Transcription:
Concussions: Prevention, Symptoms, When to Return to the Game

Melanie Cole (Host): Concussion has become a hot topic in the media and in medicine. It’s a common injury that’s likely underreported by pediatric add adolescent athletes. My guest today is Rachel Hall. She’s an athletic trainer at Bryan Health. Welcome to the show, Rachel. So first, what is a concussion?

Rachel Hall (Guest): A concussion is a brain injury that affects the way the brain works. On a deep level, it’s actually a chemical storm, so I relate it to parents as if you think of a snow globe. When you shake the snow globe, there’s snowflakes flying everywhere, and with no disruption, it settles right back down to how it started. Your brain’s the same way. If you get hit in your head, or in your body, then chemicals fly everywhere. If you let it rest and manage it properly, the brain actually recovers, and there’s no long-term damage. That’s usually my easiest way to explain it to parents, is it is a brain injury, but you’ve got to think about it from a chemical level as well.

Melanie: So when are they most likely to occur?

Rachel: Most likely they’re going to occur during physical activity. For me -- I’m an athletic trainer, most of the injuries I’ll see in regards to concussion would during an athletic event either with a blow to the head or the body. They can occur, though, just with general athletics, or in general, kids being kids, when they fall, fall off their bike, fall out of the tree, those sort of things. You just want to keep an eye out, so any time a kid or an athlete gets hit in the head, a concussion should be something that crosses your mind.

Melanie: So then, let’s talk about symptoms because that is one of the most important ways to recognize it and also, Rachel, mention whether or not some of these symptoms should be spotted by parents after play, the coaches, and/or even other athletes out on the field.

Rachel: Absolutely, most symptoms are pretty general. They’ll describe things like a headache; they’ll look confused, difficulty remembering or paying attention, everything from balance problems to dizziness, feeling sluggish or groggy, but something parents should look out for is just personality changes. Do they seem more irritable or more emotional, maybe just generally seem down or not themselves? Sometimes they’ll go as far as do they feel nauseous? Are they actually vomiting? Are they trying to hide from light or noise, double or blurred vision? And then from a coaches standpoint, too, looking at is there a slowed reaction time, are they having problems remembering plays, their decision making, or maybe they’re just not processing – those are things that both coaches and parents can look out for, and teammates are great, too. If someone’s just not acting normal, that’s a red flag of something that you need to bring to your coach’s or a parent’s attention.

Melanie: Do we think that parents and coaches, and maybe even athletes have a misguided opinion that maybe their equipment is going to protect them from a concussion? Is the equipment good enough to help?

Rachel: The prevention part has been one of the hottest topics right now. The thing I need to stress is there is nothing that’s going to prevent a concussion. Nothing is concussion proof. They need to understand that there’s a lot of aftermarket add-ons in football. There’s equipment you can add on top of your helmet. There’s many different programs -- in soccer, headbands -- none of these are actually going to prevent – they may reduce the impact, but again, think of yourself – if you padded and bubble wrapped your car, and you hit a tree, your car will be fine, but you’re still going to move on the inside. That’s the important analogy to use is your brain is still going to move. We give a false sense of security when we talk about these preventative addons. However, what science has shown is things like a good mouth guard, strength, and conditioning, especially of the neck muscles, and even proper technique, really stressing that in our younger kids these days. Those are the best tools to help prevent a concussion.

Melanie: If one is recognized, is this an emergent situation? What is the treatment? What is a parent or a coach supposed to do?

Rachel: Concussions are such a broad spectrum, and that’s another hard thing to understand is no concussion is the same. You might have a more mild form where an athlete describes, “I have a headache. I just don’t feel well,” and that’s something that a parent can monitor on their own. However, there are very significant and very dangerous concussions out there. If they’re having a hard time speaking, hard time staying awake, if they can have issues walking, those are very emergent situations that they need to get to the ER right away. If you’re lucky enough to have an athletic trainer or a medical healthcare provider on site, always check in with them. Here at Bryan, we try to stress with our parents it’s never a mistake to see your doctor or to bring a question up to your athletic trainer. That’s exactly what we’re there for, to help decide is this something that we can manage at home or something that we need to take to the next level and go to the hospital for?

Melanie: At home, should the child be kept quiet? What about things like Motrin if they have a headache? Could that be contraindicated?

Rachel: That’s a great question, and I actually had a parent brought that up to me last night. A few things that we need to stress for home care is more of the cognitive recovery, so avoiding things like television, video games, their cell phones, all things that are hard to take away from a teenager are very important to their recovery. The more you can keep their brain at rest – sleep is one of the greatest tools that we have. Get a good night’s sleep, take a few naps if you need, make sure they’re hydrated, getting good meals in addition to just staying low, calm, not doing anything too crazy, those are the best ways to recover. When it comes to actually giving your kids medications, the thing that I like to let them know is Motrin, ibuprofen, Aleve, all these anti-inflammatories, which can be great for other injuries can actually make concussions worse. They do have a little bit of a blood thinning property to them, so the most physicians will recommend straight Tylenol. That will help with the pain of a headache or some other issues, but unless you’re consulted or told directly by a physician, try to avoid those anti-inflammatories.

Melanie: And what about returning to play? That’s something all the athletes want to know and are we still saying, “When in doubt, sit it out?” When do they get to go back to play after a concussion?

Rachel: Return to play and return to learn are actually both Nebraska concussion legislation. That’s a very important thing to know is there is a gradual return to play where they increase their activity over a four-to-five-day span before getting cleared by a medical health care professional to return. That’s one of those old time myths, well if they’re symptom-free they can go back the next day, or I even hear some of the older – from five to 10 years ago – well, just wait a week and then they’re fine. It needs to be a graduated return to play under the guidance of a medical professional trained in concussions. Same thing with Return to Learn, you want to slowly introduce them back into their school system, back into the screen time so that we’re making sure that we’re not making anything worse or having any relapses.

Melanie: So then, wrap it up for us, Rachel, with your best advice about possibly preventing concussion, but more importantly recognizing those symptoms on the field and off, so that we know what we’re looking for and we can help our student-athletes.

Rachel: The best general thing is to keep an eye on your players. When something doesn’t seem right, or even if someone makes an off-handed comment about, “Wow, that hit hurts. I don’t feel good. Man, my head’s not feeling good.” Those are the general things that kids will say to you. Keep in mind they’re competitive. They want to be out there. They want to be doing things, so they’ll try and mask things, but you have to ask those questions. Don’t just accept the, “I’m okay, it’s fine,” answers. You need to look – see if something’s wrong and when in doubt, do pull them because it’s better to lose one day or one game than a week or longer. Concussions do have long-term effects and lasting effects. One of the hardest things to see as a medical health care professional is a young athlete who’s had so many mismanaged concussions or things pushed to the side that they’re no longer able to do the things that they get pure joy out of. Make sure you’re asking those questions, you’re recognizing those symptoms and if you have any questions, ask a medical provider. They’re more than willing to answer those questions to make sure that the health of the kid is the number one priority out there.

Melanie: Thank you, so much, for being with us today, Rachel, that’s great information. You’re listening to Bryan Health Radio, and for more information about healthy living, you can go to bryanhealth.org, that’s bryanhealth.org. This is Melanie Cole. Thanks, so much, for listening.