Thursday, 7 January 2016

Watching "Concussion" (the 2015 movie) as an Athletic Therapist

Like dozens of other Athletic Therapists and sports medicine professionals, I was counting down until the new Will Smith movie 'Concussion' was released in December 2015. I was a mix of anxious and excited to see it, wondering if it would be scientifically accurate, or if the facts would get caught up in the drama (also excited to see if Will Smith could pull off the accent... I think he did a good job.



I was most anxious that parents would have a knee-jerk reaction to pull their kids from collision sports and take the information about Chronic Traumatic Encephalopathy out of context. I expressed this fear to a therapist friend and she reminded me that some fear is a good thing. Parents and children need to fear the consequences of repeat head trauma, the same way we need to fear the consequences of inactivity, and the consequences of poor nutrition. 

CTE is a chronic condition. It results from numerous blows to the head, including concussive events and blows that are being called sub-concussive events. What's scary is that these sub-concussive events don't always produce symptoms, but they can contribute to the damage. It takes YEARS of these blows to produce CTE, starting from a young age. 

I like to think of it as a point system. We all start out with a certain number of points. Every time you have a concussive or sub-concussive event, you loose some. When you properly manage your concussion (take time off, get evaluated, step-wise return to play etc) you get some points back. Taking time off from contact sport gets you some points back too. Problem is that we have no idea how many points everyone starts out with, how many points a concussion is worth, or how many points you have to loose to be at risk for CTE. There's a lot of uncertainty around how the brain works, or doesn't work, but if you loose enough of these unknown points, then it's game over for you. 

So what do you do in youth sport to prevent CTE? Unfortunately we have not figured out how to prevent a concussion. Helmets prevent skull and face injuries, but don't actually protect the brain that well. Even abstaining from contact sport doesn't prevent concussions, there's an increasing number of reported head and brain injuries resulting from activities of daily living! But we can maximize the chances of the brain healing, and minimize the chances of other conditions such as CTE or Second Impact Syndrome. Here's some advise that I would give to any youth contact or high risk sport participant.

1) Always report to a coach or athletic therapist if you have symptoms. 
You can check out the list of possible symptoms in the Consensus Statement for Concussions, but it includes feeling foggy, ringing in the ears, headaches, dizziness, and a general feeling of unrest or not feeling right. The symptoms are very broad because the brain is very complex. One symptom counts though, you don't need to have multiples to suspect a concussive event. 

2) Report major hits to a coach or athletic therapist, even if you don't have symptoms! 
Sometimes if an impact is big enough, its a smart idea to to take a break for a day (or seven), just in case the symptoms develop within the next 24-48 hours. The hit may also have produced a sub-concussive event which they're saying is just as dangerous. 

3) Report if you were hit in a different sport or activity! 
The slate isn't wiped clean between sports. If you sustained a blow to the head in Lacrosse practice, and were removed from play, you probably shouldn't be playing in a football game the next day. 

4) Consider only participating in one risky activity at a time.
Most coaches have been trained on how much hitting is too much (to the best of our knowledge right now). For instance, most football teams will only have full contact practices 1-2 times per week. If you participated in more then one sport (i.e. ice hockey and wrestling) at the same time, then you may be experiencing too many blows to the head, and using up too many 'points'. It's also difficult to monitor injuries unless your coaches and therapists are talking to each other! 

5) Seek the advise of a trained professional.
Having a baseline on file is very helpful, but only if it's used! It's also only helpful if the person discussing your return-to-play decision with you is knowledgeable about concussions in sport. Even if you have not been formally diagnosed with a concussion, you can still participate in a step wise return to sport protocol, and undergo concussion rule-out testing to ensure that your brain is fully healed (and you've earned back your 'points') before returning to your activity. 

This list of course isn't exhaustive, but it's a good place to start for active teens and their parents. It is a good thing to be aware of the consequences of contact sport and have a small amount of fear of blows to the head and concussions.

If you have any questions at all about concussion management and risk mitigation surrounding contact sport, get in touch with your Athletic Therapist. They can help point you towards valid literature and help weed through the information available on the internet.