Selected Podcast
Traumatic Brain Injuries In Sports
Dr. Brayton Kiedrowski discusses the different types of traumatic sports-related brain injuries and how these types of concussions can cause lifelong effects.
Featuring:
Brayton Kiedrowski, DO
Brayton Kiedrowski, DO is a Primary Care Sports Medicine Physician. Transcription:
Prakash Chandran: Welcome to Right Beside You, a Reid Health podcast. I'm your host, Prakash Chandran. Today, we'll be talking about traumatic brain injuries in sports with Dr. Brayton Kiedrowski, a primary care sports medicine physician at Reid Health.
Now, Dr. Kiedrowski, it's really great to have you here today. Thank you so much for being here. We're talking about traumatic brain injuries today, which I'm sure covers a wide range of trauma. But I guess my first question is, are concussions mild forms of traumatic brain injuries?
Brayton Kiedrowski, DO: Yeah. First of all, thanks for having me. Wonderful to be talking with you about concussions. It's A pretty significant event in most people's life when they experience one. And when we think about concussions, they do fall under this umbrella of a traumatic brain injury. And they're confusing because, you know, we think of traumatic brain injuries and we think about brain bleeds and car accidents and really bad stuff that you end up in the ER for, but a concussion is one of those.
Prakash Chandran: So talk to us a little bit about how concussions cause long-term effects. Like what kind of long-term effects might one notice?
Brayton Kiedrowski, DO: Yeah. So the concussion, hopefully, if it's a sport-related concussion, won't give too many long-term effects, but we worry about some things that can happen in the short recovery period after a concussion. Most acutely, we worry about this thing called second impact syndrome, that can happen if someone experienced a concussion and then ends up going back into a game or a competition or maybe keeps driving after a car accident and they get hit a second time, in generally a milder form of trauma that ends up actually causing engorgement of blood vessels and brain swelling and that can have some very disastrous effects.
Prakash Chandran: Yeah, I can imagine. And so just kind of moving to the prevention side of things, I imagine it's very important to wear the proper gear for the associated sport, you know, because there is so much impact in things like football that the gear really helps to protect the player's head, maybe talk a little bit about the importance of proper gear.
Brayton Kiedrowski, DO: Yeah, proper gear is essential in whatever sport you play in. Football, hockey, lacrosse, face shields, they all come to mind as far as helmeted competition. There is no helmet that is going to prevent a concussion outright. And so the helmet doesn't make you invincible. And that's something that I think some of our football players especially can sometimes think. Not to say that a helmet isn't protective, it absolutely is. If a helmeted player goes up against a non-helmeted player, the non-helmeted player is going to get the worse end of that tackle or whatever kind of impact. But they do help prevent more traumatic brain injuries if we're thinking about this as a spectrum, and there are definitely worst traumas for your brain to experience than a concussion. And I would never want to have to send a patient to the hospital because, "Hey, you hit somebody without a helmet on." That's why we have these rules in football and all other sports that wear helmets that you got to keep your helmet on.
Prakash Chandran: Yeah. I wanted to ask if concussions can occur in low impact sports as well. You know, typically when we talk about concussions, we immediately go to football. But there are other sports where it can happen as well. Is that correct?
Brayton Kiedrowski, DO: That's absolutely correct. And I mean, we're taping this in winter, this podcast during the winter season. I see a lot of concussions in basketball, a lot of concussions in indoor sports as well. And when you think about low impact things, even, you know, fighting for a rebound in basketball, and you get an elbow to the side of your head, that can cause the force enough to cause a concussion and it would be up to either the healthcare provider or athletic trainer at the event to kind of assess the patient on the side of the basketball game or other court game that would kind of be able to assess the symptoms to be able to say, "Hey, is this person or is this athlete at risk for a concussion?"
Prakash Chandran: You know, we touched on this earlier, but what about non-sports-related concussions? Like what has your experience been with those and what types of activities might one be doing to get a concussion?
Brayton Kiedrowski, DO: Yeah. The immediate trauma that comes to mind is a motor vehicle accident. And, you know, it can happen regardless of the circumstances of the car or truck accident with a close second being kind of workplace-related injuries that happens routinely -- not routinely, but you know, enough in construction or manufacturing jobs that people would hit their head in some fashion.
Prakash Chandran: Yeah. You wouldn't think that's the case, but, you know, especially if you're doing something where things can fall on you or you can take a fall, I can imagine that it happens probably more often than people think. I wanted to move on to a certification that I heard. You know, I know that you've completed an additional certification, ImPACT. Can you tell us a little bit more about that?
Brayton Kiedrowski, DO: Sure. And I think people need to know about what ImPACT is. ImPACT testing and this company that offers, this is an additional tool that usually it's the sports medicine physicians that they get certified in something like this, but neurologists do it as well and some pediatrician. But it's an additional tool that we can use in the assessment of a patient's concussion and how they're improving. You know, concussions are difficult in the realm of traumatic brain injuries because I can't point to an image or a blood test and say, "You have a concussion and you're getting better, or you're getting worse." It's a combination of a physical exam and symptom interview and standardized tests that we use to see if someone's improving from a concussion -- well, sorry to back up -- to diagnose that concussion and then see if they're improving from it and what we can add to their treatments, treatment options to get them better. And so ImPACT testing is just another tool in the basket of things that we have as we're assessing patients with concussions.
Prakash Chandran: Yeah. Understood. And I know it's also important in establishing a baseline, right?
Brayton Kiedrowski, DO: The ImPACT test has the most validity and the most weight to it. When there is a baseline test that a patient has taken, a baseline computerized test that the patient has taken before, you know, a concussion happens, and so we can see this is their brain and brain function without any traumatic brain injury. And then we can take ImPACT tests after the injury, after the presumed concussion, to see how they are affected, and then in some cases take multiple ImPACT tests after the concussion or injury has happened to see how we are improving and whether or not we need to alter the treatment plan.
Prakash Chandran: You know, one of the things that I wanted to ask you before we close here is that you hear parents all the time say like, "I'm never going to let my kids play a high impact sport like football because I want them to stay safe. I don't want them to have the risk of a concussion." And being in the field that you are, I was wondering if you had thoughts around that or what you might say to parents that are thinking in this way.
Brayton Kiedrowski, DO: And that's a good question. And I haven't been asked that recently, but it's a question I think about often. You know, recently, my wife did most of the hard work, but we have an eight month old son. And I didn't play football as a youth, but I have in my history three concussions from soccer. You know, a sport that typically has less concussions, you know, doesn't have the protection of helmets and a plethora of referees to limit hopefully non-traumatic tackling and whatnot.
But to come back to the question, I think the benefits of sport overall as far as your teamwork, as far as problem-solving, as far as the mental and psychosocial benefits of sporting activities really outweigh the potential risk, as long as you're not taking undue risks. You know, obviously the first thing that comes to mind is targeting in football as a form of tackling where, you know, a tackler will lower their head, not focus with their eyes on the opposing player and basically ram their head into that player. Obviously, that's a dangerous move that puts you at a high risk for injury. As long as you are playing smart and playing in a protective manner and using those guidelines that different high school and collegiate organizations whether at the state or national level have put in place, I think participating in a sport that does have a higher increased rate of concussions, such as football or soccer, I think the benefits of sport outweigh the risks.
Now, I'm may change my tune if my son goes on to play football and he has five or six concussions his freshmen season or whatever that may be, but, you know, I don't have a crystal ball as far as that goes. But it's definitely something to consider. You know, you're having conversations with your kids if they're thinking about getting into a sport that may have, you know, some head contact and maybe at risk for concussion. But it's more than just isolate a sports concussion risk, it's what else does this sport do for the high school or the junior higher, or that collegiate athlete, as far as mental health and social benefits and physical benefits too. Like obesity is a rising epidemic in the United States, and I could go on for hours about that, but I'm getting a little bit of further away from your question, but I think you've got to weigh that risk.
Prakash Chandran: Yeah, absolutely. And I think it is a very personal thing that parents have to consider for themselves and their children. I think one of the things that you touched on is that sports today, we certainly try to do as much as possible to make sure that the children are safe with all the protective gear that we have. But it is physical contact sport and there's a risk anytime. But as you've correctly said, it also seems to come with all these other benefits that sometimes parents don't necessarily consider.
You know, just as we close here today, Dr. Kiedrowski. In all of your experience, you know, just everything that you've seen, is there kind of a takeaway that you want people to get from this conversation? If there's one thing you could share, what might that be?
Brayton Kiedrowski, DO: Yeah, that's a really good question. When it comes to sport-related concussion, I think engaging with your healthcare professional. And they could start with the athletic trainer at the high school of this hypothetical high school athlete that has had a trauma to his head or her head and engaging with them and telling them the information. I feel like a lot of concussions or head traumas that I eventually see as a primary care sports physician end up getting to me a little bit late, not that we didn't have a good outcome from it, but a sooner diagnosis and a quicker engagement with the people that want the best for you, I think, and that being your athletic trainer or, you know, neighborhood sports physician, it's going to help you get back to participating in that sport in a healthy manner and at a hopefully higher level of competition than if you're just kind of trying to make it through and trying to push through it with symptoms.
Prakash Chandran: Yeah. And related to that, I think that parents, and I put myself in this category, we sometimes think that there's a finality to a child or someone getting a concussion, right? Like there's no turning back from it. And I think one of the things that I've learned in this conversation is that you can recover, right? If you are proactive, you go to talk to your primary care, you give them all the information possible, that you can recover and, in some senses, be better than you were before. Is that more or less correct?
Brayton Kiedrowski, DO: Yeah, the sooner we can identify what's going on, the sooner you can recover, but the better you can recover. You know, sport-related concussion in pediatric patients, just as a catchall, if we catch it early and it gets diagnosed early and we put in the correct treatment plan and get you on the right treatment plan, again for this hypothetical high school athlete, they should get better 90%, 95% of the time in two weeks. And I know there's a lot of pressures as far as, you know, different sports. And you've got social pressures from your fellow teammates that wants you back, you know, the next game. But we have to weigh all of those things. And the sooner that you can get engaged with your primary care physician or athletic trainer or a sports medicine physician, if they're in your area, the sooner it gets diagnosed, the sooner you get the right treatment plan going, the sooner you get back to your sport.
Prakash Chandran: Well, Dr. Kiedrowski, I think that's the perfect place to end. Thank you so much for your time today.
Brayton Kiedrowski, DO: Absolutely. Thanks for having me.
Prakash Chandran: That was Dr. Brayton Kiedrowski, a primary care sports medicine physician at Reid Health. If you think you've experienced a concussion or would like to be seen by one of our board-certified providers, you can call a (765) 962-4444 to schedule your appointment or walk into our clinic Monday through Friday from 8:00 AM to 8:00 PM.
If you find this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Right Beside You. To learn more, head to reidhealth.org. My name is Prakash Chandran. Stay well.
Prakash Chandran: Welcome to Right Beside You, a Reid Health podcast. I'm your host, Prakash Chandran. Today, we'll be talking about traumatic brain injuries in sports with Dr. Brayton Kiedrowski, a primary care sports medicine physician at Reid Health.
Now, Dr. Kiedrowski, it's really great to have you here today. Thank you so much for being here. We're talking about traumatic brain injuries today, which I'm sure covers a wide range of trauma. But I guess my first question is, are concussions mild forms of traumatic brain injuries?
Brayton Kiedrowski, DO: Yeah. First of all, thanks for having me. Wonderful to be talking with you about concussions. It's A pretty significant event in most people's life when they experience one. And when we think about concussions, they do fall under this umbrella of a traumatic brain injury. And they're confusing because, you know, we think of traumatic brain injuries and we think about brain bleeds and car accidents and really bad stuff that you end up in the ER for, but a concussion is one of those.
Prakash Chandran: So talk to us a little bit about how concussions cause long-term effects. Like what kind of long-term effects might one notice?
Brayton Kiedrowski, DO: Yeah. So the concussion, hopefully, if it's a sport-related concussion, won't give too many long-term effects, but we worry about some things that can happen in the short recovery period after a concussion. Most acutely, we worry about this thing called second impact syndrome, that can happen if someone experienced a concussion and then ends up going back into a game or a competition or maybe keeps driving after a car accident and they get hit a second time, in generally a milder form of trauma that ends up actually causing engorgement of blood vessels and brain swelling and that can have some very disastrous effects.
Prakash Chandran: Yeah, I can imagine. And so just kind of moving to the prevention side of things, I imagine it's very important to wear the proper gear for the associated sport, you know, because there is so much impact in things like football that the gear really helps to protect the player's head, maybe talk a little bit about the importance of proper gear.
Brayton Kiedrowski, DO: Yeah, proper gear is essential in whatever sport you play in. Football, hockey, lacrosse, face shields, they all come to mind as far as helmeted competition. There is no helmet that is going to prevent a concussion outright. And so the helmet doesn't make you invincible. And that's something that I think some of our football players especially can sometimes think. Not to say that a helmet isn't protective, it absolutely is. If a helmeted player goes up against a non-helmeted player, the non-helmeted player is going to get the worse end of that tackle or whatever kind of impact. But they do help prevent more traumatic brain injuries if we're thinking about this as a spectrum, and there are definitely worst traumas for your brain to experience than a concussion. And I would never want to have to send a patient to the hospital because, "Hey, you hit somebody without a helmet on." That's why we have these rules in football and all other sports that wear helmets that you got to keep your helmet on.
Prakash Chandran: Yeah. I wanted to ask if concussions can occur in low impact sports as well. You know, typically when we talk about concussions, we immediately go to football. But there are other sports where it can happen as well. Is that correct?
Brayton Kiedrowski, DO: That's absolutely correct. And I mean, we're taping this in winter, this podcast during the winter season. I see a lot of concussions in basketball, a lot of concussions in indoor sports as well. And when you think about low impact things, even, you know, fighting for a rebound in basketball, and you get an elbow to the side of your head, that can cause the force enough to cause a concussion and it would be up to either the healthcare provider or athletic trainer at the event to kind of assess the patient on the side of the basketball game or other court game that would kind of be able to assess the symptoms to be able to say, "Hey, is this person or is this athlete at risk for a concussion?"
Prakash Chandran: You know, we touched on this earlier, but what about non-sports-related concussions? Like what has your experience been with those and what types of activities might one be doing to get a concussion?
Brayton Kiedrowski, DO: Yeah. The immediate trauma that comes to mind is a motor vehicle accident. And, you know, it can happen regardless of the circumstances of the car or truck accident with a close second being kind of workplace-related injuries that happens routinely -- not routinely, but you know, enough in construction or manufacturing jobs that people would hit their head in some fashion.
Prakash Chandran: Yeah. You wouldn't think that's the case, but, you know, especially if you're doing something where things can fall on you or you can take a fall, I can imagine that it happens probably more often than people think. I wanted to move on to a certification that I heard. You know, I know that you've completed an additional certification, ImPACT. Can you tell us a little bit more about that?
Brayton Kiedrowski, DO: Sure. And I think people need to know about what ImPACT is. ImPACT testing and this company that offers, this is an additional tool that usually it's the sports medicine physicians that they get certified in something like this, but neurologists do it as well and some pediatrician. But it's an additional tool that we can use in the assessment of a patient's concussion and how they're improving. You know, concussions are difficult in the realm of traumatic brain injuries because I can't point to an image or a blood test and say, "You have a concussion and you're getting better, or you're getting worse." It's a combination of a physical exam and symptom interview and standardized tests that we use to see if someone's improving from a concussion -- well, sorry to back up -- to diagnose that concussion and then see if they're improving from it and what we can add to their treatments, treatment options to get them better. And so ImPACT testing is just another tool in the basket of things that we have as we're assessing patients with concussions.
Prakash Chandran: Yeah. Understood. And I know it's also important in establishing a baseline, right?
Brayton Kiedrowski, DO: The ImPACT test has the most validity and the most weight to it. When there is a baseline test that a patient has taken, a baseline computerized test that the patient has taken before, you know, a concussion happens, and so we can see this is their brain and brain function without any traumatic brain injury. And then we can take ImPACT tests after the injury, after the presumed concussion, to see how they are affected, and then in some cases take multiple ImPACT tests after the concussion or injury has happened to see how we are improving and whether or not we need to alter the treatment plan.
Prakash Chandran: You know, one of the things that I wanted to ask you before we close here is that you hear parents all the time say like, "I'm never going to let my kids play a high impact sport like football because I want them to stay safe. I don't want them to have the risk of a concussion." And being in the field that you are, I was wondering if you had thoughts around that or what you might say to parents that are thinking in this way.
Brayton Kiedrowski, DO: And that's a good question. And I haven't been asked that recently, but it's a question I think about often. You know, recently, my wife did most of the hard work, but we have an eight month old son. And I didn't play football as a youth, but I have in my history three concussions from soccer. You know, a sport that typically has less concussions, you know, doesn't have the protection of helmets and a plethora of referees to limit hopefully non-traumatic tackling and whatnot.
But to come back to the question, I think the benefits of sport overall as far as your teamwork, as far as problem-solving, as far as the mental and psychosocial benefits of sporting activities really outweigh the potential risk, as long as you're not taking undue risks. You know, obviously the first thing that comes to mind is targeting in football as a form of tackling where, you know, a tackler will lower their head, not focus with their eyes on the opposing player and basically ram their head into that player. Obviously, that's a dangerous move that puts you at a high risk for injury. As long as you are playing smart and playing in a protective manner and using those guidelines that different high school and collegiate organizations whether at the state or national level have put in place, I think participating in a sport that does have a higher increased rate of concussions, such as football or soccer, I think the benefits of sport outweigh the risks.
Now, I'm may change my tune if my son goes on to play football and he has five or six concussions his freshmen season or whatever that may be, but, you know, I don't have a crystal ball as far as that goes. But it's definitely something to consider. You know, you're having conversations with your kids if they're thinking about getting into a sport that may have, you know, some head contact and maybe at risk for concussion. But it's more than just isolate a sports concussion risk, it's what else does this sport do for the high school or the junior higher, or that collegiate athlete, as far as mental health and social benefits and physical benefits too. Like obesity is a rising epidemic in the United States, and I could go on for hours about that, but I'm getting a little bit of further away from your question, but I think you've got to weigh that risk.
Prakash Chandran: Yeah, absolutely. And I think it is a very personal thing that parents have to consider for themselves and their children. I think one of the things that you touched on is that sports today, we certainly try to do as much as possible to make sure that the children are safe with all the protective gear that we have. But it is physical contact sport and there's a risk anytime. But as you've correctly said, it also seems to come with all these other benefits that sometimes parents don't necessarily consider.
You know, just as we close here today, Dr. Kiedrowski. In all of your experience, you know, just everything that you've seen, is there kind of a takeaway that you want people to get from this conversation? If there's one thing you could share, what might that be?
Brayton Kiedrowski, DO: Yeah, that's a really good question. When it comes to sport-related concussion, I think engaging with your healthcare professional. And they could start with the athletic trainer at the high school of this hypothetical high school athlete that has had a trauma to his head or her head and engaging with them and telling them the information. I feel like a lot of concussions or head traumas that I eventually see as a primary care sports physician end up getting to me a little bit late, not that we didn't have a good outcome from it, but a sooner diagnosis and a quicker engagement with the people that want the best for you, I think, and that being your athletic trainer or, you know, neighborhood sports physician, it's going to help you get back to participating in that sport in a healthy manner and at a hopefully higher level of competition than if you're just kind of trying to make it through and trying to push through it with symptoms.
Prakash Chandran: Yeah. And related to that, I think that parents, and I put myself in this category, we sometimes think that there's a finality to a child or someone getting a concussion, right? Like there's no turning back from it. And I think one of the things that I've learned in this conversation is that you can recover, right? If you are proactive, you go to talk to your primary care, you give them all the information possible, that you can recover and, in some senses, be better than you were before. Is that more or less correct?
Brayton Kiedrowski, DO: Yeah, the sooner we can identify what's going on, the sooner you can recover, but the better you can recover. You know, sport-related concussion in pediatric patients, just as a catchall, if we catch it early and it gets diagnosed early and we put in the correct treatment plan and get you on the right treatment plan, again for this hypothetical high school athlete, they should get better 90%, 95% of the time in two weeks. And I know there's a lot of pressures as far as, you know, different sports. And you've got social pressures from your fellow teammates that wants you back, you know, the next game. But we have to weigh all of those things. And the sooner that you can get engaged with your primary care physician or athletic trainer or a sports medicine physician, if they're in your area, the sooner it gets diagnosed, the sooner you get the right treatment plan going, the sooner you get back to your sport.
Prakash Chandran: Well, Dr. Kiedrowski, I think that's the perfect place to end. Thank you so much for your time today.
Brayton Kiedrowski, DO: Absolutely. Thanks for having me.
Prakash Chandran: That was Dr. Brayton Kiedrowski, a primary care sports medicine physician at Reid Health. If you think you've experienced a concussion or would like to be seen by one of our board-certified providers, you can call a (765) 962-4444 to schedule your appointment or walk into our clinic Monday through Friday from 8:00 AM to 8:00 PM.
If you find this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Right Beside You. To learn more, head to reidhealth.org. My name is Prakash Chandran. Stay well.