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Concussion Awareness-Treatment and Return to Play

The next steps are crucial
Once your athlete is a diagnosed by a physician as having a concussion,what are the next steps? Hopefully, your physician is experienced with sports related concussions and will give you guidelines as to what you can do and what you cannot do.“Often physical and cognitive rest (yes, may mean missing school) is prescribed for the first few boring days with no computers,TV,cell phones,texting,music,DVDs, reading or other stressors on the healing brain” as stated by Dr. Chris Koutures, a 2008 USA Olympic Team Physician.
Let your brain rest
Immediately after receiving a concussion, the brain needs time to heal and anything that might increase a symptom or cause a new symptom needs to be avoided. The goal of the initial rest period is to have the brain begin to heal and the symptoms to subside. Many times the symptoms will cease in the first few hours or days, but every concussion is different and how they will heal is hard to predict. It is key throughout the recovery to stay in close contact with your Physician as well as other sports medicine professionals such as Athletic Trainers, Physical Therapists and Strength Coaches who will be involved in the athlete’s return.
A systematic approach to return to play
Once the concussion symptoms have disappeared, often your physician will have the athlete begin with cognitive activity such as reading, watching TV and going to school. These cognitive activities may or may not cause the symptoms to return and need to be relayed to your physician prior to advancing to physical activity.The athlete may notice they can only handle cognitive activity for a certain amount of time before feeling symptoms.At this point, they may need to limit the time of activity.This time may be increased as the athlete heals.Now that the athlete is symptom free at rest and with cognitive activity, it may be time to return to physical activity.This stage in the process must be cleared by a physician. “Returning an athlete to participation should follow a progression that begins once the athlete is completely symptom free. All signs and symptoms should be evaluated using a graded symptom scale or checklist when performing follow-up assessments and should be evaluated both at rest and after exertional maneuvers” as stated in the National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion. Many times the progression will begin with light aerobic activity such as jogging or riding a stationary bike. As the athlete is able to handle the workload without symptoms, the time duration and intensity may be increased. A next step may include agility drills as well as balance exercises with a progression to more intense jumping and sprinting drills.
Progress slowly but surely
As the rehab process moves on, the athlete may get involved with sport specific exercises such as kicking drills and running drills on the pitch. If there are no symptoms during or following activity,many physicians will allow the athlete to return to a non-contact practice and progress to a contact practice.Once the athlete has handled all of the progressions without any issues, it is time for the physician to decide whether or not the athlete is ready to fully return. Often times a neuropsycholgical and postural stability test will be administered such as the Impact Test or the SCAT2 assessment to further evaluate the injury. The test scores will be compared to the athlete’s baseline test if they were tested prior to the injury or to normative data. This information will assist the physician in making his or her decision regarding safe return to play.This process may seem longer than it really is, but is imperative for a safe return. As Dr. Chris Koutures states “Incomplete healing of a first head injury makes the athlete more prone to second, often more severe head injury- with death as an uncommon but possible outcome. Some athletes may be diagnosed with post-concussive syndrome- symptoms that last for weeks to months and not only affect sport participation, but also school and personal relationships.” In the wake of the recent NFL settlement regarding concussions and ongoing legal battles in other professional sports, everyone needs to be more educated in the signs, symptoms and management of concussions to secure a more safe and positive outcome.

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