The Conclusion on Concussion

Embedded in our culture are many active pastimes. Some in particular, such as hockey, and soccer, encourage activity among men and women of all ages. Most casual play, unlike competitive leagues, is non-contact. But injury is always a possibility.

With the onset of winter the arenas are full of hockey players of all levels. Unfortunately injuries will be a constant companion for many.

Most bedevilling are head injuries. This is true for a number of reasons. Firstly, a definitive diagnosis, unlike a muscle or bone injury, is more difficult for the medical practitioner. Cognitive changes are less clear compared to muscle weakness or loss of range of movement at a joint. Often enough during the recovery period the player to all intents and purposes looks and feels healthy. As a result withholding a player from activity is more difficult – this is true
for the player himself or herself, as well as the coach or health care practitioner overseeing the player.

Persuasion is easier when pain or weakness prevents a player from skating. The symptoms associated with concussion are often easily masked by the player and thus the player appears seemingly fine.

Many of us, me included, recall having our “bell rung” or “getting dinged” while playing sport. The coaches back then knew almost nothing about player care, especially regarding head injury. Up to date research has revealed some interesting points. Most importantly we know that neglecting a concussion has serious consequences.

The player usually recognizes that they have sustained a concussion – they remember the knock and the brief disorientation. Loss of consciousness, if it occurs, will be obvious for all who are around. In fact, only 10% of concussions involve losing consciousness. The player may have difficulty completing physical tasks (balancing) and mental tasks (math sums, reporting the date) set to test their status. Often mental tasks are completed, but more slowly.

Regardless, the player will have to be removed from the game. Back a few years ago, medical thought considered the absence of symptoms to be the main indicator of whether a player was ready to return to play. No longer. He or she may feel fine, but they are still to leave play till after a medical examination.

Even though the player may feel fine, at the brain level there have been changes. Damage has occurred but performing mental tasks is usually possible – albeit via different brain pathways. It’s like having your usual walking route blocked by debris and the alternate is longer and bumpier – you get to your destination but less efficiently. The concussed player may “feel slower”.

He or she may complain of headaches, nausea, poor balance, fatigue, drowsiness, poor concentration, feeling “slow” and in the hours following, has sleep disturbances. Not all cases are the same and these concerns may vary in severity.

An initial concussion, if neglected and the player is allowed to continue, can have dire consequences. A concussed brain, even slightly so, is predisposed to a secondary concussion. Its resistance to concussion has been compromised. Result – yet further injury to an already precarious situation.

It is wise to be wise! If your child, you, or another player experiences a concussion, participation should cease. If the player loses consciousness it is a medical emergency and an ambulance must be called. If the injured person is conscious but symptoms deteriorate they must also seek urgent medical help.

During recovery the player must be as passive as possible. Jogging, cycling or any other strenuous activity must be avoided. Intense intellectual activity should be off limits as well. Studies have shown that stressing the body in any of these domains will actually inhibit the recovery process. The brain needs all the body’s resources to recover faster and properly. The brisk walk to clear the mind and that 2nd language class you were attending are on the back-burner for at least a few days if not longer. From a nutrition intake standpoint, alcohol must be avoided absolutely. Alcohol decreases the oxygen available to the brain, and brain recovery from injury requires an abundance of oxygen.

Concussions are a challenge in many ways. They occur to players of all ages and all levels of play. All may seem well with the concussed athlete, but neglect could have devastating results. Parents, coaches and players must all be mindful of concussions. Testosterone in the bleachers and win at all costs attitudes have no place in sport. We are dealing with flesh and blood and grey matter too. Be warned, be wise, and be aware.

By Jonathan Maister Bach. Social Science CAT(C) RMT SMT(C)
Jonathan is an Athletic Therapist, Massage Therapist and Sport Massage Therapist in the Markham area. He teaches Sport Massage and Sport Medicine courses across Canada and writes extensively on a variety of topics.

He may be contacted at: mrj.tor.can@sympatico.ca Tel 905 477 8900

References:
Athletic Therapy Today, pg 24, Journal dated March 2005. Pub. Human Kinetics P O Box 5076 Champaign, IL, 61825-5076

Training and Conditioning, pg 31, Journal dated September 2010. T & C, P O Box 4806 Ithaca, NY, 14852-4806

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