Concussion Management Program helps local athletes

(Educational article printed in The Barrie Examiner on Thursday, January 19, 2017)

Concussions are a concern for many parents and athletes. Fortunately, help is available at a local sports medicine clinic.

“Concussion recognition and education are the emphasis of our Sports Medicine concussion program,” says Denyse Beaumont, Director of the Concussion Program at Sports Medicine. By raising awareness, players and parents understand the risks of returning to play too soon. Returning to play before fully recovering from a concussion may result in second impact syndrome, or further injury. Having a second concussion prior to fully healing from the first one, will have more severe effects and from which it may take much longer to recover.

Sports Medicine, which recently celebrated its 27th anniversary, has built its concussion program around educating trainers, coaches and parents. The major problem with concussions is that symptoms, meaning how someone feels, do not coincide with recovery. Most people feel better long before their brain has recovered to the point that they are actually safe to return to their sport. Unfortunately, there is no scan, MRI, or X-ray that can detect a concussion. This is where the baseline testing becomes a powerful tool, as well as having someone manage the return to play process. Dr. Rob Gabor, an emergency and family/sport physician states, “having this evidenced-based, medically developed, best practice program, provides the necessary structure and system to return athletes back to play through a safe, graduated approach with essential check points built into the process.”

A concussion is a neurologic injury that causes a temporary disturbance in brain cells, as a result of extreme acceleration or deceleration of the brain within the skull. The common misconception is that you must be hit in the head to suffer a concussion injury – this is not true! Because a concussion is the result of acceleration or deceleration of the brain, a concussion can happen with a significant blow to anywhere on the body, provided sufficient force is transmitted to the brain tissue.

The brain cell disturbance causes the brain cells to discharge uncontrollably which may cause any one, or more, of the following signs or symptoms:

  • Loss of consciousness (Not necessarily – over 90% of concussions DO NOT result in a loss of consciousness)
  • Headache
  • Pressure in the head
  • Neck pain
  • Nausea or vomiting
  • Dizziness
  • Blurred vision
  • Balance problems
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling slowed down
  • Feeling of “fogginess”
  • Not feeling right or feeling off
  • Difficulty concentrating
  • Difficulty remembering
  • Fatigue or low energy
  • Confusion
  • Drowsiness
  • Trouble falling asleep
  • More emotional
  • Irritability
  • Sadness
  • Nervous or anxious

If you or your child are experiencing ANY of the symptoms listed above following a significant hit or blow to the head or body, you should be highly suspicious that they are suffering from a concussion injury.

The massive discharging of brain cells will likely reduce in a very short period of time and the patient may even feel better after a few minutes to an hour after injury. Don’t be fooled by this improvement, as there is a second phase to a concussion known as “Spreading Depression”. The initial brain cell discharge creates an imbalance within the cells of the brain, that ultimately leads to an energy deficit as the cells frantically use up all of their energy stores to reset the normal balance. These energy stores will continue to decline over the next 3-7 days. Anyone who has been around someone who has suffered a recent concussion, or has had a concussion themselves, will attest to the fact that the injured person is extremely fatigued, irritable and emotional; similar to a tired and cranky child. This is because their energy levels are depleting. This is also why the first step in dealing with any concussion is always rest, which helps to conserve energy stores and potentially help with recovery.

The second phase of a concussion is actually the most dangerous. When someone is in this low energy state, another blow, even one of much lower magnitude, can cause another concussion. Because the energy levels of the brain are already severely depleted, another concussion can cause extreme energy depletion, which may cause permanent death of the involved brain cells, potentially causing permanent disability, or in some instances, death of the individual.

On the other hand, the research has shown that if the brain has fully recovered from an energy standpoint and the person receives another concussion, there is no evidence of an additive effect. This means that it may not be the number of concussions an individual suffers but rather the way each injury is managed that is the major determining factor for long-term problems due to concussions.

The majority of concussions will resolve within 3 weeks, however just because symptoms are gone does not mean that a person is fully recovered. This is where the benefits of functional baseline testing come in for at-risk sports and age groups. The use of ImPact computerized baseline testing alone has been proven to be unreliable, but having objective functional testing is strongly supported by several recent studies. In fact, the Ontario Neurotrauma Foundation Pediatric concussion guidelines recommend that baseline testing be considered for children engaged in high-risk sports. The NCAA Sports Medicine Handbook considers comprehensive pre-season baseline testing to be the best-practice for all athletes involved in high-risk sports and the Centres for Disease Control and Prevention also suggests that baseline tests be repeated annually to establish a valid comparison. Sports Medicine uses nine medically recognized standardized tests that provide objective measures that assist the clinical team in making return to play decisions. Two important check points in the process include a treadmill test before engaging in any practice, and an exertion test prior to participation in a contact sport. These are essential steps for athletes to safely return to play.

While it is true that during the early stages following injury, rest is still the best medicine, it seems as though that timeline seems to be getting shorter, with longer duration rest creating worse outcomes for patients. So if you have been resting for more than a week or two and you are still having significant symptoms, it’s time to get some treatment. There are various options for treatment that are highly individualized, depending on the individual’s specific symptoms and functional deficits. At Sports Medicine, a team of clinicians manage the Return to Play process, step by step. The 10 Step process includes education and communication with the trainer, teacher and physician. Sports Medicine has three physicians who specialize in sport injuries integrated into the patient care model.

Sports organizations are taking a proactive approach. The Barrie Colts AAA Hockey Association has made it mandatory for the bench staff to participate in the concussion education program. Tom Dart, the Barrie Colts’ Risk Manager states that, “it has made a significant difference in helping our trainers and coaches recognize concussion symptoms. Having a professional manage the player back to play safely, with a standardized medically approved approach improves the safety of our players.” Other organizations taking advantage of the program include the Oro Minor Hockey, Barrie Red Sox Association, Barrie Minor Hockey, Innisfil Minor Baseball and the Barrie Royals Basketball.

Barrie Colts Minor Midget goalie, Avery Bernardi, was involved in a hockey collision early in the season. He had concussion symptoms and was evaluated in the clinic. After receiving treatment, and following the 10 Step protocol he was managed, together with the clinic and team athletic therapist, back into practice and eventually game play. His father, Geoff noted “it was difficult to see him sitting on the sidelines, but the more I learned about concussions, and the care he was receiving at Sports Medicine, the more relieved I was that he was following the protocol, and managed by such a great team of professionals.” He has been fine since and playing regularly without any issues.

To be evaluated for a concussion injury, Sports Medicine is located at 480 Huronia Road, Barrie and can be reached by calling 705-734-3340.