Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're learning to recognize concussion on the field and off. Joining me is Grant Ridder. He's an athletic trainer with Bryan Health.

Grant, thank you so much for being with us today. I'd like you to start by kind of defining for the listeners what a concussion is and when are they most likely to occur? What sports or activities are more at risk for concussion to happen?

Grant Ridder: Yes. Concussion, it can be more of a mild traumatic brain injury caused by a bump, blow, or even a jolt to the head. Sometimes it can even be a hit to the body as well that causes that injury. But medically, this is where they call it a neurometabolic disruption. The brain's chemical balance kind of gets all thrown off and, suddenly, it needs more energy to repair itself. But at the same time, it kind of struggles to produce that energy efficiently. So, all the neurons firing in the brain, when it gets jolted, they kind of get all scattered around, and that's what causes a concussion.

And as far as sports and activities, they can happen anywhere, anytime. Me, I'm working as an high school athletic trainer. So, a lot of times, I see them in football, I see them in cheerleading when they're stunting. Anything can cause a concussion. From falling off a bike, falling off a tree, you can see them anywhere.

Melanie Cole, MS: Well, when we think of sports grants, certain sports lend themselves a little bit better to concussion. As you said, football, cheerleading, even sports like soccer. This can happen. Now. There's equipment. Obviously, we have equipment. Baseball players wear the helmets, and football players. Do we think that parents and coaches and even athletes have an opinion about the equipment that maybe it isn't quite as protective as we think? If you are wearing a helmet in football, can you still get a concussion? Does the equipment protect our children?

Grant Ridder: Oh, for sure. Yes, wearing a helmet may limit, but you can for sure get a concussion. With almost any equipment, there's no equipment out there right now that can really completely prevent a concussion. I know guardian caps for football are a big thing, which is that extra padding on the outside of the helmet. That as well does not really limit any type of concussions. There are things like mouth guards and, proper technique that can help limit concussions. But otherwise, I think there is a misunderstanding that all this type of equipment can limit an athlete from getting a concussion on the field.

Melanie Cole, MS: Grant, speak about the importance of having a thorough concussion evaluation. Are you doing that with your young athletes? Speak about the impact test, baseline screening. And is this a good evaluation for our youth sports?

Grant Ridder: We are doing baseline testing before every season for my athletes. I think it is a good baseline because most concussions, they are invisible injuries. They're sometimes hard to see, hard to diagnose unless those symptoms are very obvious. Most of the time when evaluating a concussion, you're going based off symptoms and what they report to you. They do have testing of the eye tracking and everything, but it is good to have a baseline test where you can then go back to and look at. So, it kind of gives you numbers and another source to help identify a concussion. So, I do agree and I do think that baseline testing is a good resource for all of us.

Melanie Cole, MS: Yeah, that's an important point. And so, now, let's talk about concussion themselves. What are we looking for? Whether we're a coach or a parent on the sideline or a trainer such as yourself, standing there on the sides, what are we looking for symptom-wise? Because kids don't always recognize out there, and we do want to look to the buddy system so that our athletes are watching out for each other. But what is it? What are some of those red flags?

Grant Ridder: Yes, there are a wide range of symptoms that can happen with concussions, and everyone reacts differently to a concussion as well. I'll just name off some of them real quick, being headache or feeling pressure in the head; dizziness, which can cause trouble with balance. There's nausea, vomiting, sensitivity to light and or noise, feeling confused. Some people will just report they feel foggy or they don't just feel right. Trouble concentrating, tired, sleep disturbances, and even mood changes like irritability, sadness, or anxiety. Those are some of the very common ones.

When getting a concussion, you don't always get every single one. Sometimes they're scattered around. And like I said, everyone has different symptoms and different levels of it with a concussion. When it comes to looking out for coaches and other athletes looking out for each other, one of the main ones are mood changes that they can look at. That being sadness, irritability, anxiety. They know that athlete pretty well. They know their moods. So if that's a big change, that could be a red flag as well as forgetting plays on the field, throwing up, sensitivity to light, or like I said, just they don't know where they are. They're kind of just roaming around, not all the way there. Those are some red flags where coaches and other athletes and people can all look for when trying to diagnose or look for a concussion.

Melanie Cole, MS: So then, the big question then, what do you do? Is this an emergent situation? Is this a hospital visit? Is this a visit with the pediatrician or the child's primary care provider? Is this something-- well, I mean, and even for adults, is this an emergent situation? What do we do if we suspect concussion?

Grant Ridder: . Yes. If we suspect a concussion in one of our athletes, best thing would be pull them off the field or any sporting activity, pull them out right away, get them to a healthcare provider, whether that is to the hospital or if you are lucky enough to have an athletic trainer, get them to one of them who are qualified to diagnose and evaluate a concussion. That would be the first step is recognizing and pulling them out to be able to get looked at by a healthcare provider.

Melanie Cole, MS: Yeah, that's important. So then for the parents, what are we doing with our athlete at home? It used to be they had to stay in the dark rooms and no electronics and back to school. All of these things used to be we weren't quite sure. So, what are we doing now?

Grant Ridder: At home with a mild concussion, the best thing would be to monitor and keep monitoring because symptoms can get better or worse within hours or even days after the initial injury. So, close monitoring for the next couple days after the initial injury is very key. At home, I still like to do the dark room, the staying off the screens or watching shows or long sessions of reading, stuff like that. Anything that will create the symptoms to get worse, we want to stay away from. So, that's a lot of cognitive rest, anything like that, just to give your brain a break. Sleep is great. Nutrition and hydration is all great as well. It also comes with physical rest. Anything that could lead them to get hit in the head again, we want to steer away from. So, physical and cognitive rest at home is very important with that.

Melanie Cole, MS: Big issue, Grant, is return to play with coaches, the parents, the athletes themselves. We know that our athletes, when dedicated to a particular sport, they do not want to miss. But concussion, when in doubt, sit it out. So, how do you work with the parents who are like, "They've got to get back on the field, or they might lose their position" or whatever it is. How do you work with the parents, the coaches, and the athletes to make sure that before they go back to play, that they are good and cleared?

Grant Ridder: Yes, I have an analogy I like to tell my parents when they have questions about a concussion. Think of your brain or your head as a control center. The building itself being the skull and the brain being all of the controls and power and everything else. So when a power outage or anything happens, the brain kind of shuts down. Everything is scattered around, but the skull itself is fine. So, they may look fine from the outside, but on the inside their brain is temporarily disruptive. So, let's say your house has a power surge that everything goes down. You're not going to go to your breaker and flip all of them on at the same time. You're going to slowly flip one on, reset everything and get everything going one by one. So, that's kind of the same with the concussion. We want to give everything time to reset slowly, to monitor everything, and just let everything stabilize before we can get them to return. So, we like to do a step-by-step process of slowly increasing activity with no increase in symptoms. And once they can pass each stage with no increase in symptoms, we then can have them return to play.

Melanie Cole, MS: How many concussions would cause an athlete to be done, to sit out, they cannot play that sport anymore?

Grant Ridder: Yes. This is a tricky question because those are all around. From what I've seen, there are within one season, there's talks of, "If I get three concussions, I'm done forever with sports and stuff like that." It depends on the severity. It depends on the timeframe of when you've got those concussions, if they were back to back to back if they were spread out within four years and everything like that.

So, here in my high school, I like to do, if they have three concussions within like two, three years or even within the whole four years here, I like to get them evaluated by a doctor and make sure that they are still allowed to participate in sports. So if they do stack up concussions over and over, I do like them to get looked at by a specialist just to make sure.

Melanie Cole, MS: Yeah, that's really important. And as we wrap up, because this is great information for coaches and parents and the athletes, anybody who really wants to know and protect our youth athletes from concussion, how do you counsel them? Can you give us your best advice about preventing concussion, which would be the best thing, 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?

Grant Ridder: Yeah, I feel like we are slowly getting away from the, " Just go play, just get back in there, just tough it out." I think we're slowly kind of getting away with that, which is good. So, recognizing things on the field real quick and just knowing that getting looked at for five, ten minutes just to make sure that we have no concussion is key. Because if they keep playing with one, we could prolong recovery and they'll be out for even longer. So, recognizing symptoms like nauseous, not feeling right, sensitive to lights, trouble concentrating, trouble remembering plays, stuff like that are all good things to look out for right away while on the field.

Melanie Cole, MS: Thank you so much, Grant, for joining us today and sharing your expertise and experiences with concussion for our listeners, and I'd like to thank our Bryan Foundation partner, Sirius Systems. To listen to more podcasts from our experts, you can always visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate and review Bryan Health podcast on Apple Podcast, Spotify, iHeart and Pandora. Until next time, I'm Melanie Cole.