Concussion Management

Let’s talk concussions.

Did you know that each year U.S. emergency departments treat an estimated 135,000 sports-related and recreational traumatic brain injuries, including concussions, among children ages 5 to 18?  Children and teens are more likely to get a concussion and take longer to recover than adults. Also, athletes who have ever had a concussion are at increased risk for another concussion (Center for Disease Control and Prevention).

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain functions. Concussions can also occur from a blow to the body that causes the brain inside the skull to shake.  

The alarming fact, according to a study from Hasbro Children’s Hospital, is that concussion related visits by organized sports athletes to the emergency room have almost double in the last 10 years, with football and ice hockey leading the way. The good news is that awareness has also increased, and we hear about the topic of concussions on an almost daily basis. Awareness and education are key for a condition that is not only hard to prevent but also difficult to diagnose. 

If a concussion is suspected look for the following signs and symptoms:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea or vomiting
• Slurred speech
• Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

What to do?

The first thing to do when a concussion is suspected is to rule out a more serious injury such as brain bleeding. Seek immediate care if the following is present after a head injury:

• Vomiting
• A headache that gets worse over time
• Changes in behavior, including irritability or fussiness
• Changes in physical coordination, including stumbling or clumsiness
• Confusion or disorientation
• Slurred speech or other changes in speech
• Vision or eye disturbances, including pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
• Changes in breathing patterns
• Lasting or recurrent dizziness
• Blood or fluid discharge from the nose or ears

Managing a concussion:

If a concussion is suspected, the athlete should be removed from the activity and not be allowed to return the same day. Medical personnel should then evaluate the athlete before returning to any physical, and some times academic, activity. The athlete must then be asymptomatic, both at rest and with activity, before being cleared to return to any sports. An exertional test (a series of sprints, push ups, and jumping jacks used to raise the athlete’s blood pressure) is recommended to see if any symptoms are elicited by exercise. In the event that symptoms return with an exertional test, the athlete should continue to rest until symptoms go away and then try the test again. If no symptoms return with the exertional test, a gradual return to sports is recommended, starting with isolated fitness and moving to sport-specific drills and contact drills. The athlete should be able to complete these activities symptoms-free before fully returning to sports participation. 

In addition, and if available, post-injury cognitive testing like ImPACT should be administered to compare with baseline scores. This is a key element that adds objective information and allows for better management of a concussion. 

Evidence exists indicating that people who have had multiple concussions over the course of their lives may acquire lasting cognitive impairment that limits functional ability.

Why you should never return to your sport while still dealing with the signs and symptoms of a concussion?

One reason, Second Impact Syndrome! SIS

Second Impact Syndrome is a condition in which the brain swells rapidly after a person suffers a second concussion before symptoms from an earlier one have resolved. This second blow may occur days, weeks, or minutes after an initial concussion, and even the mildest grade of concussion can lead to SIS. The condition is often fatal, and almost everyone who is not killed is severely disabled. 

So, make sure that if you suspect you have a concussion, you report it right away. It is better to miss one game than the rest of your life. You can play a soccer game with a sprained ankle. Can you play the game of life with a sprained brain? 

Written by Zack Delgado, ATC

For more information or to make an appointment for the ImPACT (Immediate Post-concussion Assessment and Cognitive Test), please email or call Zack Delgado, ATC – Director of Concussion Management Program @ zdelgado@mostsportsmedicine.com / 301-588-7888 x220

National Athletic Trainer Month

In honor of March being National Athletic Trainer Month, Sara Nickoles, a MOST ATC, has written a piece explaining the certification process and duties of an athletic trainer.

The National Athletic Trainers’ Association (NATA) describes athletic trainers as health care professionals who work alongside physicians to ensure that patients and clients are able to participate in physical activity at the most optimal level.  Athletic trainers are proficient in the prevention, diagnosis, and rehabilitation of acute or chronic injuries sustained by athletes and the physically active, in addition to first response and basic life support care in life-threatening injuries.  Certified athletic trainers must earn a bachelor’s degree from an accredited athletic training education program and pass a board certified exam to legally practice the profession.  They must also pursue ongoing continuing education requirements to maintain their certification.  According to NATA, "More than 70% certified athletic trainers hold at least a master's degree."  Athletic trainers practice in many different settings including physical therapy clinics, high schools, colleges and universities, and professional sports.  To learn more about athletic trainers please visit The National Athletic Trainers' Association website. 


Written by Sara Nickoles, MS, ATC

Fast and furious: use interval training to get better, quicker results in damn near everything

LIFE IS FULL OF CHOICES: Paper or plastic? Soup or salad? Blondes or brunettes? And most of the time, it doesn't really matter. But as for which cardio method works best for fat loss, there's clearly a winning pick: interval training. That's because hard and fast beats slow and steady every single time (except in fables). Better yet, interval training is also a secret weapon for endurance athletes and bodybuilders. In fact, you could say it's the ultimate training tool for any goal.

An interval is a brief bout of intense physical activity--such as a sprint--alternated with a longer period of rest or lighter exercise. For example, you might run all-out for 15 seconds, then rest for 30 seconds--that's one interval. By varying the duration of either your sprint or your rest period you can change the way the interval affects your body. In other words, some types of intervals are better for losing fat, while others would be superior for endurance conditioning or weight training. You can find the best routine for your goals by following the guidelines below. Whether you want more muscle, less fat, or better performance, our interval plan for every man will show you exactly what to do.

Remember, most people prefer cardio, such as jogging, to interval training-simply because intervals are harder. But ask yourself this: Would you rather be like the majority or would you rather be better?

One note: To do these workouts, you'll have to estimate what "percentage" of your all-out effort you're working at. Basically, the speed you'd run or cycle at to save your life equals 100%--from there, adjust how fast and hard you work so your output reflects the recommended percentage.

INTERVALS FOR MORE MUSCLE

At first glance, it might not seem like intervals and muscle building go together, since intervals burn calories and excess calories are needed to build muscle. But think about it: Weight training is a form of interval training--an all-out effort each set, followed by rest. By using the right type of sprint intervals, you can mimic the way you train with weights. This increases your general fitness level for lifting, which will allow you to go harder and longer in the weight room, speeding your muscle gains. Try it one or two times a week on non-weight training days or right after your weight workout, using the sample routine below.

1. Warm up: Five minutes of jogging or cycling at 30% of your all-out effort.
2. Run or cycle for 15 seconds at 100% of your all-out effort.
3. Walk or cycle at an easy pace for one minute.
4. Repeat steps 2 and 3 up to seven more times.
5. Finish with five minutes of activity at 30% or your all-out effort.

INTERVALS FOR GREATER FAT LOSS

In head-to-head comparisons, research shows that high-intensity interval training is superior to aerobic exercise for fat loss. That doesn't mean it burns more calories; it means it burns more fat while having protective effect on your hard-earned muscle. Since sprints force your muscles to exert high amounts of force, just like weight training, they train your muscles hard, which makes your body more resistant to using them for energy. Use this workout 3-5 times per week to blast fat. (Start with the beginner routine and progress to the experienced workout as you become better conditioned.)

Beginner
1. Warm up: Five minutes of jogging or cycling at 30% of your all-out effort.
2. Run or cycle for 30 seconds at about 80% of your all-out effort.
3. Slow down to 30% of your all-out effort for 90 seconds.
4. Repeat steps 2 and 3 from 3-5 times.
5. Finish with 15 minutes of traditional cardio--jogging or cycling at a comfortable pace--to cool down.

Experienced
1. Warm up for 5-10 minutes by jogging or cycling at 30% of your all-out effort.
2. Run or cycle for 30 seconds at about 90% of your all-out effort.
3. Slow down to 30% of your all-out effort for 60 seconds.
4. Repeat steps 2 and 3 up to seven more times.
5. Finish with five minutes of activity at 30% of your all-out effort.

INTERVALS FOR ENDURANCE PERFORMANCE

Research has shown that performing intervals can increase your aerobic fitness, too, since it trains your muscles to work harder and produce energy faster. That is, you'll be able to run faster and longer. Perform the following workout one or two times per week, in addition to your regular distance training.

1. Warm up: Five minutes of jogging or cycling at 30% of your all-out effort.
2. Run or cycle for 2-3 minutes at the fastest pace you could maintain for 8-10 minutes.
3. Slow to an "active rest" for a time that's equal to the duration of your work set. Simply walk around at a very low intensity.
4. Repeat steps 2 and 3 trying to achieve the same distance you did the first time.
5. If you're a beginner, do 3-6 total intervals. If you're an advanced athlete, do a maximum of 10 intervals.
6. Finish with five minutes of activity at about 20% of your all-out effort.

Article chosen by Teresa Koebel, P.A.-C
Ballantyne, C. (2005, April). Fast and furious: use interval training to get better, quicker results in damn near everything. Men's Fitness.

Welcome!

Welcome to The Athlete's Aid: the Metro Orthopedics and Sports Therapy blog. Here one will find informative posts from an enormous variety of topics such as injury prevention, women's health, agility techniques, and much more. This blog is a collaborative effort from the entire M.O.S.T. team, which allows for a wide range of expertise from our skilled doctors, physician assistants, physical therapists, and athletic trainers. Each writer is highly educated and is able to share the knowledge gained from personal experiences and on-the-job training to bring understanding and familiarity with issues we see in the clinic every day.