This is a topic that is incredibly close to me, as I got a concussion (thankfully not HEMA-related) that put me out of work for six months and didn’t allow me to train for nine. The recovery process sucked, there were times I didn’t know if I would fully recover or how long it would take, and I wouldn’t wish it on anybody. I still deal with the effects of that injury in my life and I will for years to come.
The risk can be really high, particularly in HEMA. The whole point of what we’re doing is to hit each other. So if we’re going to continue happily bonking each other in the head for years to come, we should do our best to be safe and responsible about it. If we can prevent concussions by raising awareness, learn how to identify them, and enable healthy recoveries, we are all better off.
What is a Concussion?
A concussion is a traumatic brain injury (TBI). Any impact that causes the head to move rapidly can result in a concussion, even if your head didn’t directly take any impact. This is the big reason it’s so important to know what to look for – almost anything we do in HEMA can cause one, and you have to take immediate action if you think a concussion has occurred.
*** IF A PERSON LOSES CONSCIOUSNESS, DO NOT MOVE THEM. CALL EMERGENCY SERVICES IMMEDIATELY. ***
How do I get a Concussion?
I hope this isn’t being asked literally, because you shouldn’t want one. They’re not fun. Concussions can be caused by:
- A direct hit to the head
- A hit to the body
- Falling (even if you don’t bonk your head on the way down)
In a HEMA context, this can look like:
- Direct cuts to the head and neck (angle doesn’t matter).
- Grapples/body contact
- Throws/falls
- Thrusts to the head or neck
- Thrusts to the body
If you hadn’t noticed, that pretty much sums up almost every action we use when we fence. Starting to get why this is so important? We’re actively doing things that can cause our training partners and opponents traumatic brain injuries (TBI), so I feel very strongly that it’s something we should be taking way more seriously.
I Got Bonked. How do I Know if it’s a Concussion?
Short answer: You usually don’t.
It’s not your job as a coach, instructor, or participant to diagnose a concussion. That’s what doctors and medical professionals are for. Your job is to know what the signs and symptoms are, and monitor for them. If you even SUSPECT a concussion, stop the activity and get the affected party assessed by a professional.
The real downer with concussions is that it’s hard to tell in the moment if you have one and how severe it may be, but on the off chance that you do have one, the last thing you need is to make it worse by continuing the activity. Don’t be tough, don’t suck it up. Your brain isn’t a toy and you’re going to need it for years to come. It doesn’t just heal like a broken bone or other injuries.
If you’re the one affected, you’re ultimately responsible for your own health and safety and should make decisions based on that. If you’re an instructor or coach, don’t be afraid to pull your athlete/student (even and especially if they’re in the middle of the most important match in the most important tournament of their lives). A good rule of thumb is that if you’re not sure, pull them out. Better to be safe than sorry, especially when you consider that it’s difficult for even trained medical professionals to diagnose a concussion.
What to do Following a Concussion
If you think you or one of your training partners has suffered a concussion, you need to:
- Remove that person from the activity
- Check in and ask about symptoms of concussion
- If they report symptoms, you have to assume that a concussion has occurred
- If they don’t, you can’t just assume they’re fine – keep monitoring them
- If anything is off, assume a concussion is present
- Do not leave the person alone – make sure someone is monitoring them
- Seek medical attention immediately, preferably from a physician with concussion expertise
Nobody wants to stop playing or take themselves out, especially if it’s during a competition. But if symptoms start, you have to stop. That gold medal match isn’t worth risking the health of your brian for the rest of your life, even if it feels like it at the time. (Pro tip: If your brain is injured you probably shouldn’t trust it to make decisions for you.)
The next step is to prevent further impact. If you get hit a second time before your brain is fully recovered, signs or symptoms may be more severe and take longer to resolve. It can take time for concussion symptoms to show – anywhere from a few hours to a few days.
When you’re concussed, your reaction time is often slower – in the case of HEMA, this can mean your risk of getting a second impact is much higher. In rare cases, you could sustain Second Impact Syndrome, which is when you get a second concussion before your brain has completely healed from the last one. This can cause fast and severe swelling in your brain, and it can lead to death.
In all cases with concussions and suspected concussions, the correct course of action is to stop the activity and get assessed by a doctor before returning to play.
Signs and Symptoms
Most concussions do not involve a loss of consciousness (only 10% or so). Whether or not someone lost consciousness is a poor indicator of whether they are concussed. There is no such thing as a minor concussion. All concussions are serious injuries.
The first symptoms of a concussion may not appear until minutes or hours after the injury, but early recognition of the signs and symptoms of a concussion can improve recovery. There are many types of signs and symptoms – physical, cognitive, emotional/behavioural, and sleep. They may not always be obvious, so it’s important to be vigilant. The difference between the two is that signs are observed by other people, and symptoms are reported by the individual.
Physical Signs and Symptoms
| Signs | Symptoms |
| – Loss of consciousness – Seizure or convulsion – Vomiting – Slurred speech – Poor coordination or balance – Vacant look – Slowed reaction time – Clutching head | – Headache – Pressure in the head – Dizziness – Nausea or vomiting – Blurred vision – Sensitivity to light or sound – Ringing in the ears – Balance problems – Feeling tired or low energy – Drowsiness – “Don’t feel right |
Cognitive Signs and Symptoms
| Signs | Symptoms |
| – Amnesia – Easily distracted – Confusion – Does not know time, date, place, etc. | – Not thinking clearly – Feeling slowed down – Feeling like “in a fog” – Difficulty concentrating – Difficulty remembering |
Emotional/Behavioural Signs and Symptoms
| Signs | Symptoms |
| – Strange or inappropriate reactions – Irritability | – More irritable (easily upset or angered) – Sadness – Nervous or anxious – Feeling more emotional |
Sleep Signs and Symptoms
| Conveniently enough, the signs and symptoms are the same for both on this one. |
| – Sleeping more or sleeping less than usual – Having a hard time falling asleep |
Late Symptoms of Concussion
The signs and symptoms of concussion may not appear immediately, so keep an eye out for the hours and days following an impact that could lead to a concussion. You may have suffered a concussion even if there are no visible signs (they may not have appeared yet) and you don’t report any symptoms (you may not recognize them). Remove yourself from play following a collision that could lead to a concussion for close observation to ensure signs and symptoms do not appear.
Red-flag Symptoms
Seek medical care immediately if headaches worsen, or you observe one or more of these symptoms. They may be signs of an injury that is more serious than a concussion.
- Neck pain or tenderness
- Double vision
- Weakness or tingling in arms or legs
- Severe or increasing headache
- Seizure or convulsion
- Loss of consciousness
- Deteriorating conscious state
- Vomiting more than once
- Increasingly restless, agitated, or combative
- Growing confusion
Persistent Post Concussive Syndrome
PPCS is a condition in which concussion signs and symptoms last for more than 3 months.
This can negatively affect your whole life – relationships, work, school, activities. Trying to work through the pain will not help you recover from a concussion – if anything it will make it worse and your recovery will be longer and more painful. You may even end up with more long-term consequences as a result. Don’t be a hero.
It’s not known what causes some people to get PPCS while others don’t. We do know that the risk factors include pre-existing medical and psychological conditions, expectations of recovery, and older age. Outside of PPCS, aggravating a concussion can lead to poorer memory and concentration than you had before, increased risk of future concussions, and a longer recovery time – in some cases an inability to return safely to your sport or activity at all.
Head Protection
You might be thinking: “Doesn’t my fencing mask, gel liner, and overlay prevent concussions? The answer to that is a resounding NO. Your fencing mask does not prevent concussions.
Helmets and fencing masks are designed to try to protect the head by preventing skull fractures and scalp laceration. The padding can help reduce the impact to your head, which can be a cause of concussion. That being said, many concussions are from the rotational movement of your head and neck, and the movement of the brain within your skull. No fencing mask can prevent that.
Recovery
The good news is that most people who sustain a concussion recover with appropriate management by a medical doctor and coaches/instructors. But just because you’re asymptomatic, does NOT mean your brain is recovered. You should put your brain through a step by step process called a return to work or return to play plan. These should be supervised by a physician.
In short, concussion recovery sucks. The majority of concussions will resolve in less than two weeks, but if symptoms persist longer than that, you should be re-evaluated by a doctor and work out a more individualized treatment plan.
Going through a return to play protocol should take at least a week for adults. You *must* be symptom-free for a full 24 hours before moving on to the next stage. If you experience symptoms during any stage, you must stop the activity, wait 24 hours, and go back to the previous stage. This gets really frustrating – for many people, especially those with PPCS, healing is not linear. It can vary greatly and some steps take a long time while others come quickly.
Here is a basic outline of what a return to sport protocol looks like:
Step 1: Slowly increase cognitive tasks (reading, screen time, etc.) at home. Start small, 5-15 minutes at a time and gradually increase duration, complexity, level of distraction.
Step 2: Light aerobic exercise – walking, stationary cycling, 10-15 minutes.
Step 3: Sport-specific activity for 20-30 minutes. NO CONTACT.
Step 4: “On-field” practice – in HEMA this would be light drilling with NO CONTACT. No jostling, no bumping, no high speed or intensity.
Step 5: Practice with body contact. *This step should be cleared by a doctor.*
Step 6: Higher intensity activity – sparring and/or competition.
Concussions are not normal injuries – you can’t just work through them or tough it out. This can be very discouraging, and very isolating. Because concussions vary so greatly between individuals and symptoms are generally invisible to others, it can be hard for others to understand what you’re going through. It’s especially important to be patient and supportive throughout the recovery process.
Supporting Someone with a Concussion
If you know someone who is recovering from a concussion, try to find ways to connect with them without putting strain on their brain. Concussions can be very isolating for the person affected – they’re often not able to go out because they risk symptoms that could set them back, they’re not able to do their regular activities, and they may not be able to exercise. Depending on how long it goes on for it’s very common to feel like they’re falling behind or losing their social connections.
Be patient with them if they’re more emotional or erratic, or if they don’t seem to remember or think as clearly. Find ways to include them – in HEMA, this might look like reading manuals together or talking about fencing, teaching them to coach instead, or finding other ways that they can be around the sport without contact or risk of re-injury. Concussions aren’t something you can just push through, even in social or work settings. As someone who has gone through this, trust me: a little extra thought goes a long way.
Conclusion
As I said above, concussions are not normal injuries. They’re unique and there’s still a lot of research and work to be done to fully understand them, especially in HEMA. But as coaches, instructors, and participants, it’s up to all of us to take care of each other. The more people know about the causes, signs, and symptoms of concussions, the better we will all be able to recognize them and ultimately become a safer sport.
[Sean here. I once spoke with an engineer working at a company that specialized in technologies to protect against concussion. When asked about quantifiable metrics to predict if a concussion would occur, I was told that they don’t exist. All they can do is look at the aspects known to increase risk, and make those numbers smaller. Even the best minds working on these problems can’t tell you exactly how much will cause a concussion, there is just so much variability out there. ]
Resources:
Sport Concussion Assessment Tool: https://lms.coach.ca/cac/makingheadwayinsport-en/dist/docs/scat5-en.pdf
Return to Sport Strategy:
https://lms.coach.ca/cac/makingheadwayinsport-en/dist/docs/parachute-return-to-sport-en.pdf
Canadian Guideline on Concussion in Sport:
https://lms.coach.ca/cac/makingheadwayinsport-en/dist/docs/parachute-concussion-guideline-en.pdf