Concussion Management in Sports!

You would have to be living under a rock to have not seen the increased attention being paid to concussion and its management! And for good reason. With more data emerging regarding the potential long term damage sports related head knocks are having all over the word, including but not limited to the development of chronic traumatic encephalopathy (CTE).

CTE being a neurodegenerative disease linked to repeated blows to the head, with symptoms including cognitive impairment, depression, and other mental health problems (McKee et al. 2010, 2013, Guskiewicz et al. 2007). Probably something we would like to avoid if possible!

So, what is a concussion? Concussion is described as “A complex pathophysiological process affecting the brain, induced by biomechanical forces. It is characterised by a graded set of neurological symptoms and signs (these can include headache, confusion, decrease coordination, memory loss, nausea, vomiting, sleepiness and excessive fatigue) that typically arise quickly and resolve spontaneously over a varied timeframe.” The process of recovery can vary from person to person.

We don’t 100% understand what processes lead to a concussion, though it is thought to involve a physiological disturbance (eg. neurochemical, metabolic or gene expression changes) (Giza et al. 2001) rather than a structural injury to the brain (McCrory et al. 2012).

The benefits associated with participation in recreation and sports far out way the risks, but in the incident you may have received a knock to the head or successive concussion diagnoses management becomes important. Best practice management at Axis Performance is supported by clinical practice guidelines and recommendations, this includes:

  • Any player with a suspected or confirmed concussion is not to be returned to play (or training) on the day of their injury.
  • Best practice guidelines suggest that a player should not be allowed to return to competition until they have recovered completely from their concussive injury.
  • There exists no direct measure of recovery from brain disturbance, clinicians must rely on indirect measure, but all concussion rehab should include the following:
  • A period of cognitive and physical rest to facilitate recovery.
  • Cognitive rest will often involve minimising and re-exposing the athlete to cognitive loads such as schoolwork, video games, computer, or work. The use of alcohol, sedatives or recreational drugs can exacerbate symptoms following head trauma, delay recovery or mask deterioration and should also be avoided.
  • Monitoring post-concussion symptoms and signs to assess recovery (Axis clinicians use the SCAT5 concussion assessment tool)
  • The use of neuropsychological tests to estimate recovery of cognitive function (Once again done with the SCAT5 tool)
  • Graduated return to activity with monitoring for recurrence of symptoms.

The graded return to physical activity at Axis Performance will follow the below guideline as per McCrory, Meeuwisse & Aubrey et al. (2013).

Key take-aways:

  1. Concussion is an injury to be taken every seriously.
  2. Best practice management guidelines exist.
  3. Assessment completed by a trained health professional makes for clearer decision making around return to sport.
  4. A graded return to sport whilst closely monitoring symptoms is advised.
  5. If you or someone you know would like assistance with anything concussion related Axis Performance is the place for you.

 

References:

  1. McKee AC, Gavett BE, Stern RA, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 2010;69:918–29.
  2. McKee AC, Stein TD, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain 2013;136:43–64.
  3. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc 2007;39:903–09.
  4. Omalu BI, Bailes J, Hammers JL, Fitzsimmons RP. Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist. Am J Forensic Med Pathol 2010;31:130–32.
  5. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250–58.
  6. Giza CC, Hovda DA. The Neurometabolic Cascade of Concussion. J Athl Train 2001;36:228–35.