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Column:Concussions and moving beyond fear

Jeff Clark • Mar 30, 2017 at 12:38 AM

Concussion awareness and treatment has improved by leaps and bounds in the last decade. We have moved beyond the old thinking of, “It’s no big deal. I just got my bell rung,” to prioritizing early identification and effective management. Research does show changes to the brain from repeated blows to the head, highlighted especially in professional football players. Some of these early studies that showed elevated suicide rates and links to long-term brain disorders may have been flawed. Current quality research shows suicide rates are actually a little lower in former NFL players vs. the general population.

It is important to keep in mind that an estimated 80-90 percent of concussion symptoms resolve within seven to 10 days. Current research and media reports have no doubt elevated our fear of concussions. A 2015 Harris poll reported that 1 in 4 parents no longer allow their children to participate in certain contact sports and 41 percent of respondents considered a concussion a “living nightmare.” We must keep in mind that a concussion is a very treatable health condition for the vast majority of people and that excessive fear of injury could negatively contribute to the obesity epidemic in America. As of 2012, one-third of American children and adolescents were overweight or obese. The overall benefit of an active life style is well known and for many of us that starts with youth sports participation.

As our understanding of concussions has improved so have effective treatment strategies. Rest in the early, symptomatic stages after concussion is very important. However, simply recommending an athlete rest until they feel ready to return to school or sport is bad advice. Current guidelines promote “return to school/play progressions.” According to Dr. Brett Martin, a sports medicine physician at North Ottawa Medical Group “a step by step plan to get you back in school is just as important as getting you back to play”. These approaches involve waiting until initial symptoms resolve, then following a staged and patient-specific return to pre-injury level, while monitoring for a return of symptoms. A multi-disciplinary team (ie: sports medicine physician, athletic trainer and physical therapist) is best equipped to provide this progression. Concussions involve changes to multiple body systems including the eyes, neck, inner ear, balance, behavior and mood. Specific treatment to each of the body systems involved is important. The physician, as the team leader, can confirm the initial diagnosis and clear the athlete to start a return to sport progression and ultimately return to sport. The Michigan High School Athletic Association now requires that a physician clear athletes to return to sport.

Baseline testing of physical and brain function, such as the ImPACT test, is available to the general public at www.impacttest.com, is frequently performed by an athletic trainer, and is an important pre-season step for athletes. The results of this type of test can be an important factor in diagnosis and return to sport timelines after concussion.

Concussion is a treatable health condition. As attention to concussions increases in the US, we must not exaggerate our fears, but rather emphasize the benefit of early and effective care. A multi-disciplinary team approach, led by a qualified medical provider, is strongly recommended.

— By Jeff Clark PT, OCS, FAAOMPT

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