I recently attended a conference on concussion management and I learned a lot. No, make that a LOT lot. Concussion research has progressed dramatically since I graduated eight years ago, and there’s a void in proper concussion management amongst the sports medicine community. The conference I attended is hoping to change that.
Let me change your thinking for a minute. You’ve likely been told that a concussion is a coup/contracoup injury, meaning the brain bounces against the front of the skull, then the back of the skull, creating an injury. Research shows that is not the case. In fact, a concussion is actually a stretch/sheer injury of the brain’s white matter (the neuron’s axons), causing biochemical changes within the brain cell. That’s why most concussions show no brain damage on CT or MRI. Concussions are a temporary, recoverable injury. Hmmmm…..
Here’s the thing with concussions. They’re under-reported because players do not want to be taken out of the game.
Here’s the other thing: the brain’s most vulnerable period is in the time period immediately following a concussion, so not pulling a player from the game and subsequently providing a thorough return-to-play protocol is dangerous. In fact, the research suggests that there is no cumulative effect of concussions, so long as the player has completely recovered from the initial concussion (Eckner et al., 2011).
So how do we safely manage concussion in sport?
Well, pre-injury baseline testing can certainly help. Since symptoms alone are a poor indicator of an athlete’s concussion healing, baseline testing allows us to measure many things (balance, reaction time, cognitive ability, memory, visual processing, capacity, etc) and compare the results post-concussion to a pre-injury ‘normal’ state.
Imagine this common scenario: a 13-year old gets concussed in a hockey game. Seven days later, they are feeling good and feel ready to return to the ice. The child is adamant- no headaches, no dizziness, no concentration problems. So how do we know they’re safe to return? Well, let’s see how their balance compares to their ‘normal’…. their reaction time…. their memory. Let’s make sure that we test several areas of brain function to be sure we’ve passed that dangerous vulnerable period (Lazzarino et al., 2012). Let’s be as sure as the latest research allows us to be.
In fact, it’s my hope that standardized baseline testing becomes mandatory for all children in all sport. It’s time.