Transcription:
Preventing and Treating Sports Related Concussions

Caitlin Whyte (Host): Welcome to Picking Our Brain with Shepherd Center. I'm Caitlin Whyte. And today we are discussing concussions. The return of fall sports brings with it a return of a common sports risk, concussions. In this episode, Dr. Russell Gore, the Medical Director of the Complex Concussion Clinic at Shepherd Center discusses what causes a concussion, the risk factors for concussion in sports and how concussions are treated. So let's start with a simple question first Doctor, what causes a concussion?

Russell Gore, MD (Guest): Well there are a lot of different things that actually can cause a concussion. Generally we think of a force that's applied to the head, but it's important to recognize that you don't have to hit your head to get a concussion. You can have a sudden deceleration, suddenly stopping in a vehicle or, or being struck by another car so your vehicle suddenly speeds up. Any change in acceleration that occurs in the head can cause the brain to slosh around a little bit and someone can sustain a concussion.

Host: So focusing on sports related injuries, what are some risk factors we should be mindful of? And what are the sports that have a higher risk of concussions?

Dr. Gore: Obviously, there are sports with higher risks of concussions, just based on the way the sports are played. So we see that high impact sports, helmeted sports, sports where athletes are, are frequently running at each other, the ground or into a ball, or potentially have the, the likelihood that someone hit them in the head with a stick. Those sorts of sports are all placing athletes at risk. There's a fair amount of misinformation out there in terms of sports that put athletes at risk, because I think, you know, here in Georgia, a couple of years ago, we saw that although football was in the media and certainly is a sport that can result in concussion; we had the highest rate of concussions in the state of Georgia a few years ago, actually for the sport of cheerleading because athletes were falling and being struck in the head by other athletes doing stunts. So there are some sort of misconceptions out there about who's safe and who's not. Essentially athletes, and all of us are at risk all the time of striking our head. So we want to do everything that we can to prevent those injuries, and also try to focus on recognizing injuries so that we can treat them appropriately.

Host: Now what are some signs in the moment that a concussion has just occurred, that we could watch out for?

Dr. Gore: Sure. Yeah. So, so generally a concussion is going to result in some kind of a short term change in mental status is how we may articulate that as, as clinicians. You know what that means when you were out at the sideline and you are with other parents perhaps, and you're watching your child participating in a sport can be very subtle. So what we'll see is after a collision athletes sometimes will for a brief period, struggle with balance. They'll have a hard time, you know, just walking to the huddle or, or walking towards the sideline. And sometimes it's parents that notice those subtle changes that can occur and they can be very transient. The obvious sorts of symptoms may be confusion, athletes running towards the wrong side of the field, for example, this happens frequently. You know, they really should raise a red flag to have somebody at least to have a chance to speak with that athlete to make sure that they're feeling okay, to look for other possible symptoms.

So other symptoms that we think of generally with concussions may be headache or feeling nauseated or dizzy or reporting that they feel foggy. Those sorts of symptoms are very, very common after injury on the field.

Host: So if a concussion does occur, what does treatment look like?

Dr. Gore: You know, treatment can be very different across the athletes that may sustain a concussion because every injury is different. But I think that when we think about the immediate phase after injury, our number one focus is to remove an athlete from play so that we can prevent a second injury within a short period of time. So, initially we've just got to recognize that there is a possible injury and we need to remove that athlete from play so that we can gather more information and protect them.

After being removed from play, generally, there's going to be a short period of rest that we recommend usually for 48 to 72 hours, we recommend cognitive rest. And then this should be followed by a return to play and a return to school protocol, which really is essentially putting that athlete back into the shallow end of the pool is my favorite analogy in those areas.

So what does the shallow end look like in terms of exercise? What does the shallow end look like in terms of schoolwork? What does the shallow end look like in terms of social activity? And then we slowly move that individual from the shallow end, back to the deep end, ensuring that we're not overly increasing symptoms. That's a typical treatment plan, and this can take a couple of weeks in a lot of athletes.

Host: Now you are the Medical Director of the Complex Concussion Clinic at Shepherd Center. Tell us a bit more about what the center offers.

Dr. Gore: Sure. So the Complex Concussion Clinic is exactly what we're named. We are really focused on injuries that are more complex, but that can mean a couple of different things. An athlete or an individual that's suffering from concussive symptoms and they're, they're lasting for a long time, or they're having a protracted recovery, that certainly, just by definition is a complex injury. So once athletes have had symptoms for 2, 3, 4 weeks and the symptoms aren't improving, it makes sense for a more specialized center to get involved. Other individuals may have risk factors for a protracted recovery and they may need to have more specialized care even earlier in their concussion course. So some of those risk factors may include a pre-existing history of migraine, a pre-existing history of anxiety or depression. For some kids with learning challenges, like attention deficit disorder, it's very helpful to have specialized care earlier. So all of these athletes with risk factors may warrant a referral even earlier in their process of their injury, so that we can bring a variety of different treatments to the table and ensure that they're going to improve.

Host: Well, Doctor, as we wrap up our conversation here, is there anything else you'd like listeners to know about sports related concussions?

Dr. Gore: Sure. So I, I think there's a, there are a couple of sort of hallmark misconceptions that are out there in terms of concussive injuries that are important to just comment on. The first is that concussions and devices based on our current knowledge and what's available out there really don't prevent concussions. So although it's important to wear a helmet in helmeted sports, for example, a helmet really protects athletes from higher velocity injuries. Injuries that would be more severe in terms of brain injury, bleeding in the brain, fractures of the skull.

But those sorts of devices don't protect athletes from concussion. So we need to be careful not to become complacent because we're putting our children in helmets or devices that have been potentially advertised as preventative measures. The biomechanics of the injury really tell us that those devices won't protect you from concussion. So if symptoms arise, you need to make sure to seek help.

And then the other primary misconception that I, I think is really important for folks to recognize is just the recovery time period for a concussion. A normal concussion in an adolescent takes three to four weeks to recover. So we've had a lot of misconceptions out there about this assumption that all injuries will recover within one week. And at times, that results in actually delays in care and that it can result in some confusion among families. Sometimes folks start to panic when symptoms are still present at two weeks post-injury. It's important to recognize that for an average adolescent, it takes three to four weeks to recover after concussion.

So we need to make sure the right team is in place and folks are moving in the right direction, but we also need to set some expectations that, that you're not always going to get back for the next week's game. And so if we set those expectations early and we come up with a plan for recovery, we really decrease stress among these kids because they're not stressing out about continued symptoms in regards to school and in sports participation.

Host: Well, thank you so much for joining us today, Dr. Gore, such important information here. Learn more about Shepherd Center at sheppard.org. There you'll find other podcasts, just like this one. This has been Picking Our Brain with Shepherd Center. I'm your host, Caitlin Whyte. Stay well.