Springtime and summer have arrived, which means kids are out there playing soccer, baseball, on their skateboards and riding bikes (hopefully the adults too!). There is considerable attention in the media right now regarding concussions. Recent studies have shown that the overall incidence of a concussion is actually higher than we thought. More importantly, we know now that the effect of multiple concussions is cumulative, and that a symptom free waiting period before returning to sport or more strenuous daily activities has a beneficial impact on recovery and repeat concussions.
To simplify, a concussion is a blow to the head. There are two distinctions regarding concussions: direct and indirect. A direct concussion is a direct hit to the head, as in boxing or hockey, or perhaps a crash off your bike where you land on your shoulder and head. An indirect concussion is more difficult to identify and understand. There is movement of the body and head but inside your head, the brain gets thumped against the inside of the skull. There may or may not be a loss of consciousness. Both distinctions are considered concussions, with trauma to the brain, and medical attention is required.
It is important to be educated on concussions as an athlete and a parent. Being aware, understanding the signs and symptoms, and knowing how to manage concussions could have a significant effect on you or your child’s cognitive abilities.
Research tidbits: A 2009 study in the Journal of Neurosurgery shows there is a period of vulnerability of repeat concussions within 7-10 days of the first concussion. This “second impact syndrome” is potentially life threatening and having over three concussions will likely result in some degree of cognitive impairment. A UBC research study showed that athletes with multiple concussions are 7.7 times more likely to demonstrate a major drop in memory performance compared to athletes with no previous concussions.
How to recognize a concussion?
There are physical signs, clinical symptoms, potential changes in balance, cognition (memory), behaviour and sleep. Symptoms may include headache, nausea, feeling dizzy, blurred vision, ringing in the ears, poor concentration, feeling foggy and confusion. There may be a difficulty processing simple cognitive tasks such as counting backwards from 10 or knowing what you had for dinner last night. Sleep disturbances, drowsiness, irritability, slowed reaction time, depression, and balance loss may be some physical signs to be aware of. If any ONE OR MORE of these signs and symptoms are present after an incident, it is important to seek medical attention right away. Headaches are one of the most common symptoms after a concussive episode. They may be due to strain on soft tissue structures, nerves, muscles, joints in the neck or stress. Do not take a “sit and wait” approach. It is important to actively manage ANY symptoms following a concussion and seek medical attention.
If signs and symptoms worsen at any point, that is an indication there is increased pressure or swelling in the brain and is a medical emergency. It is not uncommon for symptoms to be delayed following a concussive episode; therefore close observation of the individual following the incident is essential.
How to manage a concussion?
Knowing the signs and symptoms is the first step.
The next step is to monitor the individual. This information is based on the most recent evidence from the Zurich Consensus on Concussions, an international conference of world experts. It used to be common practice to wake up the person throughout the night to monitor their symptoms. The latest evidence suggests it is important to rest and get sleep. Therefore, if the individual wakes up on their own – ask them questions and monitor their symptoms – otherwise, let them rest. This should continue for the next 24-48 hours.
The most recent research also recommends avoiding the use of medication. This is to prevent the masking any pertinent symptoms as well as potentially thinning the blood and increasing bleeding. It is recommended to avoid driving, activities that require alertness, and alcohol. The temporary reduced cognitive function may be risky. Following these guidelines will result in a safe and speedier recovery from a concussion.
Returning an athlete to sport
If an athlete so much as has a minor headache after a collision in sport, they will likely be removed from the sport for the rest of the day and monitored closely. This may also mean a loss of school time as well. The following six steps are recommendations from the Zurich Consensus for returning the athlete to their sport. 1: They need to be asymptomatic for 24 hours 2: They will then be tested with light aerobic exercise to see if any signs or symptoms return. This may be bike riding, a light jog or the elliptical. Light exercise raises the heart
rate and blood pressure and the athlete is monitored for how their system adapts. If all is clear for another 24 hours, they proceed to step 3: Increased intensity of activity – such as light strength resistance, running, jumping, plyometric exercises. If at any step there is an increase in any symptoms, you return to step 1, rest for 24 hours or until symptom free once again. 4: Introduce sport specific activity without any contact drills. Work on balance and coordination such as kicking a soccer ball across the field or stick handling the puck. 5: More aggressive drills are introduced, still avoiding contact. Play a full period, go hard, try to max out the system and see how the athlete tolerates it. 6: Introduce game play such as contact drills, one on one agility and skill drills. The individual should continue to be monitored closely. This six step process of returning an athlete to sport will typically take 7-10 days. 80-90% of concussions resolve in 7-10 days, but may take as much as long as 3 months to a year for full recovery.
Equipment is an important factor in reducing and avoiding unsafe collisions. Helmets for hockey, skateboards or biking need to be checked regularly for defects and cracks. Face mask screws and straps may loosen which can lead to extra motion and at impact, a concussion. Hockey face mask and chin straps should fit snugly to prevent the helmet from moving too much on the head. Helmets can significantly reduce injury risks when worn properly! If there is a direct blow to the head with a helmet on the helmet should be discarded as the internal safety mechanisms may be compromised.
With a better understanding of how to recognize and manage concussions, our athletes and kids will have a much safer and speedier recovery from this injury. We at Bragg Creek Physiotherapy wish you and your family a fun, safe and action packed summer!
Jennifer Gordon (BScPT, AFCI, GIMS, BKin)