A physical therapy and rehabilitation blog covering common athletic injuries. This is an offshoot of my work blog where I cover surgical and non-surgical rehabilitation. This is in no way intended as a blog or journal of the super intricate and technical aspects of therapy and rehab. For that there already is a wealth of information. It is my hope that this can be used to in some way simplify and make readable the truly necessary info that patients are looking for. Feel free to give feedback and or requests of topics. Good luck!
www.rehab101.wordpress.com
www.rehab101.wordpress.com
Concussions In Sports
I wanted to diverge a bit from the "normal" things you see in rehab and spend a little time on a very misunderstood topic: concussions. Recently I had the privilege to attend a sports medicine conference where I was able to listen to an expert in the field of concussions, Dr Kevin Guskiewicz from the University of North Carolina. He has been conducting research there over the last six years using specialized sensors in the football players' helmets and measuring impact forces during play. The following information is largely taken from his lectures. If you want, I can send you the PDF of his slides.
There is a lot of misinformation and even more misunderstanding about what is a concussion, what are the symptoms, and the short and long-term effects. The NFL is finally taking notice and doing what it can to make long term changes to the game. Whether their motive is to avoid future lawsuits, or just to look responsible, its good to see they're willing to listen to the experts.
So, with that said, what is a concussion? The American Academy of Neurology defines a concussion as - "Traumatically induced alteration in mental status that may or may not involve a loss of consciousness." It is important to note again that you don't have to lose consciousness to sustain a concussion.
What are the symptoms? There are somatic (body responses) that include nausea, headache, balance problems, and sensitivity to light and noise. There are neurobehavioral problems - drowsiness, fatigue, sleeping problems, and nervousness. There are cognative problems - feeling bogged down, difficulty concentrating and difficulty remembering.
How long do symptoms last? How long to wait before you can return to practice/play? Symptoms can last anywhere from a few days to several weeks. Sometimes symptoms don't appear till much later on. One study found "significant memory deficits 36 hrs post-injury in athletes symptom-free within 15 minutes (Lovell, et al., AJSM 2004)" This means that you don't necessarily develop symptoms immediately, so you can just go by how a player feels right after the hit. There are a couple tools that are helpful in determining when it is safe to return to play. One is a graduated step program to test the athlete's response to physical activity and if that activity brings on their symptoms.
What are the short and long-term dangers of concussions? The most dangerous in the short term is called "second impact syndrome" where the brain sustains a second concussion before it has healed from the first. In this scenario, the brain is unable to properly regulate blood flow and the mortality rate (rate of death in this condition) is 50%. The long-term consequences from concussions are dementia, depression, and chronic traumatic encephalopathy (see the links at the bottom for CTE info). This is from the Chris Henry link at the bottom - "According to a press release by one of the co-directors of CSTE, Dr. Robert Stern, a large study is underway involving a number of former NFL players to study their lives and then examine their brains following their death. To this end, more than 250 current and former athletes, including 60 retired NFL players, have agreed to donate their brain and spinal cord to the CSTE upon death (CSTE Press Release, 2010)."
The greatest impacts recorded in Dr Guskiewicz's research consistently are in special teams, mostly because the players are hitting at full speed. Linemen show a very high impact rate as well, and some have pushed the idea of eliminating the 3 point stance to avoid such high impact in the trenches.
There are many theories about how to change the game of football to reduce the incidence of concussions. Dr Guskiewicz has recommended to the NFL (and apparently they're finally willing to listen) to change or eliminate kickoffs completely as special teams has shown to produce the highest rated impact forces as the players have a running start. Another change is to fine and/or suspend players who "head hunt" or lead with their head. This is more of a long term culture change, and has been heavily criticized by some players who are known for producing "big hits."
There is still much research to be done and much to learn about the long-term consequences of concussions. Thankfully, many professional organizations like the NFL are finally taking some serious looks at how they can help reduce the chances for concussions. The hard work ahead is mainly in educating not just professional athletes, but college, high school, and junior high players and coaches on how to identify a concussion, the dangers, and how to safely bring athletes back to competition. Some states, like Iowa, have passed laws that require high school athletes to be released by a doctor or physical therapist before they can return to play.
Some will say, "Why don't we just give them skirts then." This isn't about "ruining the game". This is about protecting people from devastating long-term effects. Many of us can recall some of our beloved Hawks who had to quit football because of this. While football will always be a physical, even violent sport, there are changes that can be made so that we can not only have fun, but do our best to eliminate unnecessary dangers. This isn't about blown ligaments, this is in the most serious sense about life and death.
Here are some great links for more info:
The Center for the Study of Traumatic Encephalopathy - Center for the Study of Traumatic Encephalopathy Boston University
Dave Duerson, another sad statistic of CTE - http://www.nytimes.com/2011/05/03/sp...rson.html?_r=1
Bengals WR Chris Henry was found to have CTE after his sudden death, despite only being 26 years old - Chronic Traumatic Encephalopathy (CTE)
There is a lot of misinformation and even more misunderstanding about what is a concussion, what are the symptoms, and the short and long-term effects. The NFL is finally taking notice and doing what it can to make long term changes to the game. Whether their motive is to avoid future lawsuits, or just to look responsible, its good to see they're willing to listen to the experts.
So, with that said, what is a concussion? The American Academy of Neurology defines a concussion as - "Traumatically induced alteration in mental status that may or may not involve a loss of consciousness." It is important to note again that you don't have to lose consciousness to sustain a concussion.
What are the symptoms? There are somatic (body responses) that include nausea, headache, balance problems, and sensitivity to light and noise. There are neurobehavioral problems - drowsiness, fatigue, sleeping problems, and nervousness. There are cognative problems - feeling bogged down, difficulty concentrating and difficulty remembering.
How long do symptoms last? How long to wait before you can return to practice/play? Symptoms can last anywhere from a few days to several weeks. Sometimes symptoms don't appear till much later on. One study found "significant memory deficits 36 hrs post-injury in athletes symptom-free within 15 minutes (Lovell, et al., AJSM 2004)" This means that you don't necessarily develop symptoms immediately, so you can just go by how a player feels right after the hit. There are a couple tools that are helpful in determining when it is safe to return to play. One is a graduated step program to test the athlete's response to physical activity and if that activity brings on their symptoms.
What are the short and long-term dangers of concussions? The most dangerous in the short term is called "second impact syndrome" where the brain sustains a second concussion before it has healed from the first. In this scenario, the brain is unable to properly regulate blood flow and the mortality rate (rate of death in this condition) is 50%. The long-term consequences from concussions are dementia, depression, and chronic traumatic encephalopathy (see the links at the bottom for CTE info). This is from the Chris Henry link at the bottom - "According to a press release by one of the co-directors of CSTE, Dr. Robert Stern, a large study is underway involving a number of former NFL players to study their lives and then examine their brains following their death. To this end, more than 250 current and former athletes, including 60 retired NFL players, have agreed to donate their brain and spinal cord to the CSTE upon death (CSTE Press Release, 2010)."
The greatest impacts recorded in Dr Guskiewicz's research consistently are in special teams, mostly because the players are hitting at full speed. Linemen show a very high impact rate as well, and some have pushed the idea of eliminating the 3 point stance to avoid such high impact in the trenches.
There are many theories about how to change the game of football to reduce the incidence of concussions. Dr Guskiewicz has recommended to the NFL (and apparently they're finally willing to listen) to change or eliminate kickoffs completely as special teams has shown to produce the highest rated impact forces as the players have a running start. Another change is to fine and/or suspend players who "head hunt" or lead with their head. This is more of a long term culture change, and has been heavily criticized by some players who are known for producing "big hits."
There is still much research to be done and much to learn about the long-term consequences of concussions. Thankfully, many professional organizations like the NFL are finally taking some serious looks at how they can help reduce the chances for concussions. The hard work ahead is mainly in educating not just professional athletes, but college, high school, and junior high players and coaches on how to identify a concussion, the dangers, and how to safely bring athletes back to competition. Some states, like Iowa, have passed laws that require high school athletes to be released by a doctor or physical therapist before they can return to play.
Some will say, "Why don't we just give them skirts then." This isn't about "ruining the game". This is about protecting people from devastating long-term effects. Many of us can recall some of our beloved Hawks who had to quit football because of this. While football will always be a physical, even violent sport, there are changes that can be made so that we can not only have fun, but do our best to eliminate unnecessary dangers. This isn't about blown ligaments, this is in the most serious sense about life and death.
Here are some great links for more info:
The Center for the Study of Traumatic Encephalopathy - Center for the Study of Traumatic Encephalopathy Boston University
Dave Duerson, another sad statistic of CTE - http://www.nytimes.com/2011/05/03/sp...rson.html?_r=1
Bengals WR Chris Henry was found to have CTE after his sudden death, despite only being 26 years old - Chronic Traumatic Encephalopathy (CTE)
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