By Jennifer Hinkel, WWH, Director of Rehabilitation Services
Fall is almost upon us, which means changing leaves, crisp nights around a fire, hunting season and for many, football. Whether high school, college or professional level the terms “concussion testing” and “concussion protocol” have become as much a part of the game as “interception.” Anyone who has watched a football game knows that even though there is a clear definition of what an interception is, each event is impacted by many factors that create a unique situation. Unfortunately, concussions are much the same.
A concussion is defined by Webster as “a stunning, damaging or shattering effect from a hard blow especially a jarring injury of the brain resulting in disturbance of cerebral function1.” What is disturbance of cerebral function? It is the disruption of nerve pathways that in turn impact the brain’s ability to function. The extent of limitations can vary between almost none and debilitating and can be any combination of the following categories of symptoms:
- Vestibular (inner ear) – dizziness, fogginess, nausea, overstimulation in busy environments
- Cognitive/fatigue – more tired than usual, onset of headaches during/after mentally challenging activities, difficulty concentrating/remembering
- Anxiety/mood – overall increase in emotional state compared to normal, depression, onset or worsening of anxiety
- Ocular (eye) – headaches located in the forehead, pressure behind the eyes, blurred vision, difficulty with reading and screen time
- Post-traumatic migraine – severe headache that can include light sensitivity, nausea, or noise sensitivity
- Cervical – commonly known as whiplash, the force of the movement and impact can cause a level of muscle tightness that can cause pain, headaches, nausea, and dizziness.
Immediate concussion screening focuses on any red flag symptoms (indicating immediate medical attention needed), any observable signs of limitations (balance, lack of coordination, disorientation, responding incorrectly to statements), memory/cognitive function and a neurological screen to assess any vestibular symptoms. This type of testing most often occurs on the sidelines, but it is also performed in emergency departments.
Why is it so important to diagnose concussions right away? As with any injury, removing as many irritants as possible helps to speed recovery. With concussions, decreasing stimulation to the brain is the equivalent of icing an ankle sprain. Quick recovery is important but minimizing the risk of Second Impact Syndrome (SIS) is critical. While SIS is uncommon, it can be deadly2. Second Impact Syndrome occurs when a second concussion is sustained before the brain has fully healed from the initial injury. This triggers a string of responses that result in increased pressure and bleeding in the brain2. Because of the high risk of permanent damage or death in SIS as well as the quickness with which symptoms can progress, the ideal course of action is to focus on prevention.
The best way to prevent SIS is to resume activities (both daily life and athletics) at a slow pace, based on what the brain can handle. Put simply, if symptoms occur, the brain is not ready. Pushing through symptoms will only increase irritation and slow the process overall. Return to sport progressions are typically managed by sports medicine staff or coaching staff under the guidance of the sports med team, but what if progression doesn’t go as expected? These cases as well as concussions that are the result of motor vehicle accidents, falls or physical trauma are referred to physical and/or occupational therapy to guide the process of returning to normal daily life. To further complicate matters, the head doesn’t necessarily need to make contact with anything for the forces of the motion to still cause similar injury to the brain.
Concussion care is the same as other types of rehabilitation in that the initial focus is on decreasing pain/symptoms, followed by exercises designed to return patients to their prior level of function. For ankle sprains, this would consist of RICE(Rest, Ice, Compression, Elevation) initially, followed by strengthening and balance exercises. Concussion rehab targets specific areas of deficits to help guide brain function return correctly and requires additional training to effectively perform. WWH therapists have additional training for concussion care and have technology to help facilitate a very high level of care. They use the Synaptec Sensory System to combination with other exercises and techniques to help patients improve for safety in daily life as well as to return to activity in a highly stimulating environment (such as football or walking around at the state fair). This system is research based and allows the therapy team to not only provide treatments tailored for their symptoms, but also allows for assessments so progress can be tracked objectively.
While the term concussion has become commonplace, it does not mean we should treat this type of injury as such. Even though it may appear minor, each should be treated as if it could evolve into a serious medical event. In addition to longer recovery times, science shows there can be long lasting impact on function if not treated immediately with a proactive management plan.
Western Wisconsin Health’s experienced providers are available to assist you in recovering from any sports injuries. Please call 715-684-1111 to schedule an appointment. Western Wisconsin Health, Building a Healthier Tomorrow, Together.
References:
1. Webster’s Dictionary
2. https://www.ncbi.nlm.nih.gov/books/NBK448119/#:~:text=Second%20impact%20syndrome%20