At Orthopedic Associates of Long Island, we have some of the area’s most knowledgeable and respected concussion experts, partnering with St Charles Hospital on the ThinkSmart concussion program. Since 2010, our program has provided concussion education, management, and baseline testing to over 45 school districts in Suffolk County.
The CDC defines a concussion as a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
A concussion can be caused by a direct blow to the head, or an indirect blow such as from a whiplash injury. This trauma can cause contact of the brain against the inside of the skull or a shearing injury of the brain twisting inside the skull which leads to cellular damage that produces concussion symptoms.
Concussions can occur anytime. But there are certain things that may put someone at a higher risk
- Having had a previous concussion
- Female sex
- Weak neck muscles
- Playing while fatigued or injured
Concussion symptoms can vary widely. Often the symptoms present immediately after the injury. However, it is not uncommon for symptoms to take 2-3 days to develop.
- Headaches or feeling of pressure in the head
- Confusion or feeling “foggy”
- Dizziness or “seeing stars”
- Delayed response to questions/feeling slowed
- Concentration and memory problems
- Irritability and personality changes
- Sensitivity to light and noise
- Sleep disturbances
- Psychological adjustment problems and depression
- Disorders of taste and smell
Young children fall often and can suffer concussions. Their inability to understand and describe how they feel makes it more difficult to know if they have a concussion. If your child is displaying any of the following, it is important to have them evaluated.
- Dazed appearance
- Listlessness and unusual tiredness
- Unsteady walking/balance
- Crying excessively
- Change in eating and sleeping patterns
- Lack of interest in favorite toys
Sometimes head injuries can be more severe and require emergency room evaluation or head imaging. If any of the following occur, consider seeking care immediately.
- Loss of consciousness
- Altered mental status
- Worsening headache despite resting
- Visible bump on head other than on the forehead
- Weakness in any limbs
- Suspected spine injury
- High-speed injuries such as a car accident or fall from a height
Concussions are common in contact sports. The Centers for Disease Control estimate that approximately 3.8 million Americans sustain concussions each year from sports and other recreational activities.
Baseline testing, as the name implies, provides a baseline series of responses to both cognitive and physical tests that are taken before the athlete’s contact sports season begins. These responses can then be compared to those taken from similar baseline tests conducted after the athlete is suspected to have sustained a concussion.
We use ImPACT Baseline Testing at Orthopedic Associates of Long Island. Because of our relationship with so many school districts, we often times have access to your child’s baseline testing which we can then compare to testing done in the office. ImPACT testing is validated for ages 12 and up. We also offer baseline testing in our office for those that do not have baselines done with their school or sport.
Treatment for concussions is individualized based on the patient’s symptoms. Our concussion experts will help develop a treatment plan to help patient’s recover fully as quickly as possible.
Here are some good general guidelines to follow:
- Immediate removal from gym class, sports, recess and all other high risk activities as soon as a concussion is suspected. “When in doubt, sit them out!”
- Limit screen time (TV, phone, computer, video games)
- Patient may need school or work modifications to prevent symptom worsening. Our concussion experts can help with a “Return to Learn” Plan so your child is not being overworked but also not falling behind unnecessarily.
- Get a good night sleep. There is NO need to wake your child up during the night with a concussion
- Go for a daily walk. Recent data shows that light aerobic activity such as walking can help kids recover faster from a concussion
- Concussions are not visible on CT or MRI imaging. Ordering these tests is not a routine part of concussion management.
As symptoms improve, the patient can gradually return to school or work, possibly on a limited schedule. Physical activities will need to start with light activity, such as riding a stationary bike slowly or light jogging. If these activities don’t worsen symptoms, they will be progressed.
Sometimes patients with concussions have visual or balance problems that require therapy to help them recover. At our practice, we work closely with vision and vestibular experts to ensure our patients get complete comprehensive care. We also have excellent collaborative relationships with the majority of athletic trainers in the area as well.
Once patients are symptom-free and performing all of their regular schoolwork without problems, they can begin a Return to Play Protocol. This is an exercise progression that is supervised by a child’s athletic trainer or a physical therapist. The goal is to ensure that full recovery has occurred and they are not just feeling better because of the restrictions they have been on. It is important to know this before returning an athlete to a more high risk environment. Below is a sample of a return to play progression.
Step 1: Back to regular activities (such as school)
Athlete is back to their regular activities (such as school) and has the green-light from their healthcare provider to begin the return to play process. An athlete’s return to regular activities involves a stepwise process. It starts with a few days of rest (2-3 days) and is followed by light activity (such as short walks) and moderate activity (such as riding a stationary bike) that do not worsen symptoms.
Step 2: Light aerobic activity
Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.
Step 3: Moderate activity
Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine).
Step 4: Heavy, non-contact activity
Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).
Step 5: Practice & full contact
Young athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.
Step 6: Competition
Young athlete may return to competition.
According to the CDC, an estimated 1.6 to 3.8 million sports related concussion occur each year. Though this number is likely higher because of concussions that do not get reported
If a concussion is suspected, the best thing to do is to remove yourself, or the child, from play immediately until they can be evaluated by a medical professional. As the saying goes “When in doubt, sit them out!”
Yes! Only about 10% of concussions result in loss of consciousness. That means 90% of concussions do not.
Continuing to play despite suffering a concussion can be very dangerous! Kids are at risk for developing Second Impact Syndrome (SIS) if they sustain a second head injury before the first one has a chance to heal. SIS can lead to brain swelling, long term or permanent brain damage, and sometimes death. Even if you don’t sustain a second injury, continuing to play with a concussion makes you 7 times more likely to take a month or longer to recover. The best and safest way to return to the field as soon as possible it to report your symptoms immediately and begin treatment.
Concussions do not show up on imaging tests such as CT or MRI and are therefore not typically necessary to obtain. CT scans are ordered if there is concern for a brain bleed or fracture immediately after the injury. MRI is typically ordered when symptoms are worsening or not improving over time, to look for underlying problems that may or may not be associated with the concussion.
Each concussion is treated individually based on how a patient presents. However, nobody should ever return to sport while experiencing concussion symptoms! Relative Rest – both physical and cognitive rest. This includes physical activity restrictions as well as school or work accommodations. Light walking is typically recommended daily if it doesn’t worsen symptoms. Medications – Prescription medications are sometimes, but not usually needed to manage symptoms of a concussion. It may be recommended that patients start over the counter supplements, such as omega 3 or melatonin. These are generally safe and may help symptoms. Over the counter medications such as Motrin or Tylenol are sometimes taken occasionally to help with headaches as well. Do not start any medication or supplement regimen without speaking to your physician first.
The first step is to be symptom free at rest and while performing daily activities, including school and work. At that point, your doctor will decide if you are ready to begin a return to play protocol. This involves gradually increasing the type and intensity of physical activity through the course of different exercise stages (usually 4 or 5 stages) to ensure that symptoms do not return with exertion. At that point, your doctor may clear you to return to sports. Return to play protocols are a critical part of the concussion treatment protocol. Sometimes, patients may feel better because they are simply not doing the level of activity that provokes symptoms. If that is the case, your doctor needs to know this before you return to the field.
Each concussion is different, so it is impossible to put a number on how many concussions someone can get before they should stop playing sports. If you are experiencing chronic symptoms such as headaches, dizziness, or difficulty focusing/concentrating, then it is probably not safe to return to a contact sport. However, it is also important to maintain a healthy, physically active lifestyle. If it is not safe to return to contact sports, it may be safe to participate in other, non-contact, sports. It is important to seek medical advice from a concussion specialist when dealing with these questions. They can help guide you to make the right decision.
SCHEDULE A CONSULTATION
If you think you or your child has a concussion, contact Orthopedic Associates of Long Island. Call us at 631.689.6698 to schedule a consultation with our concussion specialists. We serve East Setauket, New York and all of Long Island.