Treatment of a Concussion
Russell Gunner, C.A.T. (C)
It is unfortunate that in various sports, concussions are such a prevalent topic, but an area that needs be discussed and researched. As an athletic therapist, I am continually questioned about prevention and treating concussions. In previous articles, I have discussed prevention with the use of mouth guards. Unfortunately, prevention techniques do not guarantee that an athlete will not experience a concussion and treatment would then need to be addressed.
Typically, a physician or therapist will tell you that once you have incurred a concussion of any degree, REST will be your first course of action, and they are right. Rest is the key to treating any concussion. The term "Rest" will mean anything from bed rest to non-contact practicing. To understand why rest is considered the best remedy, we need to first understand what a concussion is. Quite simply, a concussion is a bruise on the brain. Blood will pool up surrounding the outer layers of the brain, similar to a bruise on your arm. However, with the brain, greater caution must be practiced. Any further swelling on the brain, may result in blood vessels being constricted and therefore limit the necessary blood flow to the crucial areas. If this occurs, death may consequently be the result.
If you have ever witnessed a concussion assessment by a physician or athletic therapist, you would have noticed several different tests that they perform. These tests evaluate the function of the 'cranial nerves' that exit from the brain into the body's vital organs and face. For example, when an athlete is asked to follow a finger from side-to-side and up-and-down, the 3rd cranial nerve is being checked. This nerve, the "oculomotor" nerve, controls the eye muscles that perform these movements. If a serious concussion has caused severe bleeding around that particular nerve, the eyes would not follow properly. This would be cause for concern and further evaluation is necessary, perhaps a C.A.T. scan.
Following the assessment, a certain amount of time will be determined as to how long the athlete will be away from the game. The amount of concussions that the player has incurred and the severity will be the two main factors in a physicians' decision. The general rule is that after three concussions, the player will be pulled from contact sports for the rest of their careers (this rule is however rarely followed). A Sports Physician in the U.S., Dr. Richard E. Fox's research "shows that with each concussion the swelling factor goes up four times". Therefore, the second concussion will result in four times the original swelling, while a third blow to the brain results in sixteen times. Now, try to calculate out how much swelling Pat LaFontaine had after six concussions.
The following describes what the regular return to play schedule would be after suffering a concussion: (as instructed by the Canadian Academy of Sports Medicine)
1. No activity, complete rest. Once asymptomatic, proceed to level (2). Continue to proceed to the following levels if asymptomatic. If symptoms occur, drop back to a level where there are no symptoms, and try to progress again.
2. Light exercise such as walking or stationary cycling.
3. Sport specific activity (i.e. skating in hockey).
4. "On ice" practice without body contact.
5. "On ice" practice with body contact, once cleared to do so by a physician. The time required to progress from full non-contact exercise to contact will vary with the severity of the concussion.
6. Game play.
If you are to ask most physicians, they may conclude that concussion symptoms can last from hours to days to months, and that nothing more can be done to speed the healing process. However, several therapists may disagree with this, because they may feel that there are numerous treatment regimes that may be able to help with certain concussion symptoms. Therapists who are trained in Cranio-sacral therapy, Osteopathy or Acupuncture have treatment methods that have been shown to help.
When a child is born, the bones in the skull (cranium) are very pliable and are able to move to allow the baby to exit from the birth canal. Several medical professionals will say that these bones will fuse (stick) together at approximately two years of age. However, therapists from around the world have found that a certain (small) amount of movement is allowed between these bones. This theory is the common practice of cranio-sacral therapy and osteopathy. From a personal experience, I was accidentally hit in the head by a line drive off another players glove in baseball a few years ago. After the initial acute symptoms decreased (1-2 weeks), an osteopath attempted to correct some dysfunctions within the cranial bones. It turned out that when the ball hit my face, it had moved the bones around slightly but was easily visible when pointed out by the therapist. After just two treatments, she was able to readjust the bones to their proper position and almost instantly had the symptoms relieved. This is just one example of how a therapist who is trained in this field can relieve concussion symptoms such as headaches.
Acupuncture is also another form of treatment that has proven beneficial in relieving a player's concussion symptoms. Acupuncture is the insertion of very fine needles at certain points in the body that can relieve pain, ringing in the ears, nausea and other associated symptoms. Usually after just a few treatments many patients will find themselves with less headaches and more energy.
Craniosacral therapy, Osteopathy or Acupuncture are three alternative treatment options. Along with a standard amount of rest, these options have been proven to help relieve concussion symptoms and return an athlete to the ice quicker. Please remember that treatment is secondary, and prevention is ideal. You only have one brain, so protect it any way you can. Prevent a concussion before worrying about treating one.