As the new school year gets underway, many students are preparing to compete in a new season of athletic endeavors. As with any form of competition, there are certain risks for injury. One injury, in particular, has received an increasing amount of attention – concussions. It is estimated that there will be approximately 300,000 sports-related traumatic brain injuries, primarily concussions, occurring this year in the United States alone. Although most concussions are mild and not life threatening, it is important to recognize the warning signs of a concussion and make sure to take the proper steps, such as working with a licensed physical therapist, for a full recovery.
The evidence-based definition of a concussion is “a change in brain function following a force to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals with measures of neurologic and cognitive dysfunction.” Given the broad definition, it is more practical to recognize the signs and symptoms of a concussion in order to start the recovery process.
These signs and symptoms include difficulty recalling short term events before/after a hit, appearing dazed/stunned, a lack of balance or clumsy movements, or loss of consciousness. He or she may also report headaches, nausea/vomiting, visual changes, sensitivity to light/noise, confusion, or just not “feeling right”. If there is any doubt about the seriousness of a concussion, it’s best to take the individual to the emergency room. These changes may be present immediately following a concussion or may take days to develop, so close monitoring is key in order to reflect an accurate diagnosis. It is the best practice to have communication between healthcare professionals, parents/roommates, and athletic trainers/coaches to gather relevant information.
Once an individual is suspected of having a concussion and a diagnosis is made by a member of a healthcare team, it is vital to begin the recovery process. First and foremost, the individual should sit out from any competition the rest of the day until advised by a healthcare professional about when it’s safe to return to play and the classroom.
The first step recommended for recovery is rest, both physical and mental, to allow the individual’s body to heal. This means sitting out from practice, games, and weight training, as well as screen time or school assignments. After an individual is symptom-free and has returned to baseline testing (if applicable), he or she should start light aerobic activity such as walking, swimming, or biking. If they remain symptom-free after light aerobic training, the individual can progress to sport-specific activity with no impact, which includes low intensity sport drills.
The next step is full non-contact sport drills and resuming progressive resistance training if the individual was involved with resistance training prior to the concussion. Finally, the athlete should return to full practice and competition participation and if he or she remains symptom-free. Again, it’s important to recognize that the time spent on each stage before returning to activity progression is based on the presence or absence of the athlete’s signs and symptoms. Communication and observation are key between all the parties involved in the athlete’s care.
Even though an estimated 80-90% of concussions resolve themselves within 7-10 days, there may be lingering symptoms that impede quality of life. Recently, it has been suggested that prolonged physical and cognitive rest may start to be harmful for those recovering from a concussion and, as with every injury, graded rehabilitation is key to making a full recovery. Growing evidence is suggesting a more active, targeted approach to recovering from a concussion in order to better facilitate the rehabilitation process.
Multiple health care providers working together for complete examination and rehabilitation has been providing the best outcomes for affected athletes. In particular, licensed physical therapists are trained in concussion management in order to identify and treat remaining impairments from a concussion, most notably vestibular deficits, such as decreased balance, coordinated head/eye movements, and postural control. Licensed physical therapists are also trained and skilled at treating headaches and the lack of aerobic exertion that may follow a concussion. As our understanding about this unique injury continues to develop, so will our expertise on rehabilitation.
The fall is a season of new beginnings, including both athletic and academic undertakings. Having the knowledge to more quickly recognize when a concussion occurs, and of how to recover from this injury, will allow everyone to enjoy this fall season more safely. For more information about concussion management, schedule an appointment with a licensed physical therapist at Foothills Sports Medicine, or ask your healthcare professional about how you can protect yourself this fall season.