions)
Slurred or incoherent speech
Feelings of nausea (sickness)
Memory deficits (e.g. unable to memorise and recall three words or
objects, repeatedly asking a question that has already been answered,
unable to recall the competition they are at)
Disturbed vision (e.g. blurred vision, double vision)
Ringing in the ears
Any period of loss of consciousness

They suddenly begin to perform much worse than normal

Balance problems
Feeling drowsy
Feel irritable

Concussed gymnasts may be unable to focus, may be disorientated (e.g.

walking in the wrong direction), uncoordinated (stumbling or unable to walk)
or emotionally confused (e.g. crying for no apparent reason, aggressive).

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If you are unsure about whether a gymnast has sustained a concussion, err
on the side of caution. The diagnosis should be 'concussion until proved
otherwise by a proper medical diagnosis'. Think safe, and take the gymnast
out of the competition or practice immediately.
The amount of force required to knock someone unconscious is similar to that
which is capable of causing a spinal injury. If a gymnast is knocked
unconscious, assume they have a spinal injury and follow the following
Call an ambulance
Minimise movement. (In many cases a spinal injury is worsened by
moving the injured gymnast and further damaging the spinal cord)
Assess ABC - Airways, Breathing, and Circulation. If the gymnast has no
pulse or is not breathing, begin CPR. The rule if the gymnast is not
breathing is 'Save life over limbs'. If you have to move the gymnast to
allow CPR then do so, but try to minimise the movement of the head
relative to the neck.
Have somebody call a Doctor.
Explain that you have an emergency situation and ask to speak to a doctor
IMMEDIATELY. The doctor can provide general advice while the ambulance is

Receiving a concussion generally increases the risk of being concussed again often through less serious injury than would normally be required to cause a

A second concussion before a first one has fully healed can result in serious,
long-term disturbances in brain function. These can affect a gymnasts' ability
to learn, work and generally get by in the world. Symptoms are changes in
mood or personality, such as irritability, forgetfulness, extreme fatigue or
anger. In rare cases a second serious head injury can result in the death of
the person, particularly for people under the age of 18.

New Zealand gymnastics have stated that any gymnast who has been
concussed may not participate in practice or competition for a period of three
weeks from the time of the injury, unless they have a medical clearance from
a Doctor (a qualified neurological specialist should determine if the gymnast is
symptom-free). All gymnasts must obtain a medical clearance before they

resume participation. A team official should see the clearance statement

before the gymnast is permitted to start participating again.

The best way to reduce the risk of concussion is to ensure that trained
spotters are available during training and competition to prevent falls.
Gymnasts should also be progressed through skills and not attempt skills that
they are inadequately prepared for.

This article first appeared in:
HUME, P. (2004) Concussion in gymnastics. Brian Mackenzie's
Successful Coaching, (ISSN 1745-7513/ 18 / December), p. 3-4

If you quote information from this page in your work then the reference for
this page is:
HUME, P. (2004) Concussion in gymnastics [WWW] Available from:
https://www.brianmac.co.uk/articles/scni18a2.htm [Accessed

Patria Hume is Director of the New Zealand Institute of Sport and Recreation
Research at Auckland University of Technology, New Zealand. Patria`s
research focuses on reducing sporting injuries and improving sport
performance by investigating injury mechanisms, injury prevention methods,
and biomechanics of sports techniques. Patria represented New Zealand in
Rhythmic Gymnastics as a gymnast for six years. As a coach Patria`s
gymnasts have competed at Olympics and have won medals at
Commonwealth Games.

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