Back to Basics: Current Concussion Management

9 Jul

What follows below are recommendations that have been on this blog for many years.  I came up with them when it started in 2010 and not much has happened to change what was written.  In fact, more and more these ideas have been accepted, showing that it was ahead of its time in 2010.

AS ALWAYS: PLEASE CONSULT A MEDICAL PROFESSIONAL FOR A CONCUSSION, USING THIS BLOG ALONE FOR TREATMENT OF A BRAIN INJURY IS NOT RECOMMENDED.

We can discuss rehabilitation from a concussion at a later time, but the theory of this being a spontaneous and passive recovery for a vast majority of incidences continues.  It has been my experience that the “less is more approach” is best with concussions, initially.  Being, that after injury the less you do to stimulate the brain and rattle the brain the better and faster the outcomes will be.  When the injury lingers on beyond 10-14 days (usually due to too much activity in the initial phases) that is where rehab and a more dynamic approach to recovery is needed.

Please enjoy and remember that back in 2010 this was not mainstream nor widely accepted.  I hope that four years later this is commonplace.

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Sport-Related Concussion, Don and Flo Brady (NASP Communique)

INITIAL STEPS

After an initial concussion the individual should subscribe to REST, not just physical rest, but COMPLETE and UTTER rest.

  • NO TV
  • NO Texting
  • NO Computers
  • NO Radio
  • NO Bright Lights
  • NO Loud Noises
  • NO Reading

COMPLETE brain rest, in other words, SLEEP!  This should be adhered to for at least 24 hours or when the medical professional that you seek (and you should) tells you otherwise.

SCHOOL AGED INDIVIDUALS

Rest should be continued until all signs and symptoms have resolved.  Rest in this demographic should and would include exclusion from school.  When trying to learn the brain is working, thus not resting.  Even if the kid went to school the bright lights, the loud noises and the exercise the brain needs to just navigate the hallways is enough to impede progress in resolving this injury.  As a reminder, it may be good to take the cell phone, computer and video game systems from the kids.  They should return to school when all signs and symptoms have resolved.

RETURN TO ACTIVITY (including Physical Education)

Current graded return to play guidelines for athletes that have sustained a concussion.  This particular model was adapted from the 3rd International Conference on Concussions held in Zürich in 2008, and I have since modified adding one step.

  1. No activity, only complete rest, proceed to step two only when symptoms are gone.
  2. Return to school/academics (1/2 day at first), again no moving on until a full day of school can be completed.
  3. Light aerobic exercise such as walking or stationary cycling. Monitor for symptoms and signs. No resistance training or weight lifting.
  4. Sport – specific activities and training (eg. skating in hockey). No contact or risk of contact.
  5. Drills without body contact. May add light resistance training and then progress to heavy weights. The time needed to progress from non-contact to contact exercise will vary with the severity of the concussion and player.
  6. Begin drills with body contact.
  7. Game play.

As stated above each step should be only attempted if there is NO signs or symptoms as they relate to the concussion.

Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms – ONF

Consensus Statement on Concussions in Sport from Zurich, 2012, 4th International Conference on Concussion in Sport

It is also important to realize that a concussion or head injury, in general, will not resolve in a typical linear fashion.  Meaning that “on day one you have this and by day 7 you should be here,” as is common with other general orthopedic injuries.

The head is mysterious and responds differently for each individual person.  Set-backs will be common and should be expected.  When they do occur you should regress to the previous step in this process and begin again.

The general rule of thumb is 24 hours at each phase.

Be mindful and remember that if you suspect a head injury/concussion that you should consult a medical professional, preferably one that has experience with concussions and return-to-play.

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One Response to “Back to Basics: Current Concussion Management”

  1. Jodi Murphy July 17, 2014 at 11:43 #

    No two players are going to recover at the same time or in the same way. Someone might have looked like they only suffered a light “ding” and be out of commission for months. Meanwhile someone who got hit super hard might be feeling better in just a few days. The key is to not push a player too hard too fast.

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