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Concussion Discussion - What should you do?

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What is a concussion and what should we do?

The action and toughness of sports are what makes it enjoyable to engage in and fascinating to watch for many people – who doesn’t enjoy watching big hockey hits, or the powerful uppercut from a UFC fight?

However, new information about concussions and how it can affect mental function later in life has made the issue of preventing head injuries more important than ever. A real effort to spread the word about head injuries and the risk of concussion has led to a movement concussion awareness that will help to protect athletes from serious damage now and more devastating effects later in life.

A concussion is defined as a traumatic brain injury caused by biomechanical forces. Simply- a concussion is a traumatic brain injury caused by a jolt of the head or the body that causes the brain to ‘bounce’ inside the skull. This sudden movement of the brain can cause microscopic structural damage to the brain with some cell death, as well as some changes in your brains chemistry.

The facts.
- A concussion is a brain injury
- ALL concussions are serious
- Most concussions occur WITHOUT loss of consciousness
- Concussions can occur in any activity
- Recognition and proper response to concussions when they first occur is crucial to help improve recovery times, prevent further injury or even death

Did you know?
- Athletes who have had a concussion are at an increased risk to suffer another concussion
- Young children and teens are more likely to get a concussion and will take longer to recover from them than adults
- A repeat concussion that occurs before the brain has recovered from the first – usually within a short period of time – can slow recovery or increase the likelihood of long-term problems or death

Potential concussion signs
- Any loss of consciousness
- Impact seizures/ posturing of limbs
- Slow to get up following a hit/fall
- Motor coordination or balance problems (stumbling, trips, falls etc.)
- Blank or vacant look
- Disorientation
- Amnesia

Potential concussion symptoms
- Headaches
- Dizziness
- Balance or coordination difficulties
- Nausea
- Amnesia
- Cognitive slowness
- Light or sound sensitivity
- Disorientation
- Visual disturbance
- Tinnitus (ears ringing)

Common features that may be utilized to define a concussive brain injury include:
- A direct blow to the head, face, neck or elsewhere on the body that transmits force to the head
- Rapid onset of short-lived brain function impairment that resolves spontaneously (in some cases signs and symptoms may change over minutes to hours)
- Symptoms reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard imaging (brain scans etc.)
- Signs and symptoms may or may not involve loss of consciousness
- Signs and symptoms cannot be explained by drugs, alcohol, medication, other injuries, or other medical conditions

If a concussion is suspected, implement a four-step action plan:
1. Remove the athlete from play immediately
2. Ensure that the athlete is evaluated by a healthcare professional
3. Inform the athlete’s parents or guardians about the possible concussion
4. Keep the athlete out of play until they have been cleared to return by the healthcare professional

Even if a player is feeling normal following a play that may have caused a concussion, it is important to periodically assess the player because a concussive injury can evolve and may not be apparent for several minutes or hours.

When is it safe to return to participation following a concussion?

For every individual, each concussion is unique and recovery time varies from athlete to athlete. Therefore, there is no set time-from for their return to play or for the athlete to progress through the steps to return to full activity.

After being diagnosed with a concussion, the athlete can progress through the source protocol to return to participation. The athlete with a concussion moves onto the next step of the protocol only after they have demonstrated tolerance of the activities in the current step without experiencing any of the signs or symptoms of a concussion explained above. If the activities trigger any signs or symptoms of a concussion, the athlete should discontinue all activities and return to the prior step in the protocol. The athlete must not experience any worsening of symptoms during the exertion itself, as well as a reasonable time afterward. While these are guidelines, it is important to communicate with your clinician as they should be the final say on whether you progress or regress in each step.

Step 1: Rest and recovery
This step focuses entirely on physical and cognitive rest. In general, the athlete must rest and limit all activities (physical and cognitive) that increase or aggregate symptoms. This includes taking time away from:
- TV screens
- Video games
- Studying
- Exercise
- Stressful activities

Step 2: Light aerobic exercise
This step is an initiation of a gradual exercise program where the athlete can begin general cardiovascular activity and may also begin dynamic stretching and balance training. The duration and intensity of the cardiovascular training may be gradually increased as long as the athlete does not incur any concussive signs or symptoms.

Step 3: Continued aerobic exercise and introduction of strength training
The athlete continues with supervised cardiovascular exercises that are increased and may begin to mimic their sport, and strength training is introduced.

Step 4: Limited sport-specific activities
The athlete continues with their cardiovascular, balance, and strength training and can participate in all non-contact actives for the typical duration of a full practice.

Step 5: Full sport activity
After the player has established their ability to participate in non-contact activity including team meetings, strength and conditioning, and non-contact practice without symptoms, the athlete may begin to participate in a full practice with contact.

Step 6: Final clearance
Consult your doctor or clinician to confirm that the athlete’s concussion has resolved and is cleared to participate in their next game without restrictions.

References
Ellenbogen, R. G., Batjer, H., Cardenas, J., Berger, M., Bailes, J., Pieroth, E., . . . Sills, A.
(2018). National Football League Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocol: 2017-18 season. British Journal of Sports Medicine,52(14), 894-902. doi:10.1136/bjsports-2018-099203

Take it easy = make it easy

Regardless of their sport, athletes are passionate about pushing their bodies to the max and injuries keep us away from what we love to do. Difficulties arise when the athlete becomes injured because their passion and mindset are to keep pushing forward.

As much as you want to get back to activity as soon as possible, it is important to make sure you have fully recovered so you don’t return from an injury too soon. Being injured is a difficult process. No athlete wants to be sidelined, away from their teammates, or to take time away from training. Therefore, the athletes’ expectation is to return to their sport as soon as possible.

One of the biggest mistakes we can make as an athlete is to attempt to return to full participation too quickly because their passion for their sport deafens the advice from their clinician to “take it easy”. If you try and push back before an injury has fully healed, you increase your risk of having a setback in your rehabilitation, even if you were feeling pretty good that day. By returning early, you may risk slowing your recovery and you could turn what should have been easy to overcome into a long-term problem that may take longer to get back to 100%.

The most effective method for returning to action is to gradually increase the stress imposed on the body while allowing adequate time for recovery. A study by Blanch & Gabbett (2015) outlines the importance of gradually increasing training by demonstrating that if athletes perform greater workloads than what they are prepared for, they are more likely to experience a setback in their rehabilitation process.

When your clinician is telling you to “take it easy”, they are trying to allow your body to heal while giving time to slowly increase the stress you put on your body. Returning to full activity may seem like a slow progression for the athlete, however, by pushing yourself to the guidelines of your clinician - you can return to your passion in the most effective and expedient way.

References
Blanch, P., & Gabbett, T. J. (2015). Has the athlete trained enough to return to play safely? The
acute:chronic workload ratio permits clinicians to quantify a players risk of subsequent injury. British Journal of Sports Medicine, 50(8), 471-475. doi:10.1136/bjsports-2015-095445

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