Chiropractors support Rowan’s Law. They are also qualified to play a timely role within it.

Chiropractors have the competencies to:

  • Assess and diagnose post-concussion symptoms at the field level

  • Provide an informed referral, if needed

  • Work with an interprofessional care team to care for concussions and manage post-concussion symptoms

Chiropractic student with simulation mannikin at the Canadian Memorial Chiropractic College (CMCC)

The Challenge with Care for Concussions and Rowan’s Law:

  • Any blow to the head, face or neck may cause a concussion. A blow to the body from an incident like a car accident may also cause a concussion if its force causes the brain to move. A concussion is a serious injury. While the effects are typically short-term, they can lead to long-lasting symptoms and long-term effects – especially if left untreated.
  • 75 to 90 per cent of traumatic brain injuries are mild in nature. They also occur without a loss of consciousness or obvious neurological signs. This situation rules out any serious disease or injury and the need for a CT scan or MRI. 1, 2
  • With athletes, one of the biggest challenges in minimizing the impact of concussions is to recognize and assess them in a timely manner. The longer an athlete waits to be assessed by a health care professional, the greater their risk of long-term neurological issues.
  • Passed in 2018, Bill 193 Rowan’s Law (Concussion Safety) sets mandatory regulations for preventing and managing concussions in amateur sports. Chiropractors have the skills to play a key role as a member of the interprofessional circle of care when diagnosing sports-related concussions, as recommended in Rowan’s Law (Concussion Safety). But current guidelines, including the Canadian Guideline on Concussions in Sport (Parachute Guidelines), note only medical doctors (physicians) and nurse practitioners can diagnose a concussion in sport.

Rowan’s Law (Concussion Safety) 

Rowan’s Law mandates sports organizations to:

  1. Ensure athletes under 26 years of age, parents of athletes under 18, coaches, team trainers and officials confirm every year that they have reviewed Ontario’s Concussion Awareness Resources
  2. Establish a Concussion Code of Conduct that sets out rules of behaviour to support concussion prevention
  3. Establish a Removal-from-Sport and Return-to-Sport protocol

Using Best Available Evidence & Clinical Expertise

Trusted First Line Experts in Concussion Diagnosis

Evidence shows that early detection with subsequent education, reassurance, symptom management and the appropriate follow-up planning can help reduce post-concussion symptoms.

  • Chiropractors have the clinical competency to provide immediate diagnosis and assessments.
    • Four years of post-graduate chiropractic training includes core competencies in: clinical practice, neurological assessment and emergency care
  • Chiropractors are trained to identify the origin, nature and cause of disease and pathologies.
  • Chiropractors have diagnosed and treated sports-related injuries for years. Athletes of all generations have trusted chiropractic care and the credibility it brings to sports medicine
  • On the field of play, a chiropractor can immediately diagnose other head and neck injuries, such as whiplash, which commonly occur with concussions, and offer an appropriate course of care.
  • From initial chiropractic college education to further post-graduate specialized education, some chiropractors develop the knowledge and skills to make care for concussions an important part of their scope of practice.

As supported by:

  • Ontario Neurotrauma Foundation (ONF): ONF’s overall vision in setting standards in post-concussion care is: To have the right care, delivered at the right time, by the right provider, across the province. These standards relate to six separate outcomes that directly align to chiropractors’ ability to assess and diagnose concussions
  • Canadian Guideline on Concussion in Sports Recommendation 3. “Onsite Medical Assessment states: Depending on the suspected severity of the injury and access to medical services, an initial assessment may be conducted by emergency medical professionals or by an on-site licensed health professional where available.”

How Can Chiropractors Play a Timely Role in Rowan’s Law to Help Ontarians Care for Concussions?

Provide Immediate, Field-Side Assessment

If a chiropractor is on the sidelines and an athlete is suspected of a concussion, they, as the first point of contact, can help determine if they need:

  • Urgent attention, such as going to a hospital emergency room
  • To visit their medical doctor or nurse practitioner for further assessment
  • No further assessment is required

As part of an interprofessional circle of care, they can also provide comprehensive advice towards suspected concussions and help rule out more serious forms of medical and neurological conditions.

Make an Informed Referral

Most athletes will make a complete recovery and are able to return to full school and sport activities within one to four weeks of when the injury occurred. The other 15 to 30 per cent will experience symptoms that last longer and may benefit from more long-term care. A chiropractor can give these patients an informed referral to a medically supervised interprofessional concussion clinic, which may include experts in sport medicine and health care.³

Assist the Interprofessional Care Team with Concussion Management

Chiropractors can assist the interprofessional team as part of the circle of care overseeing their patient’s concussion management and recovery. They can also co-manage return to play decisions and sports-specific guidelines.

All OCA chiropractors have the expertise to help address co-existing issues related to the neck and back. Others have pursued additional training that positions them to provide care for various other concussion-related issues and or symptoms.

Build on Our Expertise in Sports-related Injuries

Chiropractors have earned the trust of athletes and are considered a credible resource when assessing and treating their injuries. The fifth most common condition being treated by chiropractors in Ontario are sports injuries.³ Some chiropractors who specialize in sports, can offer even more expertise.

Chiropractors’ Role & Impact

As highly skilled, regulated health care professionals, chiropractors have the competencies, skills and judgement to assess and immediately diagnose an athlete’s  post-concussion symptoms. Chiropractors can also make an informed referral if needed. They can and do collaborate with the patient’s interprofessional care team to manage their care and return-to-play decisions. As an integral part of amateur sports teams, many chiropractors already fulfill much of this role.

How We are Advocating for Concussion Safety in Amateur Sports

Bill 193, Rowan’s Law (Concussion Safety), was passed in 2018 and governs concussion in sport. This makes Ontario a national leader in concussion prevention and management.

On behalf of our members, we continue to consult with our Ministry contacts to reinforce the vital role chiropractors can play in supporting Rowan’s Law and reducing the impact of sports-related concussions.

What advocates say about concussion safety …

“Through increasing awareness, and changing the conversations that occur at our schools, on our fields of play, and in our homes, we can change the culture and make it easier for athletes to say when they are injured, and to get the help they need to return to play safely – athletes like Rowan Stringer.”

Rowan's Law Advisory Committee

“It’s terrible and devastating to lose a child. What’s even worse is that Rowan’s death was preventable. This is why we’ve decided to do what we can to tell Rowan’s story, educate children, athletes and all involved in child and youth sport. Our goal is to help to prevent future injury and death from concussion. Creating legislation, Rowan’s Law, will help protect our youth and fulfill Rowan’s dream of helping children.”

Family of Rowan Stringer

“A concussion is a common form of head and brain injury and can be caused by a direct or indirect hit to the head or body (for example, a car crash, fall or sport injury). This causes a change in brain function, which results in a variety of symptoms. With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal.”

Watch for updates on this page and in the OCA members’ bulletin

[1] Gioia, G. A., Collins, M., & Isquith, P. K. (2008). Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the acute concussion evaluation. The Journal of head trauma rehabilitation, 23(4), 230-242. https://pubmed.ncbi.nlm.nih.gov/18650767/
[2] McCrory, P., Meeuwisse, W. H., Echemendia, R. J., Iverson, G. L., Dvořák, J., & Kutcher, J. S. (2013). What is the lowest threshold to make a diagnosis of concussion?. Br J Sports Med, 47(5), 268-271. https://bjsm.bmj.com/content/47/5/268
[3] Attitudes of Ontarians Towards Chiropractic Care (Environics) ©2019
[4] Côté, P., Shearer, H., Ameis, A., Carroll, L., Mior, M., Nordin, M., & OPTIMa Collaboration. (2015). Enabling recovery from common traffic injuries: A focus on the injured person. UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation. January 31, 2015. ENABLING RECOVERY FROM COMMON TRAFFIC INJURIES: A FOCUS ON THE INJURED PERSON, 5, 5. Guide on Concussion in Sport, July 2017 https://www.fsco.gov.on.ca/en/auto/Documents/2015-cti.pdf