Sports medicine is a newer field of medicine dedicated to preserving function and life passions. The profession blends elements of orthopedics, family medicine, emergency medicine and neurology.
One of the hottest topics in sports medicine over the last decade is concussion. From a decade ago, concussion research has moved with leaps and bounds. Within my practice, we now treat over 400 concussions a year.
Concussion is a blow to the body or head that leads to a shaking of the brain inside the skull and then subsequent symptoms. This fact, that a blow to the body can cause a concussion, limits how much a helmet or headband may decrease concussion risk, and there is no medical research that shows advantages from select equipment manufacturers at preventing a concussion.
A concussion injury leads to decreased neurological brain cell communication. Symptoms usually begin immediately, but they may be delayed by several hours. Contrary to popular belief, there is no imaging study that shows a concussion. Only in select cases is there even a need for imaging to be ordered; modern imaging studies only show anatomical destruction, whereas concussion is a purely brain-functioning problem. Symptoms come from three domains: somatic (how you feel), cognitive (how well you think) and emotional. Common examples of somatic symptoms include headache, dizziness, nausea and feeling tired. Cognitive symptoms include decreased ability to concentrate, difficulty with vision and decreased speed of thought. Emotional symptoms may include outbursts of anger, depression and tearfulness.
Immediately following a concussion, the brain begins to use massive amounts of energy to try and heal itself. This is why initially rest and decreased physical and cognitive activity is needed to allow for the most rapid healing of the brain. Usually, individuals will experience concussion symptoms for less than one week, but a very small minority may experience symptoms for a year or more.
Initially, it was thought that complete rest and as close to a black-room environment was the best treatment during this first week of a concussion. However, new research suggests this could lead to prolonged concussion symptoms in the pediatric population. A quiet, relaxed environment may be more optimal (think spa-like) and provide for more rapid healing. An even bigger discovery within the last year would suggest that at around one week after injury, light aerobic activity may provide quicker recovery for those with prolonged concussion symptoms. In fact, in my practice, I have seen a large decrease of prolonged concussion symptoms with this transition in care philosophy.
The last trend I would like to talk about is using ocular vestibular sensory and motor tracts to diagnoses concussion and as part of a postconcussion rehabilitation program. The ocular vestibular track is a select group of nerves that link our eyes and our balance system. Research has shown that stimulating these neurological systems can help a patient recover from a prolonged concussion.
Individuals who are symptomatic for greater than one month often benefit from rehabilitation. These programs are very intensive and involve multiple therapists – speech, occupational and physical – as well as neuropsychologists. These programs often employ re-establishing these neurologic pathways by practicing their functions in a repetitive manner. Various memory and balancing games, repetitive eye motions and musculoskeletal movement patterns are all used to overcome the brain circuitry deficits involved with long-term concussions.
New research being conducted, including my own, is establishing how well these systems can be used to diagnose concussion.
The understanding and treatment of concussion has changed dramatically in my career. I believe with future progress, sports medicine physicians will be able to help their patients recover faster and with less chance for prolonged symptoms and damage from concussion. This will lead to a more rapid transit back to the activities our patient’s love.
Dr. Shannon Woods is medical director of sports medicine at CoxHealth. He can be reached at shannon.woods@coxhealth.com.
