Concussions: a big hit part 2

Concussions: a big hit part 2

In part 1 of my blog on concussions I discussed the science behind the injury and the importance of seeking help from a trained professional. In this edition I wanted to focus more on recovery from concussions. To start, I’d like to address prevention. The biggest question everyone wants answered is: are concussions preventable? No. As long as athletes continue to go faster, higher and stronger concussions will occur, in anyone, at any level of sport. Second, can we reduce the risk? Maybe. Collisions are part of many sports and occur at high speeds which means concussions are likely to occur. Contact sports have been under the microscope more so but concussions occur in non-contact sports as well. So where does that leave the sports world? If we can’t prevent concussions and we’re not even sure if we can even reduce the risk that much, then how can we make life better for athletes experiencing concussions. Ahh, there in lies the real issue of the matter. Concussions are injuries that require appropriate recovery.

“the NFL doesn’t have a concussion problem, the NFL has a concussion RECOVERY problem” Dr. Cameron Marshall withcompleteconcussions.com

I recently attended a course on concussions. The instructor (Dr. Cam Marshall with completeconcussions.com) mentioned something that will always standout with me. Regarding the recent media attention and lawsuits surrounding the National Football League (NFL) and concussions he said “the NFL doesn’t have a concussion problem, the NFL has a concussion RECOVERY problem”. In my opinion, we could expand this issue to all professional sports. When money mixes with injury recovery there will always be big problems. The biggest problem with concussions and recovery is a potentially deadly condition called second impact syndrome.This is when the brain has not recovered from the initial concussion before a second concussion causes swelling within the brain, and although it is rare the outcomes are often catastrophic including death.1

The leading experts suggest 80-90% of people recover from concussions within 7-10 days.2 The same group of experts provide a 6-stage return to sport progression.2 The downside to this is the majority of health professionals (no extensive training on sport related concussions) are informing athletes of these stages without any supervision of the concussed athlete and whats worse want to book a followup in 7-10 days (similar to guidelines). So basically, ‘follow these steps on your own and wait to see you in 7-10 days’. For an athlete this can be extremely lacking in details. How do they train? How many sets? How many reps should they do? What about heart rate? (directly related to blood flow issues with symptoms) What can they do? Tempering expectations in recovery is key. I believe managing concussions is the best approach. By managing, I suggest healthcare professionals trained in concussion management follow a detailed and supervised approach with the athlete and require a more in-person approach monitoring symptoms with each stage of recovery. One thing I haven’t touched on is baseline testing. I will say that used in conjunction with concussion evaluation and management they can be a helpful tool to provide information only. Baseline testing should be conducted IN ADDITION to exercises related testing (heart rate), vestibular testing (balance and coordination), neck pain treatments (can mimic concussion symptoms), sport psychology (fear avoidance behaviors) as an evidence-based management program (completeconcussions.com) The evidence for baseline testing alone to determine when recovery is complete does NOT exist.2 Sport-related concussion recovery requires more than a simple yes/no answer. A team approach with complete recovery from concussion should be the main focus. Managing athlete expectations, managing signs and symptoms, having all the stakeholders involved appropriately educated and, finally, creating an honest and safe environment for concussed athletes to RECOVER is the best approach. Contact your concussion management team for more information or email me at stevepiper@mysportchiro.com

References

1. McCrory, P., Davis, G., & Makdissi, M. (2012). Second impact syndrome or cerebral swelling after sporting head injury. Current sports medicine reports, 11(1), 21-23.

2. McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., … & Turner, M. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British journal of sports medicine, 47(5), 250-258.