CONCUSSION POLICY
Black Belt World takes the safety of our athletes, coaches, and community very seriously. Our masters, instructors, and staff follow our concussion protocol adapted from the Taekwondo Canada Concussion Protocol.
POLICY
1.1 Black Belt World Canada has developed this Policy to help guide the assessment and management of athletes who may have a suspected concussion as a result of participation in Black Belt World hosted events.
PURPOSE
2.1 The Taekwondo Canada concussion protocol on which this Policy was modelled after aligns and has been approved with Parachute Canada through the Canadian Guideline on Concussion in Sport (parachute.ca).
SCOPE
3.1 This Policy is intended for use by all individuals who participate in Black Belt World hosted events, under the recommendation of Taekwondo Canada.
DEFINITIONS
4.1 Concussion: as defined by Parachute Canada (parachute.ca)
4.2 Health Care professionals: licensed and in good standing in Canada by their provincial professional association, including but not limited to: athletic therapists, physiotherapists, chiropractors, registered nurses, etc.
4.3 Medical Doctor: Medical doctors that are licensed and in good standing who are qualified to evaluate patients with a suspected concussion include: pediatricians, family medicine, sports medicine, emergency medical doctor, internal medicine, physiatrists, neurologists, and neurosurgeons
PROCEDURE
5.1 Pre-Competition Education
Despite recent increased attention focusing on concussion there is a continued need to improve concussion education and awareness. Optimizing the prevention and management of concussion depends highly on annual education of all sport stakeholders (athletes, parents, coaches, officials, trainers, licensed healthcare professionals) on current evidence-informed approaches that can prevent concussion and more serious forms of head injury and help identify and manage an athlete with a suspected concussion.
Concussion education on the Taekwondo Canada website includes information on:
The definition of concussion
Possible mechanisms of injury
Common signs and symptoms
Steps that can be taken to prevent concussions and other injuries from occurring in sport
What to do when an athlete has suffered a suspected concussion or more serious head injury
What measures should be taken to ensure proper medical assessment
Return-to-School and Return-to-Sport Strategies, AND
Return to sport medical clearance requirements
Who: Athletes, parents, coaches, officials, trainers, licensed healthcare professionals are expected to review this information on the Taekwondo Canada website prior to each Taekwondo Canada sanctioned or hosted event.
How: Participation in Taekwondo Canada sanctioned, or hosted events includes a confirmation check box that all participants have reviewed this information prior to registration for an event.
5.2.1 Concussion Prevention
The incidence of concussions can be mitigated by the proper implementation of prevention strategies, including:
Limiting contact during training and competition, in particular for younger participants
Modifying rules to limit the use of certain drills or techniques to help reduce the risk of injury
Checking equipment often. Make sure equipment fits well, is in good condition, is stored properly, and is replaced according to manufacturers’ instructions
Fair play and respect for opponents are ethical values that should be encouraged in all sport, recreation and physical activities
The incidence of concussions can be mitigated by the proper implementation of prevention strategies by ensuring coaches, officials, parents and athletes are properly educated about concussions, policies and procedures are followed at all times and that training and competition venues are properly prepared and free of obstacles.
5.2.2 Head Injury Recognition
Although the formal diagnosis of concussion should be made following a medical assessment, all athletes, parents, coaches, officials, trainers, licensed healthcare professionals are responsible for the recognition and reporting of athletes who may demonstrate visual signs of a head injury or who report concussion-related symptoms.
A concussion should be suspected:
In any athlete who sustains a significant impact to the head, face, neck, or body and demonstrates ANY of the visual signs of a suspected concussion or reports ANY symptoms of a suspected concussion as detailed in the Concussion Recognition Tool 6.
If an athlete reports ANY concussion symptoms to one of their peers, parents, coaches, officials, trainers, licensed healthcare professionals or if anyone witnesses an athlete exhibiting any of the visual signs of concussion.
In some cases, an athlete may demonstrate signs or symptoms of a more severe head or spine injury including convulsions, worsening headaches, vomiting or neck pain. If an athlete demonstrates any of the ‘Red Flags’ indicated by the Concussion Recognition Tool 6, a more severe head or spine injury should be suspected, and Emergency Medical Assessment should be pursued.
Who: Athletes, parents, coaches, officials, trainers, and licensed healthcare professionals.
How: If a head injury is suspected, athletes, parents, coaches, officials, and trainers, are expected to use the Concussion Recognition Tool 6 in the event there is no licensed healthcare professionals immediately available.
5.3 Onsite Medical Assessment
Taekwondo Canada sanctioned or hosted events will have a licensed medical doctor on site for the duration of the event. Depending on the suspected severity of the injury, an initial assessment may be completed by another on-site licensed healthcare professional. In cases where an athlete loses consciousness or it is suspected an athlete might have a more severe head or spine injury, assessment by a medical doctor shall take place. If a more severe injury is not suspected, the athlete should undergo Sideline Medical Assessment or Medical Assessment.
5.4 Medical Assessment
In order to provide comprehensive evaluation of athletes with a suspected concussion, the medical assessment must rule out more serious forms of traumatic brain and spine injuries, must rule out medical and neurological conditions that can present with concussion-like symptoms, and must make the diagnosis of concussion based on findings of the clinical history and physical examination and the evidence-based use of adjunctive tests as indicated.
The medical assessment is responsible for determining whether the athlete has been diagnosed with a concussion or not. Athletes with a diagnosed concussion should be provided with a Medical Assessment Letter indicating a concussion has been diagnosed. Athletes that are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a concussion has not been diagnosed and the athlete can return to school, work and sports activities without restriction.
Who: The medical doctor officially appointed to Taekwondo Canada sanctioned or hosted events will provide the Medical Assessment letter.
5.5 Concussion Management
When an athlete has been diagnosed with a concussion, it is important that the athlete’s parent/legal guardian is informed if they are a minor. All athletes diagnosed with a concussion must be provided with a standardized Medical Assessment Letter that notifies the athlete and their parents/legal guardians (if they are a minor) that they have been diagnosed with a concussion and may not return to any activities with a risk of concussion until medically cleared to do so by a medical doctor. Because the Medical Assessment Letter contains personal health information, it is the responsibility of the athlete or their parent/legal guardian to provide this documentation to the athlete’s coaches, teachers, or employers. It is also important for the appointed medical doctor to provide this information to sport organization officials that are responsible for injury reporting and concussion surveillance.
Athletes diagnosed with a concussion should be provided with education about the signs and symptoms of concussion, strategies about how to manage their symptoms, the risks of returning to sport without medical clearance and recommendations regarding a gradual return to school and sport activities. Athletes diagnosed with a concussion are to be managed according to their Return-to-School and Taekwondo-Specific Return-to-Sport Strategy under the supervision of a medical doctor. When available, athletes should be encouraged to work with an appointed Taekwondo Canada athletic therapist or physiotherapist to optimize progression through their Taekwondo-Specific Return-to-Sport Strategy. Once the athlete has completed their Return-to-School and Taekwondo-Specific Return-to-Sport Strategy and are deemed to be clinically recovered from their concussion, the medical doctor can consider the athlete for a return to full sports activities and issue a Medical Clearance Letter.
The stepwise progressions for Return-to-School and Return-to-Sport Strategies are outlined below. As indicated in stage 1 of the Return-to-Sport Strategy, reintroduction of daily, school, and work activities using the Return-to-School Strategy must precede return to sport participation.
Return to School Strategy
The following is an outline of the Return-to-School Strategy that should be used to help student-athletes, parents, and teachers to collaborate in allowing the athlete to make a gradual return to school activities. Depending on the severity and type of the symptoms present student-athletes will progress through the following stages at different rates. If the student-athlete experiences new symptoms or worsening symptoms at any stage, they should go back to the previous stage. Athletes should also be encouraged to ask their school if they have a school-specific Return-to-Learn Program in place to help student-athletes make a gradual return to school.
Stage | Aim | Activity | Goal |
1 | Daily activities at home that do not give the student-athlete symptoms | Typical activities during the day as long as they do not increase symptoms (i.e. reading, texting, screen time). Start at 5-15 minutes at a time and gradually build up. | Gradual return to typical activities |
2 | School activities | Homework, reading or other cognitive activities outside of the classroom. | Increase tolerance to cognitive work |
3 | Return to school part-time | Gradual introduction of schoolwork. May need to start with a partial school day or with increased breaks during the day. | Increase academic activities |
4 | Return to school full-time | Gradually progress | Return to full academic activities and catch up on missed schoolwork |
McCrory et al. (2017). Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.
Taekwondo-Specific Return-to-Sport Strategy
An initial period of 24-48 hours of rest is recommended before starting Taekwondo-Specific Return-to-Sport Strategy. The athlete should spend a minimum duration of 24 hours without symptom increases at each stage before progressing to the next one. If the athlete experiences new symptoms or worsening symptoms at any stage, they should go back to the previous stage. It is important that youth and adult student-athletes return to full-time school activities before progressing to stage 5 and 6 of the Taekwondo-Specific Return-to-Sport Strategy. It is also important that all athletes provide their coach with a Medical Clearance Letter prior to returning to full contact sport activities.
Although World Taekwondo has their own concussion regulations with set timing for return to competition, Taekwondo Canada events require athletes to have medical clearance which supersedes World Taekwondo rules for Taekwondo Canada and Black Belt World Canada sanctioned or hosted events.
Stage | Aim | Activity | Goal of each step |
1 | Symptom-limiting activity | Daily activities that do not provoke symptoms or make symptoms worse | Gradual reintroduction of work/school activities |
2 | Light aerobic activity | Light jog or stationary cycling at slow to medium pace. No resistance training. • Light intensity jogging or stationary cycling for 15-20 minutes at sub-symptom threshold intensity | Increase heart rate |
3 | Sport-specific exercise | Low intensity sport-specific exercises. No head impact activities. • Moderate intensity jogging for 30-60 minutes at sub-symptom threshold intensity • Low intensity poomsae • Low intensity target kicking | Add movement |
4 | Non-contact training drills | Higher intensity sport-specific exercises with no contact Harder training drills with moderate resistance May start progressive resistance training • Participation in high intensity running and drills • Paddle sparring • Moderate intensity poomsae -no freestyle | Exercise, coordination and increased thinking |
5 | Full contact practice | Following medical clearance Part A) • Training with controlled contact • Eliminating situations of hard impact • Sparring drills with partners Part B) • Participation in full practice without activity restriction • Freestyle and high intensity poomsae | Restore confidence and assess functional skills by coaching staff |
6 | Return to sport | Normal training & return to competition |
5.6 Multidisciplinary Concussion Care
Most athletes who sustain a concussion while participating in sport will make a complete recovery and be able to return to full school and sport activities within 1-4 weeks of injury. However, approximately 15-30% of individuals will experience symptoms that persist beyond this time frame. If available, individuals who experience persistent post-concussion symptoms (>4 weeks for youth athletes, >2 weeks for adult athletes) may benefit from referral to a medically supervised multidisciplinary concussion clinic that has access to professionals with licensed training in traumatic brain injury that may include experts in sport medicine, neuropsychology, physiotherapy, occupational therapy, neurology, neurosurgery, and rehabilitation medicine.
Referral to a multidisciplinary clinic for assessment should be made on an individualized basis at the discretion of an athlete’s medical doctor or nurse practitioner. If access to a multidisciplinary concussion clinic is not available, a referral to a medical doctor with clinical training and experience in concussion (e.g. a sport medicine physician, neurologist, or rehabilitation medicine physician) should be considered for the purposes of developing an individualized treatment plan. Depending on the clinical presentation of the individual, this treatment plan may involve a variety of health care professionals with areas of expertise that address the specific needs of the athlete based on the assessment findings.
Who: Multidisciplinary medical team, medical doctor with clinical training and experience in concussion (e.g. a sports medicine physician, neurologist, or rehabilitation medicine physician), licensed healthcare professionals.
5.7 Return to Sport
Those that have been diagnosed with a concussion and have successfully completed their Return-to-School and Taekwondo-Specific Return-to-Sport Strategy can be considered for return to full sports activities. The final decision to medically clear an athlete to return to full game activity should be based on the clinical judgment of the medical doctor taking into account the athlete’s past medical history, clinical history, physical examination findings and the results of other tests and clinical consultations where indicated (i.e. neuropsychological testing, diagnostic imaging). Prior to returning to full contact practice and game play, each athlete that has been diagnosed with a concussion must provide Black Belt World Canada with a standardized Medical Clearance Letter that specifies that a medical doctor has personally evaluated the patient and has cleared the athlete to return to sports.
Athletes who have been provided with a Medical Clearance Letter may return to full sport activities as tolerated. If the athlete experiences any new concussion-like symptoms while returning to play, they should be instructed to stop playing immediately, notify their parents (if they are a minor), coaches, trainer or teachers, and undergo follow-up Medical Assessment. In the event that the athlete sustains a new suspected concussion, the Black Belt World Canada Concussion Policy should be followed as outlined here.