In the past two weeks, we defined concussions and the signs and symptoms to help identify one. In the final part of this series, we will cover my favorite part: Management and Return to Sport.
A study in 2014 showed that in 43.5% of concussion cases, the patient returned to sport too soon and in 44.7% of concussion cases, the patient returned to school too soon. That’s almost every other concussion. Come on, we can do better.
Let’s build on my previous example about Billy Bob – It’s Saturday, the day after the playoff football game, where he had to sit out after receiving a concussion. He didn’t sleep much. He has a headache, some trouble concentrating, and light sensitivity. What should Billy Bob do next?
In the past, medical professionals would advise staying in a dark room and resting till all symptoms go away. But with more recent research, we see that being in these dark caves and shut off from the world can actually hinder your recovery.
For the first 24-48 hours, I do think rest is an important component. But what I would recommend is to try to go about your normal day within your capacity and don’t exceed your symptom threshold. What does this mean in English? Try to work with what you currently have and don’t make it worse. The goal here is to get back into your normal routine as fast, but safely, as possible.
Below is a slide from a recent presentation I gave in June at one of our National Physical Therapy Conferences regarding concussion management.
What this basically shows is that there’s a “sweet spot.” Too much rest and/or too much activity can make a concussion worse. We call this graded exposure. This is why understanding your threshold is important and using your symptoms to help guide the process.
To better understand graded exposure, I always like to give patients the pool analogy. You don’t want to be in the shallow end and you don’t want to be in the deep end. You want to be somewhere in the middle where you can start causing some stress on your body in order to create positive adaptations.
Now, there are many different routes that concussion management and treatment can go. This all depends on the clinical exam and the signs and symptoms the patient is experiencing. I’m going to keep this general in order to provide a 360 degree view of these different options:
These are all areas that Physical Therapists can address and help treat.
Return to Play
The Concussion in Sport Group (CISG) creates consensus statements for physicians and healthcare providers involved in athlete care every 4 years. Below outlines our most current model from their meeting in 2016 for the concussion return-to-play process.
I also like this integrated model by Complete Concussions below where they combine school and play together to give you a better overall picture of this process.
And, I would be remiss if I also didn’t mention 3 other aspects of health that are very important in this recovery process:
Our best recovery weapons are sleep and nutrition. We have to approach this from a holistic perspective if we expect to have the best outcomes.
I want this article and the rest of this concussion series to serve you as a resource. If you suspect you or someone you know has had a concussion, it’s important to make sure it gets addressed. Concussions are incredibly complex and it takes a team approach to make sure each person gets the best care.
At Athletes’ Potential, we have Doctors of Physical Therapy who are able to appropriately screen and assess for concussions as well as offer treatment for the management of this condition. If you have any questions, please call us at 470-355-2106.
Dr. Ravi, PT, DPT, CSCS
Last week, we dove head first into concussions (sorry, I can’t help it), looking at what exactly defines a concussion and what sports populations are most at risk. If you missed it, check out Concussions, Part 1.
The interesting part about concussions is that you may not see some signs or symptoms present until minutes, hours, or even days later, which is why I want to equip you with the knowledge to know what to look for in part 2 of this Concussion series.
The easiest way to do this is to break it down into acute (sudden/very recent concussion) and chronic (prolonged period of time after concussion) phases.
But first, a story about Billy Bob.
So say it’s 3rd and goal with 10 seconds left in the 4th quarter. Your high school team is losing 22-27. This game decides whether your team goes to the state championship. The ball snaps and Billy Bob, the running back, runs towards the goal. He is instantly met by the middle linebacker with a head-to-head collision. Now, it’s 4th down. Billy Bob lays there and struggles to get up. The team Athletic Trainer (AT) runs on the field and finds that he is able to now stand up, but definitely notices something is off. Billy Bob repeatedly assures the AT that he is okay and can play the final play.
What do you do as the AT? As the head coach? As the parent? – do you sit Billy Bob out? What about the game?
This seems like a no-brainer (again, sorry), but can be a very controversial call, especially when there’s a game on the line.
I always go by the rule: “When in doubt, sit it out.”
Now, you’re probably saying, “Ravi, quit being a softy and suck it up. There’s a game to win!” But as someone who has personally experienced a concussion, I would say the risk is not worth the reward. Let me explain why…
Introducing Second Impact Syndrome (SIS) – This happens when an initial concussion has occurred or not fully resolved and the individual receives another concussion, this time resulting in more severe complications including excessive swelling in the brain. That’s no bueno.
If I have you freaked out, don’t worry. This is a rare occurrence, but it can happen. As long as everyone is doing their job, there should be nothing to worry about.
And, statistically speaking, most concussions resolve within a matter of 7-10 days.
“Can imaging diagnose a concussion?” No. This is a HUGE misconception. Currently, there is no imaging that can effectively diagnose a concussion. Typically, most concussions present as a functional issue, rather than a true structural issue (Think more of how a computer program runs rather than the wires connecting it) which is why imaging is rarely helpful.
Signs and Symptoms of a Concussion:
Each concussion can present with different signs and symptoms based on numerous factors (i.e. where the impact was, number of concussions, severity, etc.), which is why every concussion must be evaluated and treated on a case-by-case basis. As you can see above, headache takes the cake for most common symptom. Recognizing these signs and symptoms can be very helpful to make sure no concussion goes undiagnosed.
Introducing Post-Concussion Syndrome (PCS) – this is categorized as a complex disorder in which symptoms – such as headaches and dizziness – continue to persist for more than 21-28 days after the initial injury.
A variety of factors can play into why there are prolonged symptoms:
A team approach is most effective to tackle these acute and chronic concussion cases by utilizing a variety of treatment approaches.
Next week, we’ll discuss the final part of this series where we’ll cover management and return to play for concussions. In the meantime, if you have any questions, please feel free to reach out by giving us a call at 470-355-2106 or clicking the button below!
Dr. Ravi, PT, DPT, CSCS
It’s August, which means summer break is over, school is starting back up, and sports are around the corner. This also means the overly-compulsive dads, moms and coaches are on high alert. But come on, everyone loves seeing kids run around the field like little drunk adults.
As a Physical Therapist and Performance Coach, I always get the question – “do you think my son or daughter should play ‘insert any contact sport’?” This is a loaded question, but 11/10 times I will recommend kids to be active in any way they can. Research has repeatedly shown that physical activity and organized sports contribute to better performance in the classroom, improved growth and development, greater social interactions, and positive long-term health habits.
By allowing your son or daughter to take part in sports, there is always an inherent risk of injury. And with contact sports, concussions are always on our radar.
You as a parent or coach may have some questions: What exactly is a concussion? How do I know if my son or daughter has had one? Should I keep them locked up in a dark room forever? When is it safe to let them go back to sports?
My goal is to answer these questions for you. This article will be 1 of a 3-part series related to concussions and how to get ahead (get it?) of these injuries.
Each year, 1.6 to 3.8 million concussions result from sports/recreation injuries in the United States. Sports concussion can affect athletes of any age, gender, or type or level of sport played. While most concussions result in full recovery, some can lead to more severe injuries if not identified early and treated properly.
Concussion Rates Per Sport
The below numbers indicate the amount of sports concussions taking place per 100,000 athletic exposures. An athletic exposure is defined as one athlete participating in one organized high school athletic practice or competition, regardless of the amount of time played.
Now, does this mean we need to throw in the towel and keep our loved ones from playing sports? I don’t think so. But context is king, and every individual and situation is different. Is this their first concussion? Did they make a full recovery? These factors and many more go into whether we should let them play.
Concussions can be complex and tricky. It’s not like a broken bone or cut, where these injuries can be seen with our eyes. Concussions are internal injuries, which is we must be educated on what they are and the appropriate steps to handle them.
So, What's A Concussion?
What Causes A Concussion?
Approximately 90 percent of diagnosed concussions do not involve a loss of consciousness, so it is important to look for signs and symptoms of concussion, which is something we will discuss in Part 2 of this series. Stay tuned!
Thanks for reading,
Dr. Ravi, PT, DPT, CSCS
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.