Concussion and sports: What do I need to know?

By Heather Karls, D.C., C.C.S.P.

The goal of sports chiropractic care is optimal health for the athlete. With this in mind, the treatment and diagnosis of sports related concussion has gained a greater importance, as we have learned of not just the short term effects, but the potential lifelong problems that can come with a concussive injury.

What we commonly call a concussion, is actually damage to the brain resulting in a traumatic brain injury (TBI). This TBI can be caused by any hit, punch, bump, impact, or strike to the head, neck, or body that transmits force to the brain and causes a disruption to the normal brain function. These injuries can range on a spectrum from mild to severe. Mild concussion might include a rapid onset change in consciousness or mental status, while severe concussion would include amnesia or a longer period of unconsciousness. According to the Centers for Disease Control, 153 people a day die from injuries that include TBI. This is just in the United States alone.

Much of the following information is from the Centers for Disease Control, the Concussion in Sport Group (CISG), and the American Academy of Neurology.

The effects of a concussion can last a few days, weeks, or the rest of a person’s life. Repeated mild TBIs occurring over an extended period of time can result in cumulative neurological and brain functioning symptoms. Repeated mild TBIs occurring within a short period of time (hours to weeks) can be fatal.

A concussion is an injury to the brain. As such, it can cause bleeding in the brain or pressure that causes the brain to swell and push out against the skull.  The signs in an older child or adult that a concussion is an emergency and requires immediate medical attention include:

• A headache that gets worse and does not go away
• Weakness, numbness or tingling in trunk or extremities
• One pupil larger than the other
• Repeated vomiting or nausea
• Slurred or unclear speech, gait problems
• Unable to be awoken, loss of consciousness, or very drowsy
• Seizure
• Disorientation; confused about time, unable to recognize people or places
• Restlessness or agitation

A child may show any of the above and can include:

• Non-stop crying
• Unable or unwilling to nurse or eat.

Once a life threatening condition is ruled out, you still may experience the signs of a concussion. These are variable but can commonly include:

• Nausea or vomiting early after the injury
• Headache
• Dizziness
• Blurry Vision
• Irritability or difficulty controlling emotions
• Seeming “out of it,” a blank stare, dazed look or cloudy thinking
• Tiredness or Sleeping more than usual or conversely, not being able to sleep for very long
• Balance problems, slowed reaction time
• Difficulty remembering new information and inability to concentrate

It is a fact that most athletes are in a hurry to heal and get back to play as soon as possible. Chirpractic treatment for each athlete is individually based, as their symptoms, sport, level of play, and previous injuries are all taken into account. Often there is neck, upper back, or other strain or sprain injuries associated with a concussion. This treatment can be addressed concurrently with the concussion treatment.

One of the reasons sports chiropractic is helpful in managing concussion is that medications are typically not recommended in concussed athletes. There are several reasons for this, the most important being that pharmacological agents/medications may mask or modify the symptoms of concussion, thereby giving an inaccurate measure of the athlete’s status.

Some people with a concussion feel better within a few days or a few weeks. For others, the symptoms will be prolonged a month or longer. Concussion treatment is very unique to each individual. Symptoms are often the guide to knowing what you can and cannot do. Your chiropractor can help to guide you through this time of healing. If an activity does not provoke your symptoms, then you can continue to gradually increase that activity. The first few days you should rest and limit physical activity, as obviously you want to avoid anything that would potentially cause any more trauma to the brain.

After this point, you can progress to light and non-strenuous activity. Return to work or school gradually. If symptoms worsen, cut back on that activity until it is can be performed with no increase in symptoms. Make sure you allow plenty of time for sleep. Remember, you are healing! Continue to increase your regular activities and monitor your symptoms. When your symptoms are almost gone, you may try more rigorous activities.

In sports chiropractic care, a general return to play guideline includes first returning to regular non sports activities, then starting with some light aerobic exercise. This is followed by gradual sport-specific exercise. Next we add in training drills that are non contact. Then we will guide the athlete to full contact practice. If there are no setbacks, the athlete can return to full season play.

Also, in sports chiropractic circles there has been a lot of discussion on Chronic Traumatic Encephalopathy (CTE) in athletes participating in contact sports. You might have especially heard this associated with football, boxing, hockey, and rugby. CTE is not limited to these sports however. Traumatic brain injuries and concussions, as well as subconcussive head impacts, may lead to the symptoms of CTE.  Subconcussive head impacts are blows to the head that do not cause noticeable symptoms, and CTE has been diagnosed in people who have had no history of concussion. The current literature shows that the more subconcussive impacts or other brain injuries, the greater the chance an athlete has of getting CTE. CTE can show subtle symptoms. It can affect the way a person thinks, to the point where it can impact their daily activities. CTE can also affect emotions and cause depression or anxiety as well as mood and personality changes, aggression, or the inability to modulate impulsive behavior.

CTE is an emerging area of study for sports chiropractic and there is a lot yet unknown about this puzzling disease, but as we learn more about concussion and CTE, we can better help our athletes in the short term, as well as implement new ways to prevent, reduce, and treat long term cognitive issues.