Since the release of the movie Concussion starring Will Smith, some of the most frequent questions I am asked in my physical therapy practice are related to concussions.
As many of you saw in the movie, a concussion occurs as a result of the brain being physically jostled within the skull. This can cause swelling, bruising and trauma to brain tissue. Symptoms may include headache, problems with balance/coordination, concentration and memory.
MLB has made great strides to protect it's players and umpires from brain injury by implementing rules changes to reduce hits on a defense-less catcher, mandatory baseline neurological testing, new protocols for evaluating and clearing players for return to play and creation of a seven day disabled list.
It is very important that someone that has been concussed not be allowed to return to contact sport participation until these symptoms have resolved. If one returns to sport too soon they run a greater risk for a second concussion and additional damage to the brain. This can lead to permanent brain damage, long term disability or even death. Yes, this is scary stuff.
If concussion is suspected one should see a physician immediately to determine the severity and implement the proper treatment. Treatment for a mild to moderate concussion includes rest to allow swelling or contusion to reduce. This means rest from cognitive tasks, concentration and physical exertion. Aspirin free medication may also be prescribed as ibuprofen, Motrin and Advil may increase risk for further bleeding. Yes, physical therapy including vestibular rehab may be appropriate once a physician has deemed it safe to resume light/ moderate activity.
80-90% of concussions heal spontaneously within 7-10 days, however developing brains of children and adolescents may take longer. This is why Major League Baseball adopted the 7 day disabled list for players with concussion to prevent them from returning too early. This also takes the onus off the player feeling the pressure to return. He must fulfill the criteria in a series of neurological exams in order to be cleared for return to play.
The problem in youth sports is many coaches, parents and trainers don't have the experience or training to determine if in fact their athlete has been concussed and are allowed to resume participation risking further injury as I described above.
One quick and easy test for determination of concussion is the King-Devick test. There are over 50 peer reviewed studies supporting this objective visual screen as an excellent tool that can be administered by a lay person right on the field to assess whether an athlete has sub-optimal brain function and needs to be taken out of the game and sent to a physician immediately or allowed to return to play. Here is a link about the test from the Today Show. There's even a smart device app for it.
youtu.be/URjMCuRJrrE
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