Understanding what a concussion is, its symptoms and treatment can hopefully lead to a successful recovery.
Dr. Charles Tator, a neurosurgeon, scientist and researcher, founded ThinkFirst Canada and is probably the most proactive expert with regard to concussions in hockey.
He has stated that, “There are no current medical scans or blood tests that can give conclusive physiological diagnosis of a concussion. There is, however, a standardized list of symptoms to allow physicians to determine if such an injury has been suffered.”
He is talking about tests like the Sports Assessment Concussion Tool, which lists 22 symptoms consistent with the injury’s presence. They include headaches, dizziness, nausea or unconsciousness in the immediate wake of an injury, or longer term symptoms such as light sensitivity, ringing in the ears, emotional changes or memory loss.
One common misconception is that a person has to be knocked out to suffer a concussion, but a blow anywhere on the body that causes a severe and sudden movement to the head may do it.
Tator’s associate Dr. Michael Cusimano, who is also a neurosurgeon and professor at University of Toronto, treats brain injuries every day at St Michael’s Hospital.
“I came to the realization many years ago,” he recently told a symposium, “that the best medicine is prevention and so I’ve dedicated a lot of time to this.”
He is the president of the ThinkFirst program in Canada which stresses players become good skaters, keep their heads up when handling the puck, be aware and alert, approach boards on an angle, communicate with teammates and, above all, have respect for the safety of everyone on the ice.
Like these doctors, Powell River Kings’ physician Dr. Steyn Naude has treated many concussions.
Everyone agrees that no two players and no two concussions are the same. Patience and treatment must be monitored carefully. “Initial treatment includes mental rest, which is where most people go wrong,” said Naude. “They go with physical rest which is great but...we need to stress the mental rest as well. No TV, no reading, no XBox, nothing like that. Basically they vegetate.”
If there are no symptoms, players can try a little bit of physical activity as part of the recovery process, Naude said. “Then you have steps up where you are hopefully symptom-free after a real good workout.”
Players can then go through sport-appropriate exercises like a good skate in a non-contact game. “We assess them, give them a normal examination and, by the history, clear them for a full-contact practice,” said Naude. “If they can go through a full-contact practice with no symptoms for 24 hours, they’ll get the okay to go and play. That way you make sure the players heal up as best as they can before the next potential concussion.”
Complete recovery is important because typical time lost in days increases 2.25 times for every recurrent concussion.
Once players have had a concussion, they are more prone to have another and Naude warns, “Multiple concussions also raise the degree rating slightly, which adds to the recovery time, and possible post-concussive problems.”
While 80 per cent of players recover from concussion symptoms, according to psychiatrist Dr. Shree Bhalerao, the other 20 per cent typically “go into a spiral that leads and feeds into depression and diminished motivation. They become withdrawn, have impaired sleep, anxiety and a feeling of fear to return to the ice.”
Another danger he warns is, “that medications can exacerbate and make post-concussive symptoms worse early on, so you have to be very cautious.”
Between 15,000 and 20,000 athletes will suffer concussions in Canada this year. Some of those, elite professionals like National Hockey League star Sidney Crosby, are keeping the injury in the news.
As both a parent and physician, Naude said, “There’s a lot more awareness with high profile players that has brought concussions to the forefront. ThinkFirst, Hockey Canada, Football BC and even minor hockey are putting a lot of effort into educating people. They’re thinking about concussions more than they used to. That makes my job a lot easier.”
This is the third in a series about concussions in hockey.
