As hockey season arrives, things to watch out for when it comes to concussions

By JIM FORBES
Chiropractor

Hockey is starting out all over Lambton County and one major issue surrounding the sport is concussions.  Being involved with minor hockey last year I witnessed first hand the confusion of parents and players in dealing with a concussion. 

As well, the long absence of Sidney Crosby, Canada’s best hockey player, made concussions the most important issue Canadian hockey.             

The intention of this article is to familiarize parents, players, and coaches on what a concussion is, dispel the myths of concussions, learn how a concussion presents in a player, the steps to take if you suspect a concussion, and learn the most recent guidelines on when and how to safely return to play. 

WHAT IS A CONCUSSION?

A concussion is a disturbance in brain function that can occur from a blow to the head or when the head is shaken violently.  It is important to emphasize that a concussion is a functional disturbance not a structural one, thus, there is no issue with the physical structure of the brain, but the way it works is disrupted from the impact. 

MISCONCEPTIONS AROUND CONCUSSION

It is a common misconception that a player must lose consciousness in order to have a concussion.  In fact, loss of consciousness is NOT associated with the severity of a concussion and only occurs ~10% of concussions. 

Recent research has stated that the severity of memory loss around the time of the impact is associated with the duration of concussive symptoms. 

Another misconception about concussions is that the severity of the hit is related to the severity of the concussion.  A player may sustain a concussion with incidental contact, therefore, symptoms must be monitored regardless of the severity of the incident.

SIGNS AND SYMPTOMS OF A CONCUSSION

In a high school football study in the U.S. only 47% of players reported their concussive symptoms.  Of those who failed to report, 66% did not think their injury was serious enough, 41% did not want to be held out of play, and 36% did not know their symptoms were consistent with a concussion.  It is obvious that players need to know what the signs and symptoms of a concussion are and their implications.

The disturbance of brain function from a blow to the head causes many signs and symptoms most of which are NOT exclusive to concussion. 

Headache for example, is one of the most common symptoms of a concussion and parents and players alike might not attribute the headache to a serious or incidental hit during the game, especially if the player has had headaches before. 

Identification is the first step to proper management, for this reason, everyone must be informed of what the signs and symptoms of a concussion are so early management and thus timely recovery may begin.  Below is a list of common signs (something that can be observed by player or parent) and symptoms (something that is felt by the player) of concussion:

Signs to look for:

  • Forgets events prior to hit
  • Forgets events after hit
  • Behavior or personality change
  • Just not themselves

Symptoms:

  • Uncoordinated movements
  • Bad balance
  • Slow to answer questions
  • Appears to be in a fog / dazed
  • Slow to answer questions in practice or in school.

WHAT TO DO ONCE YOU SUSPECT A CONCUSSION

First and foremost, once a player receives a hit which causes them to stay down either from injury, loss of consciousness or both, you must assume there is a spinal cord injury until proven otherwise. 

This means that the player should NOT be moved from the position they are in until a spinal cord injury is ruled out by the paramedics or the adequately trained manager. 

Once this is ruled out, remove the player from the game or practice.  Monitor the player for signs and symptoms, and do NOT administer medication.  Notify the coach and parent of the injury and proceed to your medical doctor as soon as possible. 

The medical doctor will perform what is called “neuro-cognitive testing” which means they will test how the brain is functioning.  Because the symptoms of a concussion may be subtle there is a testing protocol that should be followed to ensure all areas of brain function are checked. 

NEURO-COGNITIVE TESTING

It is now becoming common practice to evaluate a player's neuro-cognitive function and overall behaviour prior to receiving a concussion. 

Prior to the start of the season a test can be performed which measures various aspects of a players brain function, this score is “the baseline” or “normal score” for that particular player.  If the player then has a concussion, the test is performed again and the two scores are then compared. 

This test is performed periodically and symptoms are monitored as the athlete progresses through the recovery process.  Two of the more common tests are the ImPACT test (adopted by the Sarnia Minor Hockey Association) and the Sport Concussion Assessment Tool (SCAT-2).

 WHEN AND HOW TO SAFELY RETURN TO PLAY

80 – 90% of concussions resolve within 7 – 10 days, however, new research suggests that child and adolescent recovery may take longer. 

This has been an issue of immense debate ever since Sidney Crosby missed half of the last NHL season.  Now, everyone wants to now when they can safely return to play without putting themselves at risk for future concussions and thus jeopardizing their mental health down the road.  Below are the Zurich Guidelines for return to play from a concussion. 

These guidelines were created by experts in the field of concussions and have since been adopted by Hockey Canada.  They consist of 6 steps, each of which must take a minimum of 1 day to complete.  If a player fails to achieve or does not continue to achieve the goal of a particular stage, they must return to the first stage and be examined by their physician.

RETURN TO PLAY GUIDELINES

Zurich / Hockey Canada

1) Stage 1 = No activity, complete physical and mental rest.

         – avoid tasks that involve a lot of thinking (homework, remove from school, etc)

2) Stage 2 = Light aerobic exercise (walking, stationary bike)

         – avoid resistance / weight training

         – keep heart rate below 70% of your max (max heart rate = 220 – your age) 

3) Step 3 = Sport specific activities and training (skating)

4) Step 4 = Drills without body contact.

begin resistance / weight training

PROGRESS TO STAGE 5 ONLY WITH MEDICAL CLEARANCE

NEED REASSESSMENT AND NOTE FROM MEDICAL DOCTOR

5) Step 5 = Begin drills with body contact

6) Step 6 = Game play

CONCLUSION

Contact is part of sports and concussions will occur, however, they should not go unnoticed.  Players and parents alike must be educated to identify the signs and symptoms of concussion so that early identification and thus timely management can take place.  Light hits should not be taken lightly, as incidental contact can cause concussive symptoms.  Thus all reports from a player should be monitored and when in doubt keep them out!

Dr. Jim Forbes is a chiropractor who practices in Sarnia from the Hare Chiropractic and Wellness Centre on Colborne Rd. at Cathcart.

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