By Kahn Nirschl
PT, DPT, OCS, FAAOMPT
Football is a high-speed, high-impact contact sport, and players are certainly susceptible to this. As a physical therapist, we speak to the idea of prevention for many of the injuries that we treat.
With that in mind, the question is whether there is anything with prevention in mind that can be applied to the prevention of concussions in athletics, namely football. Let’s first define what a concussion is, its management, and discuss some options for prevention.
What is a concussion?
A concussion is a type of minor brain injury caused by a direct blow or trauma to the head that leads to a temporary loss in brain function. It is important to understand that the symptoms of a concussion may not start right away.
It may take a few hours to even a few days for symptoms to fully emerge. Symptoms that can be present initially following the injury may include confusion, amnesia, loss of consciousness, ringing in the ears, nausea and vomiting, or convulsions.
Symptoms that can present in a more delayed fashion can include irritability, headaches, depression, sleep disorders, poor concentration, trouble with memory, as well as personality changes.
Upon suspicion of a concussion, a physical assessment should be performed as soon as possible. A medical professional such as a physician will detect some of the physical signs through a neurologic exam and medical imaging if the severity of symptoms warrant.
If a concussion is diagnosed, it is important for the athlete to rest, limiting external stimuli that would affect the person’s nervous system and brain. These stimuli include avoiding television, texting, computers, radio, bright lights, loud noises and reading, as well as school itself.
This rest period should be continued until all signs and symptoms have resolved, and this initial rest period can take several days.
Return to activity should be initiated once the original signs and symptoms are no longer present. A gradual and progressive approach recovery has been outlined that has 7 phases of recovery.
Each phase outlines what activities are allowed. If symptoms reoccur, then a return to the previous phase is required. The 7 phases of recovery are as follows and require a 24 hour period of no symptoms before progressing to the next phase:
1) No activity, only complete rest, proceed to phase 2 only when symptoms are gone.
2) Return to school/academics (1/2 day at first). Once a student can complete a full day without symptoms, then they may proceed to Phase 3.
3) Light aerobic exercise such as walking or a stationary bicycle, but no resistance training or weightlifting.
4) Sport-specific activities and training that do not involve any type of contact such as jogging.
5) Drills progressed without body contact to include weight lifting. Gradually progress resistance without a return of concussion symptoms. The time needed to progress from non-contact to contact exercise will vary based on the severity of the concussion.
6) Begin drills with body contact.
7) Game Play.
It is important to note that the threshold for additional concussions is less once someone has experienced a concussion, and a player who returns to sport should be very closely monitored and any return of symptoms should be met with a discontinuation of sport participation and a resumption of the 7 phases of recovery.
Are concussions preventable?
Now that we have covered what a concussion is and its management, we turn to the question of whether we can prevent concussions. It is fair to say that that with certain sports where contact is likely, such as football, that absolute prevention of this type of injury is not possible.
With that being said, there are some things that can be done to try and reduce the severity and incidence of a concussion.
An interesting study in a July 2011 publication of the Journal of Neurosurgery revealed that supplementing with Omega 3/DHA fish oil after head injuries reduced the observed signs and symptoms associated with a concussion.
It was hypothesized that Omega 3 fatty acids in fish oil reduced the neural inflammation induced by the concussion injury. There has been additional discussion that Omega 3/DHA fish oil can have potential to limit damage from concussions in a preventive fashion before the even occurs.
The good news is that fish oil is a supplement that can be found at local supermarkets in the pharmacy.
Another interesting approach to prevention of concussions is through the strengthening of the muscles of the neck. Stronger neck muscles help to cushion against and lessen the linear and rotational forces that can cause a concussion.
In 2014 at Nationwide Children’s Hospital in Columbus, Ohio, a research group demonstrated that neck strength was a significant predictor of concussion, with the odds of concussion falling by five percent for every one-pound increase in aggregate neck strength.
This research was also effective in demonstrating that a new, cost-effective tool to measure neck strength was reliable and cost effective enough to be used in most settings, as most systems to previously measure neck strength were outside of the financial constraints of school districts.
A hand held tension scale device attached to a Velcro adjustable head strap with a D ring to measure neck strength in pounds was used. This holds tremendous promise in pre-season screening programs for the future as more data emerges on those who are at greatest risk for concussion as well as having a cost-effective method to track increases in strength that can help prevent concussions.
My hope for all of the football players returning to the field this fall is to have an injury-free, successful football campaign.
Should some of our favorite boys of fall experience a concussion, my hope is that the information contained here might be helpful in their overall recovery.