The 4 Pillars of MERGE Performance Institute
BLOG (#MERGEeducation) Because human performance is our passion, we want to help you be your absolute best. And because we draw from a wealth of knowledge and experience as athletes, coaches, and professionals in the sports performance and fitness world, you'll find articles on topics ranging from nutrition to footwear, running mechanics, and more. NOVEMBER 2018 "Friday Night Lights" Concussions are no joke! by Jeremy Clausen, MS, ATC, LAT, CSCS When you think Fall, what do you think of? The cool Fall air? The changing of the leaves? A pumpkin patch with your family or significant other? How about the screaming of fans at a Friday night football game after a big play or a big hit? Personally, those are just a few of the reasons that Fall is my favorite season of the year. However, as an Athletic Trainer, for the athletes under my care the events that transpire under those Friday night lights can be life changing and in rare instances, life threatening.Amongst the life altering events that Certified Athletic Trainers care for under those Friday night lights is a topic that has garnered significant national publicity and attention over the last decade due to an increased number of these injuries happening and being diagnosed in the public eye via high profile sporting events, concussions. Whether it is a Friday night high school football game, a Friday night 5th grade basketball practice, or a Friday night junior high dance recital, concussions happen and must be dealt with appropriately. To do so, it is important to understand that when a medical professional utilizes the term “concussion,” they are referring to a traumatic brain injury. With more and more concussions being diagnosed, these injuries are being pressed into the public eye on a daily basis. The resulting effects have been numerous. One such effect has been the increased number of questions marks surrounding concussions, from diagnosis to treatment to return to sports/work/education. Thankfully, the enormous number of question marks surrounding the topic have been met by an equally enormous amount of research to help sports medicine professionals better understand what they are dealing with when treating an individual suffering from a concussion. Amongst the pioneers into, and advocates for, concussion research, few individuals have played as significant a role as Chris Nowinski, Ph.D. A former collegiate football player and WWE wrestler, Chris now devotes his life to helping achieve a better understanding of concussions, both how to treat them and how to prevent them, and to the secondary conditions associated with concussions, such as Chronic Traumatic Encephalopathy (CTE) and Second Impact Syndrome. Individuals such as Chris are a driving factor for one of the other significant effects resulting from increased concussion awareness, and that is concussion prevention. Concussion prevention can be done through a multitude of means, dependent on the sport, position, or activity. Within the sport of football, multiple initiatives have been implemented within the past few years to try and make the sport safer for its participants, from the youth level all the way to the professional level. In youth football, the “Heads Up” initiative has been developed to encourage youth athletes to see what they are tackling and always tackle with their heads up, while college and professional football has also seen their fair share of rule changes to prevent the significant helmet contacts commonly associated with “targeting” penalties and with the high velocity collisions seen on kickoffs. Another example of a sport implementing regulations to make the sport safer is collegiate Cheer and Stunting, which in recent years has begun to regulate the types of stunts that flyers can perform, due to the dangerous nature of some of the stunts. However, as with all injuries, no matter how much work is done on the prevention side of things, concussions will continue to occur. Therefore, it is important to be able to recognize some of the signs and symptoms commonly associated with a concussion and what should be done if a concussion is suspected. First, it is crucial to understand how a concussion happens. A concussion can be a result of the result of one direct blow to the head, due to multiple blows to the head, due to a whiplash mechanism at the neck, or due to a significant and forceful fall onto the pelvis or hips. The reason that each of these mechanisms can result in a concussion is due to the fact that a concussive event is not just due to a blow to the head, but rather it is due to the resulting impact of the brain contacting the inside of the skull due to the movement of the brain inside of the skull produced via the direct blow. The impact of the brain on the skull results in bruising and swelling on/in the brain over the area which contacted the skull. Based on which area of the brain contacts the skull, an individual will show a variety of signs and symptoms associated with a concussion, including but not limited to: headache, nausea, blurred vision, sensitivity to light, sensitivity to noise, dizziness, personality or mood disturbances, balance disturbances, inability to concentrate, irritability, sadness, ringing in the ears, disorientation, cognitive dysfunction, and motor coordination dysfunction. If an individual is suspected of having sustained a concussion, the individual should be immediately removed from participation in sporting events/activities and discontinue physical activity until evaluated by an appropriate medical professional. If the individual suspected of sustaining a concussion is an athlete, and an athletic trainer is available, a concussion evaluation can be performed immediately. If the individual is not an athlete, or an athletic trainer is not available, the individual should be evaluated by a physician as soon as possible, likely at the nearest Emergency Department. Regardless of whether the individual is a professional athlete, a weekend warrior, or a 5-year-old gymnast, the individual should never return to activity the same day as a suspected concussion due to risk of further injury, such as Second Impact Syndrome. After the diagnosis of a concussion has been made, careful steps should be taken to accommodate the symptoms that the individual presents with. While deciding what accommodations should be made, it is important to remember that no two concussions are the same, which means that no two concussions will present with the exact same symptoms, with the exact same severity, over the exact same timeline. Examples of these accommodations include wearing sunglasses, both inside and outside, for an individual presenting with light sensitivity, decreasing screen time (televisions, computers, phones, etc.) to avoid strain on the eyes and headaches, and even a doctor note allowing for time off of work when deemed appropriate by a physician. Importantly, old wife’s tales such as locking an individual in a dark room and waking an individual up every hour have been proven to be unnecessary and unwarranted. However, while an individual is still symptomatic, the individual should avoid exercise and other physical activity, unless otherwise instructed by their physician or athletic trainer and limit mental exertion according to symptom severity.Upon the cessation of symptoms, there should be a gradual return to play, return to work, or return to learn protocol that is specific and documented to ensure that the individual can resume normal activities without having symptoms return. These return to activity protocols are in place to safely and gradually increase the stimulation of the brain with the final phase being a full return to activity. It is important to stress the brain through increased cognitive function and through increased physical activity resulting in increased blood flow to the brain. During these protocols, if an individual presents with symptoms at any time, they must wait until asymptomatic and then restart the protocol at the step prior to when redeveloping symptoms. Depending on the severity of the concussion, the evaluating physician may want to see the individual again prior to providing them with clearance back to full activity, whether that is work, learning, or athletics.Regardless of the severity of the concussion, it is important to remember that a concussion is a traumatic brain injury and can alter an individual’s life. While there are a multitude of signs and symptoms that can be present with a concussion, vomiting and loss of consciousness are not amongst those symptoms. If either of these two symptoms are present throughout the evaluation process of a suspected concussion, it is important to recognize that they represent a potential life-threatening emergency, a brain bleed, and necessitate an immediate trip to the nearest emergency room.Currently there is no full proof method for preventing concussions, in fact, there may never be. Even in sports that utilize protective equipment such as helmets, the helmets are in place only to prevent skull fractures, as a helmet cannot and will not prevent the movement of the brain inside the skull, which results in a concussion. Furthermore, there is not diagnostic test that is 100% accurate and diagnostic imaging is only utilized to rule out more serious conditions such as a brain bleed or skull fracture. Therefore, the key item in the concussion discussion becomes education. Education on concussion prevention, what to look for as far as signs and symptoms of a concussion, and how to properly care for a concussed individual.If you would like more information on concussions, I would encourage you to reach out to your primary care physician or a local athletic trainer or sports medicine professional. Furthermore, the 5th International Conference on Concussion was held in 2016 and provides a clear and concise position state on these potentially life altering injuries. Lastly, follow individuals such as Chris Nowinski on social media to get a better understanding of what the experts in the field of concussion research are currently looking into, both for the present and for the future.