201-25 Mill Street

Gananoque, ON 

K7G 2L5


Tel: 613-382-4200

Fax: 613-382-8900

Business Hours:

Mon - Fri: 7am - 6pm

​​Saturday/Sunday: Closed


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Concussion Management

Book an appointment with our  concussion trained Athletic Therapist to be clinically evaluated for a concussion and to begin your rehabilitation back to school/work/play!

What is a Concussion?

●     A concussion us a form of brain injury  resulting from a direct blow to the head/face or indirect blow anywhere to the body, transmitting forces to the brain.

●     These high impact forces on the brain result in rapid acceleration, deceleration and twisting movements of the brain, causing axon (nerve fibre) damage. (e.g. whiplash)

●     Axons are stretched or torn resulting in an “ionic shift” of important metabolic pathways. This means there is a chemical imbalance of the neurotransmitters (signaling molecules within the brain), resulting in impaired physiological processes that contribute to physical, cognitive, behavioral and emotional signs and symptoms seen in a concussed individual.

●     These changes can take place within minutes of the injury and can last for hours, days or weeks before normalization occurs.

●     Concussions can produce a wide range of symptoms which can pose a challenge for coaches, therapists, parents and healthcare professionals.


Signs and Symptoms

  • Headache

  • Dizziness

  • Neck Pain

  • Nasea/Vomiting

  • Poor Concentration

  • Trouble focusing on objects/words

  • feeling "foggy"

  • Depression and/or Anxiety

  • Confusion

  • Amnesia or Poor Memory

  • Flashing Lights

  • Blurred or Double Vision

  • Seeing "Stars"

  • Irritability or Emotional Changes

  • Ringing in the Ears

  • Slow to Follow Directions

  • Decreased Playing, School or Work Ability

  • Easily Distracted

  • Vacant Stare

  • Drowsiness or Fatigue

  • Difficulty Falling/Staying Asleep

  • Feeling "off" or Not Like Oneself

●     Concussions can be difficult to properly recognize given the wide range of symptoms and individual responses and as well as symptoms may be delayed for several minutes to hours after the initial injury.

●     Signs to look for:

○     Individual displaying once or more symptoms listed 

○     Mechanism of injury may be subtler and not as obvious as a “big hit”

○     Individual not acting as usual self

○     Having difficulty remembering events, words or following directions

●     For athletes, if a concussion is suspected, there should be absolutely NO return to play until ruled out by a medical doctor.

●     Contact a qualified Physician (eg. Family or Sport MD) as soon as possible. It is not usually necessary to visit the ER unless your symptoms are severe and/or rapidly worsening. 


Acute Care & Rest

Acute Concussion Care

Anyone with a suspected concussion should not return back to activity the same day, even if he/she is feeling better. Problems caused by a head injury can increase if provoked, prolong recovery or increase your likelihood of sustaining a “second impact syndrome.”


Problems from a concussion injury could arise over the first 24-48 hours. The patient should not be left alone and must go to the hospital at once if they experience:

  • Excessive drowsiness or cannot be awakened

  • Changes in behaviour

  • Repeated vomiting (>2 episodes)

  • Extreme dizziness

  • Worsening headache (10/10 pain scale)

  • Persistent double vision

  • Weakness or numbness in the arms and/or legs

  • An inability to recognize people or places

  • Unsteadiness on their feet

  • Slurred speech

  • Seizures

  • Amnesia


Remember, it’s better to be SAFE! Consult your doctor after sustaining a suspect concussion then book an appointment with a trained concussion provider.

Concussion Rest Protocol - "Energy Management"

Importance of rest (mental and physical) - first 2-4 days:

  • Help the brain manage neurometabolic energy crisis causing added stress

  • Keeps you comfortable and less risk of exacerbating symptoms

  • Establish proper sleep hygiene

  • Light activity (BELOW symptom threshold) to help jump start the concussion rehabilitation

***The “dark room” or “black box therapy” approach was once widely used by healthcare professionals for early concussion rehab. This therapy technique isolated the concussed client in a dark room for days away from all physical and cognitive activity. This included no school, work, sport, reading, electronics, and limited light and noise. This approach is now discouraged due to significant health consequences (depression, anxiety, sleeping disorders) and lack of evidence to suggest that prolong periods of rest improved concussion rehabilitation.

Old sleep managements (do not perform):

  • Do not encourage excessive sleep or poor sleep habits

  • “Sleep as much as you need” is an outdated recommendation and must be avoided!


Concussion Recovery

How Long is the Recovery After Sustaining a Concussion?

Symptom duration and post injury recovery is highly individual and may be influenced by various factors. The majority of concussion-related symptoms are thought to resolved in a short time frame (days to weeks); however in some, symptoms may persist for months:

  • Some children & adolescents

  • Individuals who have suffered multiple concussions in a close time frame

  • Individuals experiencing persistent migraine-like headaches, visual or vestibular dysfunction or a high symptom load

  • Individuals with history of migraine, depression, ADHD, learning disabilities or sleep disorders

  • Why some individuals 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/work/school protocol be carried out.

When Can I Return Back to Work/School/Play?:

●     The time-course for concussion recovery varies widely from person to person, thus rehabilitation and return-to-participation timeline is impossible to implemented as a “cookie cutter” approach.

●     Returning an individual back to school/work/play is very case-specific and will depend on many factors. It is very important to seek advice from a Health Professional trained in concussion management when making that decision.

●     Partial (part-time) back to school or work is highly encouraged as soon as possible with accommodations → you do not have to be completely symptom-free to return back to school/work).

●     Accommodations are often required initially to limit symptom aggravation such as shorter days/shifts, reduce workload, frequent breaks, or altered work tasks. Once symptoms improve these accommodations can be lifted.

Excessive/prolonged rest at home with lots of sleep is highly discouraged as it can have more negative consequences, such as poor sleep habits, anxiety/depression, social withdrawal, hyper-awareness of symptoms, etc. that can impact your recovery.

I have a history of a concussion. Am I at risk of sustaining another one more easily?

●     When the brain is in a state of metabolic dysfunction (such as with a concussion) it is believed to be more “vulnerable” to subsequent trauma. That is, a relatively minor second blow to the head may produce more severe and irreversible changes in brain function. The physiologically altered brain is essentially weakened and less able to withstand or recover from a subsequent (though potentially mild) concussion.

●     In this way, concussive injuries are thought to be cumulative, with progressively less force required to induce trauma to the brain each time

●     Athletes often minimize the severity of concussion-like symptoms, or do not report symptoms at all following head injury. This may be because the athlete wants to continue playing and believes the symptoms are mild enough to play through. The athlete may believe having their “bell rung” is part of the game. In these situations, often the athlete, parent, coach, or trainer does not realize the significant consequences of playing with a concussion.

●     However - in general, when a concussion is identified early, managed properly, and return to sport is gradual, the risk to that athlete of sustaining a future concussion is not likely to be significantly different.

Post-concussion syndrome:

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 (or re-assessment) in order to receive the right education and management strategies for your condition.

Second Impact Syndrome:

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.

Rowan's Law

References - all information above was taken from the following sources:


  • Level 1 Shift Concussion Management Program: Concussion Care - Clinical Training and Education for Healthcare Providers - 2018