Concussions in sports are an important public health issue due to the large number of people who incur theses injuries and the potential long term effects, especially with repeated concussions and the prevalence in adolescent athletes. It is estimated that there are over 300,000 sports related concussions annually in the United States, although the Centers for Disease Control (CDC) suggests this number could be as large as 3.8 million. This does not include the number of concussions that occur from falls, motor vehicle accidents, recreational activities and/or work related activities. Deciding when someone has fully recovered from a concussions and can safely return to normal activities is a difficult challenge facing healthcare providers, undeniably, the consequences of concussions have become a growing concern and the need for clinical guidelines is unprecedented.

WHAT IS A CONCUSSION?

A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of rapid acceleration of the head from a hit elsewhere on the body. Adapted from the Zurich 2012 Concussions Consensus Statement, a concussion is further defined as follows:
• A concussion may be caused by either a direct blow to the head or other part of the body that results in “impulsive” forces transmitted to the head
• A concussion may not involve a loss of consciousness (LOC). Less than 10% of concussions have a LOC.
• A concussion can cause a disturbance in normal brain function, but there is no detectable structural damage (e.g., MRIs or CT Scans)
• A concussion typically results in clinical symptoms which may very among individuals but more commonly include dizziness, headaches, etc.
• A small percentage of cases may result in post-concussive symptoms that may be prolonged and, at times, result in long term consequences

WHAT SHOULD I DO FOLOWING A CONCUSSION?

Experts agree that following a suspected concussion, you should be evaluated by a qualified healthcare provider who ideally has experience in head trauma. The evaluation will include a neurological examination, a review of your medical, a symptom checklist, cognitive tests and functional tests (e.g., vision, balance, etc.). The more common symptoms that occur with a concussion include (but are not limited to) one or more of the following:
• Headache
• Memory loss
• Nausea/Vomiting
• Confusion
• Dizziness
• Drowsiness
• Unsteadiness
• Weakness
• Numbness and/ or Tingling
• Foggy headedness

If the status or symptoms worsen then it is recommended to seek further medical attention. It is also recommended that you rest and avoid the following for 24-48 hours:
• Strenuous activity or return to previous level of activities until cleared
• Excessive visual stimulation (e.g., computer, television, busy places, reading, etc.)
• Loud noises (e.g., music, television, etc.)
• Aspirin or non-steroidal anti-inflammatory medications, alcohol or sleeping pills
• Studying
• If applicable, it is recommended not to drive
Again, a neurological examination and evaluation should be performed following any severity of head trauma. There is also growing support for the use of more comprehensive testing following a concussion such as computerized cognitive and balance testing. When available, it is recommended to seek the care of a healthcare provider that specializes in concussions, which would ideally include a team approach.

When can I return to play/work/life?

It is commonly agreed upon that a gradual (“step-wise”) activity program can be initiated. It is important that each step along the way does not increase your concussion symptoms. When you begin the next step, if it increases your symptoms wait 24 hours before trying that step again. Below is an example of such a program:

1. No activity, complete rest – mental, physical and emotional stress, which includes minimizing visual or auditory stimulation

2. Light aerobic exercise such as walking or stationary cycling. Exertional (50-64% max heart rate), balance, vision and/or eye-head coordination activities will be determined accordingly

3. Moderate aerobic exercise and/or sport or job specific training. Exertional (65-76% max heart rate), balance, vision and/or eye-head coordination activities will be determined accordingly

4. Non-contact training drills but more aggressive sport or job specific exercises, strengthening and/or plyometrics. Exertional, balance, vision and/or eye-head coordination activities will be determined accordingly
5. Full contact/100% job demands after medical clearance – through practice or “part-time”

6. Return to previous level of activities and/or “game day”

NOTE: The best approach in concussion management is a team approach. Experts agree that particular caution be used with adolescents. Always seek the care of a physician or other qualified healthcare provider with any questions or concerns you may have about a medical condition. All materials associated with Hubbard Chiropractic and Balance Center, LLC are not intended to be a substitute for professional medical advice. Hubbard Chiropractic and Balance Center, LLC and its materials are not intended to treat, diagnose, cure, or prevent any disease. Experts agree that final authority for Return to Play (RTP) shall reside with the physician or the physician’s designee. All material by Hubbard Chiropractic and Balance Center, LLC is provided for educational purposes only.