Scott Webb (Host): Concussions are very common, and sometimes they're mild and sometimes they're more severe, and the symptoms can last for weeks or months. In either case, my guest today and his therapy colleagues at Franciscan Health can help. And joining me today to tell us more about concussions is Dr. Blake Averill. He's a sports medicine specialist practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about concussions, symptoms, diagnosis, recovery. And I think concussions, Doctor, are one of those things that most of us think we understand, right? But I'd rather hear it from an expert. So, let's start there. What is a concussion?

Dr. Blake Averill: So when I think concussion, I say an impact or force to the head, neck, or body that results in a functional disturbance or functional injury to the brain that is not seen on imaging, and is diagnosed clinically. So, breaking that down a little bit, when we say impact or force to the head, neck, or body, really it's emphasizing that it doesn't have to be the classic, "I'm playing a football game and somebody had a contact right to my head." It can be a contact to the neck, it can be to the chest, right? Any quick change of motion.

And then, when we talk about a functional injury, what that means is you can use the term mild traumatic brain injury as well as concussion. And that really indicates that even if you get a CT or an MRI, you would not see anything on those images, and that is part of what defines a concussion.

Host: Okay. Yeah, good to have a foundation there. And I think we've all, probably everybody listening here has had concussions diagnosed or not, or knows people. You know, I've had them, my kids have had them playing sports, all of that. What are the most common signs and symptoms of a concussion and are there any, let's say, surprising signs or symptoms that we might not think of?

Dr. Blake Averill: Absolutely. I think that's what people are most surprised at when they come in to see me, is we have them fill out a symptom sheet, right? And it's a list of over 20 different symptoms that they can say, "Do they have them? And how severe are them?" And they're saying, "Wow, this is from the concussion." So, a lot to go through.

I think most commonly you think of headache, dizziness, nausea, vomiting, sensitivity to bright light, sensitivity to noises. Those are certainly the most common ones that we see. We can break those down further into what we call cognitive symptoms. So, there can be confusion, mental fog. People often complain, they just feel slowed down. They can't, you know, interpret or understand and act as quickly as they usually do. But even symptoms of inattention, difficulty concentrating, they can't complete their task at work that they used to be able to, or they can't finish their homework at school as easily.

The other section is what we call mood changes. And this is one that people find most surprising, I think is anxiety, depression, anger, irritability, something we call emotional lability, meaning you can go up and down really fast. I'm in tears in one minute and I'm angry the next minute. All those can be from a concussion.

Host: Yeah, it's so great that we have experts, because I had never really thought about that before. But now, you've got me thinking about, you know, what was my son's mood when he had that concussion playing football. And, you know, you're right, up and down, dramatic changes. Yeah, really interesting. I guess I'm wondering, are there some activities or environments that sort of worsen concussion symptoms?

Dr. Blake Averill: Absolutely. And when you think about how this is a brain injury, when you do things that cause you to use your brain too much, that's when you can worsen this. So, anything overstimulating, right? When we think about our high school athletes, it can be something as simple as their Chromebook or their iPad at school. It can be gym, it can be band or choir. Anything that's going to stimulate the brain can cause it to be worse.

Scott Webb: Yeah. And you know, I'm thinking back or when I've watched games and it seems like one of the first things that they tend to do is sort of isolate the person, the player. Darker environments, less stimulation, certainly no iPhones or Chromebooks, you know, those kinds of things. Is that why they do that? Because the stimulation is just too much.

Dr. Blake Averill: Initially, yes. And I do want to make sure I'm not only talking about our high school athletes, because these are things that I see very frequently in our entire population, right? It can be, you know, "I'm working on my house accidentally slipped off my ladder. I got in a a car accident." I see a lot of adults with these kind of issues too.

And it's similar at their work, right? They have to give a presentation at work or they have to finish, you know, a document they've been working on. So, it's really anything. And as you mentioned initially, we talk about getting them out of that stimulus really for just a short period of time, maybe 24 to 48 hours, just to see how severe these symptoms are, because they can change. It's not something where you have this concussion and, 30 minutes later, you have all your symptoms. You may not see or feel some of the symptoms until hours or a day or two later.

Host: Yeah. Yeah. I've had a couple of concussions as an adult, as you say, just being a human, working around the house, you know, that's exactly what happened to me, where I bumped my head doing something around the house. And then, like two days later, it felt like a truck had run over me. And I really hadn't had any symptoms other than my head hurt where I hit it, but it took a couple of days before it to really sort of kick in, if you will. And it sounds like that's pretty common.

Dr. Blake Averill: Yes, very much so. And that's why education is a big piece of this. Because you may wake up the next day, feel fine. And then, like you said, you feel like you got hit by a truck and you don't necessarily correlate those. So then, you keep doing what you're doing. You keep pushing through things that can potentially lengthen your recovery process.

Host: Well, yeah, and there's just such a push, even with the best coaches, the most well-intentioned coaches, you know, there's just this push, this pressure. And our kids do it to themselves as well. It's not just about, as you say, high school athletes, but our kids do that to themselves. They push themselves so hard to get back on the field, get back on the courts, and that sounds like that's a mistake, right?

Dr. Blake Averill: Yes, very much so. This is one of those conditions that's different than a lot of other injuries. I pretty frequently tell my patients that both my parents were high school coaches. So growing up, most things are "rub some dirt on it."

Host: Right. I was thinking rub some dirt on and back out there. Yeah.

Dr. Blake Averill: But this is one of those things that is not that way. If you go back too early, if you push through your symptoms, that will only make this last longer and become more severe.

Host: Yeah. Wondering, in your role as a sports medicine specialist, how do you evaluate and diagnose concussions?

Dr. Blake Averill: It is a clinical diagnosis as we talked about before. Even if they were to go to the ER before they saw me, almost every time that scan is going to be normal. So, it comes down to the history, having them talk me through what happened, what did you feel after, what have you been feeling since? Do you have any memory loss? That's also a common sign or symptom where you can get memory loss from before the accident or memory loss after. Usually, it's only a couple hours, but they say, "Yeah, it's kind of fuzzy," right?

Host: Little foggy. Yeah.

Dr. Blake Averill: And then, the other thing is an exam. So whether it's on the sideline or in the office, we have a certain protocol we go through where we're assessing different parts of what a concussion can impair, right? We're looking at orientation, their short-term memory, their delayed memory, their concentration, their coordination and balance, how their eyes are able to track and move together. All things that we do in and out of the office that can help us diagnose a concussion.

Host: Sure. Thinking about sort of treatment, if you will, and when we should see a doctor and I'm thinking, "Okay, well, there's not really much you can do for a concussion," right? There's no magic pill or anything like that. So, just from you, your experience and advice, Doctor, like, when should we reach out? When should we see a provider for a concussion? Is that necessary?

Dr. Blake Averill: I think it's absolutely necessary. And especially when we are talking about high school athletes, there are requirements to have them be released by a physician. But even, in the adult population, whether it's something that impairs their work, right? I think seeing us as soon as possible is only going to help things get better quicker. Because a lot of that comes down to education. Like we talked about, people don't understand what those symptoms are. So just having an understanding yourself of, "Okay, this is from the concussion. This is what I can push through. This is what I can't push through. This is what I need to avoid. Even just that education piece can be a huge part of earlier recovery. But there are things we can do to help treat it.

So, you had mentioned earlier about bringing people out of those stimulating environments. And that is key early, but we don't want to keep doing that. The paradigm has shifted from go sit in a cold, dark room for a week to, "Actually, that makes things worse and we need to get you back out there." So, we use a lot of buzzwords in medicine, right? We call sub-symptom exercise. So, the next day, the day after, I say, "I want you out there. I want you walking outside for five or ten minutes. I want you on a stationary bike or an elliptical or a treadmill. We want you getting the heart rate up a little bit, and then we want you going to work for a little bit or going to school for a little bit," because getting back into that environment controlled or stimulating a little bit actually promotes an earlier recovery.

Host: Yeah. The first time I heard that I thought, "Well, that's counterintuitive. That's not how we learned, you know, how to treat concussions back in the day." But times, they change. More advances, more knowledge, all of that. And I just want to get a sense here at the end, Doctor, and I appreciate your time today. As you say, the education is a big piece of this. And hopefully, we're putting some good stuff out into the world for folks. But for someone who's been diagnosed with a concussion, what's the expected rehab timeline? I feel like it's not one-size-fits-all. but in general, maybe broadly, how long does it take for folks to recover?

Dr. Blake Averill: As you said, it's certainly an individual thing. But on average, for adults, we say vast majority recover within two to three weeks. And children and adolescents, a little bit longer. Closer to that four-week mark is the average. Now, there are a subset of patients where symptoms can last longer. Unfortunately, even three months, six months, 12 months out. So, that's one of the reasons why we also encourage people to come in early. Because if you happen to be one of those unfortunate people who have these prolonged recoveries, we actually have a lot of fantastic specialized therapies that can help that.

Just as an example, right, we talked about the brain fog or the slowness, right? We have these specialized speech therapists who are trained in concussion or traumatic brain injuries. We have these specialized physical therapists who specialize in the dizziness, the vertigo, the neck pain causing headaches. There's so many things we actually can provide and have at Franciscan that we just encourage people to please come in, whether you think it's severe or not, we can just help you get better quicker.

Host: Yeah. That's perfect. Well, it's great to have you back on. Appreciate your time today. Hopefully, folks benefit from your wisdom and advice. If you think you have a concussion, severe or not, see your provider. There's lots of help, lots of therapies available. Thanks so much.

Dr. Blake Averill: Sounds great. Thank you very much.

Host: And for more information about sports medicine services, visit franciscanhealth.org/sportsmedicine. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.