As winter continues its frosty full-court press across the St. Croix River Valley, now’s a good time to up your awareness of mild traumatic brain injury (MTBI), also known as concussion.
What’s the connection between concussion and winter?
- Several of the sports where concussions most commonly occur are played in winter, including hockey, basketball and wrestling.
- Winter recreational activities — alpine skiing, snowboarding, figure skating, broomball —can all involve falls or collisions that cause blows to the head or body, potentially resulting in a concussion.
- In winter, even the simplest stroll to the mailbox can be interrupted by a slip on the ice and, bang, a broken bone, a fractured skull or — less visible but no less serious — a concussion.
Diagnosing and treating sports-related concussion is a year-long focus and passion for Dr. Lincoln Likness, who leads Hudson Physicians Sports Medicine. He’s served as a physician for multiple sports teams, from high school level to the pros. Dr. Likness is among a select group of physicians certified by not one but two medical boards for expert diagnosis and treatment of concussion.
When asked how to navigate another winter to be better informed to deal with concussion — especially sports-related concussion — Dr. Likness shared the following insights and information.
Putting context around sports concussion
What exactly is a concussion? The American Medical Society for Sports Medicine defines it as “a traumatically induced transient disturbance of brain function that involves a complex pathophysiological process.” Translation: An injury which disrupts normal brain function, with symptoms that are usually temporary. Dr. Likness relates this to scrambled wires in the brain cells.
Estimates show that as many as four million concussions occur in the United States each year. Health researchers believe that number is conservative, and that as many as half of concussions go unreported. While concussions can occur in all walks of life, a significant number happen in sports, with the highest incidences in football, cheer, hockey, rugby, soccer and basketball.
Helmets, mouth guards and other equipment can protect athletes from facial injuries and lacerations, but haven’t been proven to reduce concussion risk or severity. That’s in part because MBTI happens inside, when a blow or whiplash to the head, neck or body causes the brain to be jostled or jarred against the skull and bruised, sometimes severely.
Concussions — and the potential for repeat concussions — are such an important consideration and risk factor in certain sports that some athletes and their families are choosing not to participate after discussion with an MTBI expert. Meanwhile, athletics organizations and government agencies — including the Wisconsin Interscholastic Athletic Association and the Wisconsin legislature — have established guidelines and even laws designed to ensure that athletes who might have sustained a concussion are removed from action immediately and only allowed to return to participation (RTP) after being cleared by an appropriately trained medical professional.
“There have been important strides taken across a number of fronts to acknowledge the risk and promote the proper diagnosis and treatment of concussion,” Dr. Likness said. “It doesn’t mean concussions won’t happen. But I think as a society we’re more aware and better prepared to recognize and treat them properly than ever before.”
Concussion symptoms and diagnosis
What are the symptoms of concussion? Likness explains that in most cases — as much as 90 percent — the person suffering MBTI does not lose consciousness. Instead, common symptoms can include headache, balance challenges, nausea, blurred vision and sensitivity to light and sound. Concussed patients often describe feeling “in a fog,” and may exhibit drowsiness, confusion, difficulty focusing and irritability.
Fortunately, symptoms typically clear within one to four weeks. But Likness notes that accurate diagnosis, and development of a treatment and RTP regimen, should be left to medical professionals with concussion expertise. Parents, coaches and athletic directors who suspect a young person has sustained a concussion should help them get prompt medical care, starting right away on the sidelines (assuming a trained professional is present), getting them to urgent care or, at minimum, a next-day clinic appointment.
“We also need young athletes to be honest and tell their coach or medical team when they’ve experienced a hit that leaves them feeling abnormal,” Dr. Likness said. “Athletes who try to hide or ignore a concussion so they can get back to the action will likely experience increased symptoms, longer time out of their sport, and can face dangerous and sometimes deadly health consequences.”
Baseline assessment — a tool for concussion diagnosis and treatment
Concussed athletes typically are prescribed a recovery protocol that includes rest, some cognitive and balance assessments, and a medically guided return to their activity when appropriate. Upon symptom resolution and medical clearance, gradual increase in physical activity towards full practice, then game play, happens by following an internationally recognized guideline.
One of the assessments Dr. Likness and his team use with concussed patients is called ImPACT™, for Immediate Post-Concussion Assessment and Cognitive Testing. It’s a computerized assessment that measures, among other things, reaction time, cognitive processing speed, and visual and verbal memory.
Dr. Likness said ImPACT, as well as evaluation of an athlete’s medical history, balance and other factors, is especially helpful when conducted before the injury. That’s why Hudson Physicians Sports Medicine offers what are called baseline concussion assessments. Young athletes and active adults who take the assessment before getting injured give Likness and his team valuable data with which to evaluate injury severity, and the athlete’s progress toward recovery, should a concussion later occur.
Short of avoiding the head or body impacts that can cause concussion, there is no proven way to completely prevent it. Rule changes in certain sports have helped reduce some of the risk. Dr. Likness said his best advice to young athletes, parents, coaches and athletic directors is to educate themselves about concussion, identify concussions when they occur, and get the best medical care for an injured athlete as soon as you can.
“An important part of my practice is meeting with parents and athletes to discuss concussion and sports participation,” Dr. Likness said. “And at Hudson Physicians Sports Medicine we’re committed to working with local coaches, athletic directors, clubs and teams to ensure they have access to the health information and medical expertise they need to keep our athletes as safe and healthy as possible.”
Want to brush up on your concussion knowledge this winter? Dr. Likness recommends the following resources:
- Centers for Disease Control
- American Medical Society for Sports Medicine
- Wisconsin Interscholastic Athletic Association
Interested in scheduling a baseline concussion assessment for a young athlete — or for the adult athlete in you? Call Hudson Physicians at 715-531-6800.
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