~by Dr. Philip Van De Griend
With Fall, comes concussions
Fall is one of my favorite times of year: cooler weather, the leaves change their color…and football starts! However, the hard hits of football also bring concussions. The definition of a concussion has changed over the past several years. The current definition of a concussion is a complex pathophysiologic process affecting the brain caused by a head injury
. We now know that you do not need to have a loss of consciousness to have a concussion. You simply need a head injury and any neurologic symptoms (see table below). Also, concussions are no longer graded as mild, moderate, or severe. You either have a concussion or you don’t. Period.
Diagnosis and Symptoms:
A concussion is a clinical diagnosis based on the patient’s injury mechanism and symptoms. They need to have some type of head injury and at least one of these symptoms:
Headache, Light Sensitivity, Irritability, “Pressure in Head,” Noise Sensitivity, Sadness, Neck Pain, Numbness/Tingling, Feeling More Emotional, Nausea, Dizziness, Nervousness, Vomiting, Feeling Mentally Foggy, Drowsiness, Fatigue, Concentration Problems, Sleeping More Than Usual, Visual Problems/Blurry Vision, Memory Problems, Sleeping Less than Usual, Balance Problems, Feeling Slowed Down, Trouble Falling Asleep
Treatment and return to play:
The best treatment for a concussion is time and rest; both physical and mental rest. Most concussions (about 80-90%) usually resolve within 7-10 days, although children and adolescents can take a little longer (14 days on average). Complete rest is encouraged until the symptoms have completely resolved in order to prevent a prolonged recovery. We also use some adjunctive treatments to give the brain energy to heal and to reduce inflammation. Fish oil (ie. Omega 3 Fatty Acids) is a supplement that theoretically reduces inflammation in the brain. The brain likes to use water and carbohydrates as fuel when recovering, so eating lots of carbohydrates and drinking lots of water help the brain recover as well. A person should avoid bright lights, visually stimulating materials, or loud noises when recovering from a concussion. These things stimulate the brain too much and usually cause worsening of symptoms. Specifically, key things to avoid are computer screens, movies with a lot of visual stimulation (eg. action movies with explosions or fast moving cars), and texting on your phone. Following these treatments hopefully prevents a “Post-Concussion Syndrome”, which is a prolonged concussion (usually longer than 3 weeks).
Remember, a concussion is an injury to your brain. You need to allow your brain to rest when it is injured just like you shouldn’t run when you injure your knee. Worse, if you return to sports before your concussion has resolved, you are at great risk of post-concussion syndrome (which have even been known to last for a few years), and you are at much greater risk of suffering a second concussion much easier than the first one. Most importantly, an athlete should NEVER return to play the same day that they suffered the concussion. This puts them at risk for “Second Impact Syndrome” which is often fatal. For this reason, there is a 6 day return to play protocol
that an athlete needs to go through with a licensed healthcare provider ONLY AFTER his/her symptoms have been completely resolved for 24 hours. The athlete then needs written clearance for participation, according to Iowa law.
Remember, following the tenant of rest and seeking care with your physician are important for concussion recovery and often results in faster return to activity. Make sure to help your kids, friends, or student athletes have fun playing sports, but also help them to stay safe and ensure a healthy and successful brain for whatever their future may hold.