USA Diving and its medical team are committed to providing education and guidelines for athletes, coaches and parents regarding the recognition and management of concussions. The safety of divers sustaining head injuries is of paramount importance to the health of competitive divers.

Concussion is a hot topic in the sports world due to the potential seriousness of the injury. Diving is a limited contact sport! It is important to recognize a concussion and seek medical attention as the brain is in a “vulnerable” state during this period. Another head injury during the post-injury period can significantly prolong post-concussion symptoms or even be life threatening.

All coaches, officials, athletes, and parents should be familiar with the guidelines and information sheets below. Additional information may also be found on the Centers for Disease Control website.

Effective January 15, 2016, all USA Diving coaches will be required to complete a concussion awareness training course offered by the CDC or National Federation of High Schools. (Certificates dated earlier than January 2014 will not be accepted.)

Concussion Education

The Zurich Medical consensus conference notes that a Concussion 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. The CDC similarly defines a concussion as a type of traumatic brain injury, caused by a bump, blow, or jolt to the head. This sudden movement of the brain causes stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain.

A Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously, usually in 7-10 days.

Concussion may result in acute clinical symptoms that largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural CT or MRI studies.

Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged.

Symptoms-Observed

Can’t recall events prior to or after a dive
Appears dazed or stunned
Forgets an instruction, is confused about what dive to do, or is unsure of his/her score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior, or personality changes

Symptoms-Reported

Headache
Nausea or vomiting
Balance problems or dizziness (vestibular dysfunction), or double or blurry vision
Bothered by light or noise
Feeling sluggish, hazy, foggy, or groggy
Confusion, or concentration or memory problems
Just not “feeling right” or “feeling down”

Signs and symptoms generally show up soon after the injury. However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. For example, in the first few minutes your child or teen might be a little confused or a bit dazed, but an hour later your child might not be able to remember how he or she got hurt.

You should continue to check for signs of concussion right after the injury and a few days after the injury. If your child or teen’s concussion signs or symptoms get worse, you should take him or her to the emergency department right away.

Action Plan for Coaches

Should one of your athletes sustain a head injury that you think may be a concussion:

  • Remove the athlete from diving
  • Ensure that the athlete is evaluated by a health care professional experienced in evaluating concussions
  • Inform the athlete’s parents or guardians about the possible concussion and give information on concussion for parents.
  • Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating concussions, says it’s OK for the athlete to return

Medical Assessment

Look for medical professionals trained in the assessment of concussion. A good resource is the American Medical Society for Sports Medicine (www.amssm.org). A listing of sports medicine physicians in your city or area is available on their website. Many primary care physicians and neurologists are also trained in the management of concussions.

Medical assessment of the concussed athlete includes a detailed history of the current and any prior concussions, a neurologic examination, and a cognitive evaluation. The mainstay of concussion management is cognitive and physical rest until resolution of symptoms. Thereafter, repeat cognitive assessment is routinely done to ensure an athlete’s cognitive function has returned to baseline.

Baseline neuropsychological testing is a preseason evaluation of cognitive function, usually computerized, conducted by a trained health care professional. Results from baseline tests (or pre-injury tests) can be used and compared to a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion.

Following resolution of symptoms and the return of normal cognitive function, an athlete will go through a graded, step wise increase in physical exertion to challenge the brain and body to ensure normal function with no symptoms. Upon completion of this progression, an athlete is considered ready to return to diving. Remember that children and young teenagers may normally take a few days longer to recover than an adult.

The following is a return to diving exercise progression developed and used by St.Vincent Sports Performance.

The diver must remain symptom free during and after activity in order to advance to the next phase of the progression. If a diver experiences recurrence of symptoms, go back to the previous level of diving that did not cause symptoms for 24 hours before attempting to advance levels again. In general, begin with low numbers of somersaults and twists and increase gradually as the athlete adapts. Limit total number of dives initially to 15-20.

Day 1

  1. Feet first water entry from side of pool. If asymptomatic, advance to #2
  2. Trampoline with ropes and belts for 20 minutes.
    1. Start with Somersaults, advance to b. if asymptomatic
    2. Somersaults with twists
    3. If asymptomatic for 24 hours, advance to Day 2

Day 2
All divers start on 1-meter springboard

  1. Feet first water entry from side of pool. If asymptomatic, advance to #2
  2. Start with Line ups, Straight dives, advance to b. if asymptomatic
  3. Dives with somersaults and twists
  4. If asymptomatic for 24 hours, advance to Day 3

Day 3
For 1-meter divers, increase number of dives per day by 5-10
For 3-meter springboard divers, go to 3-meter board. Platform divers, go to 5-meter

  1. Start with Line ups, Straight dives, advance to b. if asymptomatic
  2. Dives with somersaults and twists
  3. If asymptomatic for 24 hours, advance to Day 4

Day 4
For 1-meter and 3-meter divers, increase number of dives per day by 5-10
For platform divers, go to 10-meter

  1. Start with Line ups, Straight dives, advance to b. if asymptomatic
  2. Dives with somersault and twists
  3. If asymptomatic for 24 hours, advance to Day 5

Day 5
Full diving without restrictions, athlete may participate in competition

Post-Concussion syndrome

Occasionally, athletes may experience a prolonged course of post-concussion signs and symptoms. Athletes with underlying problems such as ADD, learning disability, depression/anxiety or migraine headaches, may take longer to recover. Many with a protracted recovery may be experiencing problems such as depression and anxiety. Brain imaging (eg, MRI), physical therapy for dizziness, and medications for symptoms such as headache, depression or sleep disturbance may be needed. Additional specialty consultation with a neurologist, neuropsychologist, or neurosurgeon is sometimes needed for these athletes.

 Legislation

  1. Provision of education or training on concussion recognition and appropriate responses.
  2. Removing a youth athlete from play or practice in the event of a suspected concussion.
  3. Returning a youth athlete to practice or competition after evaluation and clearance by a designated health care provider.
  • Laws continue to develop over time and requirements for coaches are becoming more common. In 2014, 20 states had laws requiring training for coaches in some form or another. It will be important to monitor laws in your state. The National Conference of State Legislature’s website is listed below to assist you.
    • Each Club, LDC, and Host is responsible for identification and compliance with the state and local laws including educational and insurance requirements for the management and treatment of concussions.

Insurance

  • USA Diving provides members an excess accident medical insurance. This policy is excess to a member’s personal medical insurance coverage while participating in a USA Diving sanctioned, sponsored, or approved event, including practice. The coverage is outlined on the USA Diving website here

Resources

Centers for Disease Control and Prevention
http://www.cdc.gov/headsup

Concussion Fact Sheets

For athletes

For coaches

For parents

CDC video course on concussion:
http://www.cdc.gov/concussion/HeadsUp/Training/index.html.

National Federation of High Schools Concussion video course:
https://nfhslearn.com/courses/61037

Zurich Concussion Conference (2012)
Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012 - http://bjsm.bmj.com/content/47/5/250.full

National Conference of State Legislatures
http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx.