By: Dale J. Buchberger, PT, DC, CSCS, ACBSP
Just because football season is months away doesn’t mean that athletes in other sports can’t suffer a head injury or concussion. While there are spring sports where contact is inevitable direct contact is not a requirement to suffer a concussion. Because the brain floats inside the skull a severe whiplash type motion that causes the brain to impact the inside of the skull can result in a concussion. When a concussion occurs without direct impact it is often undiagnosed for a period of time following the initial onset of symptoms. Parents and coaches should understand that the onset of symptoms may be delayed for several hours and that direct contact is not necessary for an athlete to suffer a concussion. Many of the guidelines and management strategies used in the past have been altered in recent years. Many organizations that train individuals to recognize and manage concussion have come out with consensus statements and have joined together to provide a set of guidelines on the diagnosis, management and return to play for the concussed athletes.
Parents, coaches and sports medicine personnel should be aware of the Zurich consensus statement drafted in 2008. This cutting edge document changed how sports medicine professionals manage concussion especially in the adolescent athlete. In 2011 the American Chiropractic Board of Sports Physicians (ACBSP) also published its own consensus statement based on the Zurich paper. In addition, later this month the ACBSP will release a concussion registry (ACR) designed for any type of sports medicine professional to take an online course in current concussion protocol. The ACBSP recognized that just because the providers may have had concussion training in school, the majority of their training is obsolete and recurrent training is imperative to stay up to date. All of this information can be accessed at www.acbsp.com.
The Zurich statement defines concussion as, “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” This definition omits the need for a direct blow to the head. In an era where we have become dependent on technology for most medical diagnosis such as MRI, the Zurich statement states that imaging techniques such as MRI or CT scan are not used to diagnose concussion as much as they are used to diagnose intracerebral bleeding or injury. In other words, if the MRI of your son or daughter’s brain is normal it does not mean they don’t have a concussion. On the contrary it means they may have a concussion but they don’t have a more severe intracerebral injury. The corner stone of concussion diagnosis remains a detailed history and a physical examination performed by a professional knowledgeable in the current principles of sport related traumatic brain injury.
Treatment and management of concussion should include both physical and cognitive rest until the athlete is symptom free. This means that the athlete should be restricted from physical activity and that sensory stimuli need to be reduced as well. Examples of items and activities to remove from the athlete’s daily routine are computers, television, cell phones, text messaging, iPods, iPads, etc. We are unfortunately in a technologically dominant society and many of these items and/or activities force the concussed brain to work too hard. This type of rest is imperative to allowing the brain to heal properly. Parents, providers, coaches and anyone else involved in the athletes care need to educate the athlete on the healing benefit of reducing sensory stimuli or cognitive rest. Recovery times vary from athlete to athlete and trying to place all athletes into time frames of recovery is simply wishful thinking. Once the athlete is symptom free a graded program of exertion is employed that starts with light aerobic exercise and ultimately ends with return to play (RTP).
According to Bill Moreau, DC, DACBSP Managing Director of the United States Olympic Committee’s Department of Sports Medicine, “The key point regarding concussion is that all concussions are significant. In the adolescent athlete the proper care of the concussed athlete is especially important because the adolescent’s brain is still developing. All segments of society have a responsibility to help decrease concussions in sport by athletes playing by the rules, healthcare providers should protect concussed athletes by not returning them to play, officials should enforce the rules of sport and parents should support any health care provider that holds their child out of athletics because they sustained a head injury. Each and every sign, symptom and modifying factor needs to be considered when managing concussion, especially in the adolescent population.”