Tuesday, May 6, 2014

Concussions- what you need to know!

By: Dr. Ciro Errico and Dr. Terry Weyman

Concussions are a big part of every sport. Being on the sidelines of different sports, I see many injuries including concussions. But, what exactly is a concussion?

Before I begin to explain concussions, let me cross out the myth about a concussion being only a direct trauma or hit to the head, and/or a complete loss of consciousness. Another big myth is that a concussion is a bruise to the brain. Both statements are incorrect.

A concussion is a physiological change in the brain induced by a biomechanical force. A force can be applied anywhere on the body causing an ‘impulsive’ force transmitted to the head.  This transmitted ‘impulse’ to the head causes a short lived impairment of neurological functions that can resolve spontaneously, but some neurological functions can come on immediately, after several minutes, or hours after a trauma.[1]

Signs and symptoms of a concussion that often go unnoticed are: feeling ‘foggy’, headaches, feeling overly emotional, unexplained sadness, irritability, forgetfulness, slow reaction time, sleepy, and insomnia. When someone is having one of these symptoms (and there is a mechanism of injury that could dictate the reasons), a concussion must be suspected and a proper assessment must be made by a MD, DO or DC. On the sidelines, an ATC or medic can also evaluate an athlete.

What if the symptoms get worse? If a headache becomes worse, if slurred speech occurs, seizure or convulsion, decrease in coordination - the patient should receive immediate medical attention due to the possibility of a deeper cerebral injury.

Concussions also have different degrees of severity. According to the Cantu guidelines, concussions have several grading scales: Grades I, II, and III. Grade I concussions are not associated with loss of consciousness, and post-traumatic amnesia is either absent or less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week. Grade II is a loss of consciousness for less than five minutes or exhibit post-traumatic amnesia between 30 minutes and 24 hours in duration. They also may return to play after one week of being asymptomatic. Grade III concussions involve post-traumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.[2] The week begins the day after all symptoms have dissipated.

The reason for the athlete to rest more and be reevaluated is due to the dangers of a possible second concussion also known as Second Impact Syndrome, which is highly dangerous. Here is why: When someone suffers a first concussion, there is a physiological change occurring in the brain that does not allow proper signaling between the synapses. When a second concussion occurs, the brain may lose the ability to properly regulate blood flow causing the brain to swell due to increase pooling in brain. The pooling does not allow the blood to drain causing pressure build-up in the brain ultimately resulting in brain damage and/or death.  

So, how do we prevent concussions? Preventing a concussion is hard. There is no real way to prevent a concussion predominantly due to the fact that a concussion does not need to be a direct blow to the head. Concussions can be caused by shoulder charges in soccer, tackling in football, bumping your head on a cabinet door, getting rear-ended in a motor vehicle accident, or even texting while walking and walking into a lamp pole. Concussions, again, are physiological changes in the brain. Headgear and helmets are great for general protection against skull fractures. Mouth guards are also good for preventing an athlete to bite off his tongue, however be aware that when wearing mouth guards, they can cause an athlete to clench his jaw allowing the muscles in the neck and head to tighten up before an impact. This allows less chance of a neck sprain/ strain, but because a concussion is a physiological change in the brain, an athlete may still suffer a concussion. All studies, and including the International Conference on Concussions in Sports, show there are no studies conclusive against protection for concussion.

When managing a concussion, first thing first: parents, coaches, teachers, and teammates need to be aware of the symptoms and get the person properly evaluated. Concussions are difficult to manage due to the severity and, more importantly, due to the physiological changes that occur in the brain. First of all, the athlete or patient should rest. Rest is going to be the key to begin the healing process: this includes resting from training and playing. For young adults, teens, and children resting also means staying home and/or limiting school activities; the information can cause the brain to overwork and as a result decrease healing. Another rest is from technology including video games, TV, computer, phones, and texting because the stimuli that the brain needs to function can overwork the brain resulting in decrease healing time. Secondly, water! Drink plenty of water. Drinking water allows an athlete to stay hydrated, and allows the body to increase healing potential.

What else is available for management? Chiropractic care and adjustments are great with concussions. When someone suffers a concussion there is also a whiplash injury that occurs simultaneously at the upper cervical (neck) area. This causes a physiological change in the muscles surrounding the spine often times causes tightens. It’s putting an extra strain on the neck which in turn will put an extra strain on the healing process for the concussion. Getting adjusted allows less interference on the central nervous system which helps the body change physiologically back to its normal state. Mild Hyperbaric Chamber is another great tool that can be utilized. The hyperbaric chamber increases the oxygen, and pressurizes the body allowing the oxygen to absorb in the body to allow healing to happen at a faster pace.  

Concussions affect everyone from the parent to the athlete. For proper healing, it is imperative to understand the first steps to recovery which are understanding what a concussion is and being knowledgable of the best ways for a concussion to heal. When a concussion occurs, it becomes a full effort by everyone to help the athlete reach full recovery.  

Dr. Ciro Errico is the Team Chiropractor for California State University-Channel Islands (CSUCI) Lacrosse Team and Newbury Park HighSchool Lacrosse. He is also the Team Chiropractor for Club Sports at California State University-Northridge (CSUN). He is a treating Chiropractor at Chiropractic Sports Institute (CSI)

Dr. Terry Weyman is the Chiropractor for Pepperdine University and works with Extreme Athletes in both Motocross and Mountain bike racing. He is the clinic director of Chiropractic Sports Institute

More info on CSI visit their website www.gotcsi.com

[1] International Conference on Concussion in Sport (Zurich; Nov. 2012)
[2] American Association of Neurological Surgeons 

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