By Robert Roddy MBA ATC LAT
In today’s athletic community, one of the most concerning injuries that an athlete can sustain is a traumatic head injury resulting in a concussion. Once an injury like this occurs, there are various steps that the athlete, athletic trainer, and sports medicine team must go through to return the athlete to athletics as well as to everyday activities. Recognizing the various signs and symptoms involved in a concussion is key in early detection.
Recognizing the Signs and Symptoms
When an athlete sustains a head injury and is suspected of having a concussion, the athletic trainer or team physicians will ask the athlete a series of questions to rule out which signs and symptoms the athlete is experiencing. Not every athlete will exhibit the same kind of signs or symptoms. Therefore, it is essential for medical personnel and athletic trainers to understand and identify the key signs and symptoms of a concussion. Signs and symptoms of concussions are separated into two categories, cognitive and somatic. Below is a list of the cognitive and somatic signs and symptoms of concussions.1
1. Cognitive
a. Confusion
b. Anterograde Amnesia
c. Retrograde Amnesia
d. Level of Consciousness
e. Any Disorientation
f. Inability to Focus
g. Delayed Verbal or Motor Responses
h. Slurred Speech or Incoherent Speech
i. Excessive Drowsiness
2. Somatic
a. Headache
b. Dizziness
c. Inability to Balance
d. Nausea
e. Photosensitivity
f. Sensitivity to Sound
The athletic trainer determines if the athlete is exhibiting any of theses signs or symptoms by administering a SCAT test, neuropsychological testing, cranial nerve testing, and BESS testing. Once a concussion is suspected by the athletic trainer, the athlete is then referred to a licensed healthcare professional. After the physician has confirmed that the athlete does have a concussion, the individual is recommended to be withheld from athletics until the signs and symptoms have resolved for 48-72 hours. Studies have suggested that the recovery period range is from 1-7 days for total cognitive resolution, and 3-7 days for total resolution.1
Return to Learn
Besides athletics restrictions, it is very common for physicians to suggest that individuals suspected of a concussion should be limited to cognitive stress in school and at home. During this time, the student athlete is advised to limit the amount of time they spend on their phone, watching tv, computer or laptop, reading, and long periods of strenuous concentration. School work should be limited to 30 minutes initially with a gradual increase of studying once the symptoms begin to resolve.1
Return to Play
Once the athlete has shown no signs or symptoms for 48-72 hours, the athletic trainer reevaluates the athlete with neuropsychological and vestibular/balance testing. The steps below should be progressed only when the student athlete can perform the steps while remaining asymptomatic.2
Step 1) Rest: Until Asymptomatic (at least 48 hrs.)
o No physical exertion/activities of daily living only
Step 2) Light Aerobic Exercises (HR: < 70% – 15-20 min)
o Light aerobic training/conditioning in a controlled setting Ex: stationary bike, walking, swimming
Step 3) Sport Specific Exertion (HR: <80% – 45 min)
o Submaximal conditioning/exercise that stresses the student athlete in a setting like the environment that they will participate in during practice or competition
Ex: running on field or court, body weight exercises, individual cardio/endurance drills
Step 4) Contact Training Exertion (HR: <90% -60 min)
o Sport specific exercises with equipment
Ex: resistance band training, functional training, position drills, sport specific movements
Step 5) Full Contact Practice
o Restore confidence and assess functional skills
Ex: athlete participates in monitored practice
If the athlete successfully completes the steps of the return to play protocol, the student athlete is required to be cleared by a licensed physician before they can completely return to full athletic participation and competition.
By Robert Roddy MBA ATC LAT
Robert Roddy is the head Athletic Trainer for MD Sports, Inc. As a former college athlete, Robert understands the concerns and demands that are involved with being a high performance athlete. He has treated, managed, and rehabbed athletes in the high school, collegiate, amateur, and general population level in South Florida for over 10 years. Robert brings a level of compassion and a quality of care to assist the athlete’s return to activities with a better quality of life.
References
1. Florida State University- Sports Medicine. Concussion and Mild Traumatic Brain Injury (mTBI) Management Protocol. https://www.ncaa.org/sites/default/files/2017-18CProto65_FloridaStateU_Protocol_20170803.pdf. Updated: July 5, 2017. Accessed March 13, 2018.
2. Florida Atlantic University- Sports Medicine. Concussion Management Plan. http://grfx.cstv.com/photos/schools/fau/genrel/auto_pdf/2015-
16/misc_non_event/2015ConcussionManagementPlan.pdf. Published April 29, 2015. Accessed March 13, 2018.