With a new school year starting, there continues to be a strong focus on sports-related concussion. As a family medicine physician with specialized training in sports medicine, I see many athletes with sports-related concussions in my office at Delphos Medical Associates. I work together with St. Rita’s athletic trainers to provide a team approach to the care of athletes with a concussion. We strive to provide excellent guideline-based concussion management to facilitate the safe return of athletes to school, life and sports.
The first step in the management of a concussion is recognizing that a concussion may have occurred. A concussion is a disturbance with how the brain works and is classified as a mild traumatic brain injury. It may be caused by a blow or bump to the head or a whiplash-type motion. Concussion symptoms most often resolve within days to weeks but may last months. An athlete does not have to be “knocked out” to have a concussion, and only about 10 percent of concussions have loss of consciousness.
Common symptoms of a concussion include headache, nausea, balance problems, vision changes, sensitivity to lights or noise, confusion, feeling foggy, not feeling “right” and sleep problems. Parents or coaches may notice and athlete appears dazed or confused, forgets plays, has an unsteady gait, answers questions slowly or has memory problems. When any of these signs or symptoms is present, an athlete should be removed from play until evaluated by an appropriate healthcare provider.
Initial management of a concussion involves removal from all physical activities. Also, an athlete that might have sustained a concussion should remain out of sports as sometimes symptoms develop a few hours after the injury. An athlete who sustains a concussion should never return to activity on that day. Initial treatment involves physical and mental rest. This means limiting the use of electronic devices such as texting, playing game on a phone, tablet use and computer use. Reading a book or doing intense homework may worsen symptoms as well. The goal of this rest is to improve symptoms. As a general rule, if symptoms worsen with doing a particular activity, then the concussed athlete probably should not be doing that activity. Also, driving is not recommended while an athlete is concussed.
The return to school and physical activities is a gradual process that occurs as an athlete’s symptoms improve and should be overseen by a physician or other healthcare provider. After an athlete is having minimal symptoms at rest, they will gradually increase their cognitive activities at school and at home until they have resumed normal cognitive activities. While symptoms are improving, we may recommend light physical activities such as walking or stationary bike which can help improve symptoms.
When an athlete is asymptomatic at rest and with cognitive activities, the athlete may take a computer-based neurocognitive test such as ImPACT. The test involves performing a variety of memory and cognitive tests and measuring performance as well as reaction time during these tasks.
The last step in the concussion protocol involves a progression of physical activities. This is a gradual increase in the intensity of physical activities, the addition of contact and the return to full practices and games. This return to play progression is commonly supervised by the athletic trainer to ensure there is not any return of symptoms with exertion. Concussion management involves a team approach to recognize, treat and manage concussions.
Dr. Jason Hageman is a family physician at Mercy Health- Delphos Medical Associates, located at 1800 E. Fifth St., Suite 1, Delphos, Ohio 45833. To schedule an appointment please call 419-692-5611.