National concussion guidelines announced for high performance sport in Canada

CALGARY – Canada’s high performance sport community has announced national sport-related concussion guidelines designed to protect its national and next generation athletes.

The comprehensive and standardized sport-related concussion guidelines, developed by chief medical experts at the Canadian Olympic and Paralympic Sport Institute (COPSI) Network, Own the Podium (OTP), the Canadian Olympic Committee (COC) and the Canadian Paralympic Committee (CPC), reflect a collaborative commitment to lead national policy development and provide world-leading health care provision for high performance athletes, coaches, staff and officials across Canada’s sport system.

“The multi-disciplinary approach used by the COPSI Network has developed significant expertise and partnerships in becoming a leader in the management of sport-related concussions,” said Dr. Brian Benson, Chief Medical Officer and Director of Sport Medicine at the CSI Calgary. “These national high performance sport concussion guidelines are a product of extensive collaboration within the Network.”

“The concussion guidelines build on the existing foundation established by Parachute Canada and the COPSI Network, exemplifying Canada’s desire to protect athlete health and welfare,” added Dr. Andy Van Neutegem, OTP Director of Performance Sciences, Research and Innovation. “Achieving excellence is the ultimate goal of all high-performance programs in Canada, while always protecting the health and safety of our athletes and coaches. OTP and its partners will continue to drive research in injury prevention and management, collaborating with experts to provide evidence-informed practices for National Sport Organizations.”

The following is an outline of the sport-related concussion guidelines that have been established. Click here to read the guidelines in full detail.

1.    Concussion Definition – Sport-related concussion is defined as a traumatic brain injury induced by biomechanical forces. There are several common features that may be utilized in clinically defining the nature of a concussive head injury.

2.    Sport Concussion Policy, Protocol and Education – All high-risk Olympic and Paralympic winter and summer National Sport Organizations must have an up-to-date sport concussion policy and protocol in place that specifically addresses concussion education/awareness, code of conduct, removal from sport and return to sport.

3.    Pre-season Clinical Assessment (healthy, uninjured) – During the pre-season period and prior to the first day of competitive season training camp, it is suggested that all high-risk sport athletes complete various clinical assessments under the supervision and guidance of the team physician at the time of COPSI Network Comprehensive Athlete Medical Intake on an annual basis.

4.    Concussion Recognition and Removal from Sport Participation for Medical Evaluation – If a concussion is suspected, the athlete must be removed from training or competition and evaluated immediately. It is recommended that a COPSI Network, COC or CPC team certified athletic therapist, physiotherapist, chiropractor or physician be onsite during practice, training and competition. 

5.    Acute Sport Concussion Assessment and Management:

a. Sideline Assessment – If an athlete is suspected of sustaining a severe head or spine injury during a game or practice, an ambulance must be called immediately to transfer the patient to the nearest emergency department for further medical assessment. If there is no concern for a more serious head or spine injury and after the first aid issues have been addressed, all suspected cases of concussion must be removed from the playing field and assessed by the medical team in a distraction-free environment.

b. Clinical Assessment and Management – (1) Concussion is a clinical diagnosis with the aid of a comprehensive clinical history, including mechanism of injury and previous injury history, and detailed neurological examination as soon as possible following the injury by the team physician or a physician experience with sport concussion. (2) If a concussion is formally diagnosed, both physical and cognitive rest is advised for the initial 24-48 hours post-concussion. (3) After 24-48 hours of relative rest, athletes can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds. (4) When the athlete is determined by the medical team to be free of concussion-related symptoms at rest and with exertion, it is suggested the athlete repeat the web-based cognitive/neuropsychological test for post-concussion evaluation.

c. Return to Sport (Unrestricted Training and/or Competition) – It is recommended that athletes return to unrestricted training and competition only after the following circumstances have occurred: (1) There is resolution of concussion-related symptoms at rest. (2) There is no recurrence of concussion-related symptoms at exertion levels required for unrestricted practice and competition. (3) The athlete’s post-concussion clinical and neuropsychological status has returned to individual baseline levels as judged by the team physician. 

d. Persistent Symptoms – Approximately 15-30% of patients will experience persistent symptoms. It is suggested that treatment be individualized and targeted to specific medical, physical and psychosocial factors identified on multidisciplinary assessments.

In collaboration with the COC and the CPC, the guidelines will be recognized prior to and at Olympic and Paralympic Games and at Pan American and Parapan American Games periods effective immediately. 

“This collaboration is an excellent example of how the COPSI Network can help standardize the health and safety of high performance athletes across the country,” said Dr. Robert McCormack, COC Chief Medical Officer. “This is a great step and we support these guidelines which will help inform our approach for the upcoming Lima and Tokyo Games and beyond. It is important that Team Canada is protected and assessed with the highest level of precision on the sporting world’s biggest stage.”

“We believe this collaborative commitment marks Canada as a world-leader in protecting high performance athletes from sport-related concussions and we hope it sets the standard at Games,” added Dr. Andy Marshall, CPC Chief Medical Officer. “However, we also acknowledge that these guidelines need to be reviewed regularly and we call upon any new medical and scientific advances to join our development of world-class health care for our athletes.”