Harry is playing soccer with his friends. Suddenly he collides with Matt and hits his head on the ground. There is no blood or even a bruise, but something pretty serious is going on with Harry. He has a massive head wound. Now, maybe massive is a little dramatic, but a concussion with or without loss of consciousness is very serious business.
Some of the symptoms Harry may be experiencing are as follows:
● Difficulty with balance and coordination.
● Difficulty sleeping.
● Increased sleepiness.
● Double or blurred vision.
● Sensitivity to light and sound.
● Slurred speech.
● Glassy-eyed stare.
● Difficulty with short-term or long-term memory.
● Slowed “processing” (eg, a decreased ability to think through problems).
● Difficulty concentrating.
● Worsening grades in school.
● Mood swings.
● Decreased tolerance of stress.
● Change in personality or behavior.
We are coming off of a generation that was taught and also thought concussions were not a big deal. Thoughts were we can just rest, but not sleep, and resume activity as usual. Research has shown that this is not the case! Rest is still advised, sleep is vital, and avoiding a second head injury could save your life!
A second head injury prior to the first concussion being healed is called Second Impact Syndrome and can cause permanent brain damage or in more serious cases death. Research has shown that second impact syndrome has a 100% chance of brain damage and a 50% chance of death.
Now, let’s get back to Harry for a minute. With the symptoms he is having from colliding with Matt, he will want to see a physical therapist or a medical doctor for diagnosis of a concussion and a team consisting of a physical therapist, speech therapist, and physician for treatment of his concussion. Together, they will examine Harry’s symptoms and determine the best course of action.
When Harry is safe to return to activity his PT will prescribe exercises, with supervision, to get back some of the strength and endurance that was lost during the resting phase. Even though Harry is athletic and in great shape this can be a slow process as exercise can increase symptoms.
Once Harry is able to complete everyday activities without symptoms he will be able to slowly go back to playing soccer. This will happen in 5 phases.
- Phase 1: Light aerobic, non impact activities like swimming and stationary biking.
- Phase 2: Moderate aerobic activities like jogging
- Phase 3: High aerobic, non contact sport specific drills at 70-80% max heart rate including sprints and regular weight training
- Phase 4: Practice! At this point full contact practice will be introduced, if it is appropriate for the sport. Walk through practice is not considered full practice.
- Phase 5: Let’s Play! Finally, regular game play.
It is important to note here that moving between phases requires Harry to complete the phase with no symptoms of any kind. Return to play could take as little as 5 days, or it could take longer depending on symptoms throughout the phased return to play protocol.
Time to recap…Concussions are a big deal and can be a life altering incident. Avoiding a second head injury while healing from the first can save your life. Rest is important as it allows the brain to heal from traumatic injuries. Avoiding any activities that increase symptoms is important. Physical activity along with lights, sounds, screen time, reading and even TV can exacerbate symptoms.
It is important to be honest about symptoms! It does no good to deny symptoms just to get back in the game. A second head injury can be fatal.