Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Case study ( 8365 views as of April 18, 2024 )

Bradley is a 20-year-old hockey player who collided with the boards after a hard body check. He was not knocked unconscious, but felt dizzy and nauseated. He could not remember the score in the game or the name of his coaches. A trainer at the rink assessed him for concussion and did not let him return to play.

Later, he developed a headache and couldn’t sleep that night. The next day he noted that his balance was off, he couldn’t tolerate any noise or bright lights, and he felt nauseated when looking at the TV or computer. He couldn’t organize his thoughts and he felt as though he was in a fog. He became irritable and occasionally tearful. He could not return to school.

Bradley should first be assessed by his family physician or a sports medicine specialist within 24-48 hours. He should not return to play for a minimum of four weeks, and not before his symptoms have resolved. A determination about whether a neurologist should be consulted and whether an MRI is needed can be made. Medications may be helpful to treat some of the symptoms. A psychologist may be consulted for management of mood symptoms and assessment of psychological function.

As his symptoms settle, Bradley may benefit from a graduated conditioning program under the supervision of a physiotherapist or athletic trainer. A plan for returning to play can be made with the help of his physicians. Persistent symptoms (post-concussion syndrome) may develop and he should be monitored by his physician until his symptoms resolve.

Author: Dr. Dean Johnston

Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Case Introduction

Symptoms Of Concussion In Sports

Presented by

Dr. Dean Johnston

MD, MHSc, FRCPC

Neurologist

Treatments

Cranial-Sacral Massage After Concussion In Sports

Practitioner help from:

Caroline Scherf

Massage Therapist
Treatment Options For Concussion In Sports

Practitioner help from:

Dr. Dean Johnston

MD, MHSc, FRCPC

Neurologist
Concussion In Sports - Future Recurrence

Practitioner help from:

Dr. Mariana Brussoni

PhD, Psychologist

Psychologist

Treatments

Use Of MRI To Assess Concussions

Practitioner help from:

Dr. Greg Louie

Radiologist
Sports Psychology To Help Recover From Concussion

Practitioner help from:

Dr. Mariana Brussoni

PhD, Psychologist

Psychologist
Tension Headaches and Concussion In Sports

Practitioner help from:

Dr. Steve Martin

BSc. Hons (Kin) MD MSc CCFP FCBOM Dip Sport Med. PG Cert Med. Ed.

Sports Medicine Physician

Conversation based on: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 08 January 2024

Although running is a great way to stay active, many runners have to deal with an injury at some point. More than 80% of running injuries are caused by repetitive stress, but sudden injuries like a sprained ankle or a torn muscle can also happen.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 31 December 2023

However, it can also occur without a direct impact to the head, such as when a person experiences a strong jolt to the body that causes the head to jerk rapidly. Concussions can lead to a variety of symptoms, both physical and cognitive, which can vary in severity and duration. Common symptoms include headache, dizziness, confusion, memory problems, sensitivity to light or noise, nausea or vomiting, fatigue, and changes in sleep patterns. In some cases, the symptoms may be subtle and may not be immediately apparent. It is important to note that concussions are considered a mild form of traumatic brain injury. However, they should still be taken seriously as they can have both short-term and long-term effects on brain function. It is crucial to seek medical attention if you suspect a concussion, as healthcare professionals can provide an accurate diagnosis and guide appropriate treatment and management strategies. Recovery from a concussion varies from person to person and depends on several factors, including the severity of the injury and the individual's overall health. Rest, both physical and cognitive, is often recommended to allow the brain to heal. It is important to gradually return to normal activities under the guidance of a healthcare professional to prevent further injury. In some cases, specialized rehabilitation programs may be recommended to address specific symptoms or aid in the recovery process. Overall, concussions should be taken seriously, and individuals who have experienced a head injury should seek medical attention to ensure proper evaluation and appropriate management.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
K. Michael 14 January 2016

I wonder if there is a change happening in concussion management. Just recently two children of friend's of mine have suffered concussions. They both had clear return to school and recovery plans provided to them by the hospital

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- K. Michael 14 March 2016
  
  I think this is a huge step forward @MichelleKaarto. I know when my daughter hit her head the doctor was worried about the wound and didn't even examine her for a concussion. It wasn't until a week later when we were at home that our family doctor brought it up.
- Michelle Kaarto, BScK, CSEP CEP 18 January 2016
  
  @K.Michael - I believe there is far more awareness today with the increasing focus on brain health and the impact of concussions. I think the schools and most family doctors are far more aware of the importance of monitoring symptoms of concussions, and of having a structured plan to return to school or work.
Michelle Kaarto, BScK, CSEP CEP 13 November 2015

Does anyone know if there is mandated training for coaches of children's recreational and competitive sports teams to help them assess concussions? I would hope that all coaching staff is trained to perform baseline assessments and then treat kids who sustain a head bump or injury, even at a recreational level since concussions can happen at any level.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- K. Michael 10 December 2015
  
  I know several people whose children play hockey and none of them have ever encountered staff trained in more than the most basic first aid
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 November 2015
  
  Certainly was not done in my children's soccer leagues in Vancouver.
AllieS 02 September 2015

I have come across literature that suggest high fat and/or high glucose diets might negatively affect cognition. Important to note that a rat model was used, but does anyone have additional information on whether or not this might be useful for Bradley's recovery?

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- K. Michael 07 November 2015
  
  That's very interesting. I wonder if what is normally considered to be good fats - avocado is an example - would in turn help in healing a concussion or dealing with the side effects
Dr. Cirelle K. Rosenblatt RPsych PhD, CIC Psychologist, Vancouver, BC 06 July 2015 Advance Concussion Clinic

Concussions most definitely affect a student's ability to learn and retain information. Primarily because a prominent symptom of concussion is diminished ability to focus or sustain attention. This directly impacts and impedes the ability to encode or store that information, an integral part of the learning process. Return To Learn must be managed in a similar way to Return to Play, or recovery can be prolonged or complicated. Consulting with a concussion specialist, such as at Advance Concussion Clinic, can support a healthy and safe Return all around.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
Dr. Cirelle K. Rosenblatt 22 April 2015

This Case Study touches on a number of navigational challenges for the average concussion patient. While it can be clear that the athlete must not return to sport in the immediate aftermath of the injury, the return process can be difficult to manage. How long should an individual rest? What happens if symptoms don't resolve spontaneously? And, for students for whom return to learning should begin within 3-5 days post-injury, how can this be balanced with ongoing recovery? Concussion rehabilitation to address commonly affected systems--preferably by an interdisciplinary team--can be valuable in supporting healthy recovery, successful return to learning, and a guided return to normal exertion tolerance and

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- AllieS 09 December 2015
  
  @K.Michael, I believe it does! Especially if more than one concussion has been sustained, the effects accumulate since damaged brain cells don't regenerate.
- K. Michael 30 June 2015
  
  Would a concussion affect a student's ability to learn and retain information ?
Gordon Bohlmann Physiotherapist, Vancouver, BC 08 April 2015 Marpole Physiotherapy Clinic

One of the most important advances in concussion management is the need for base-line testing. A baseline test is simply a tool that allows a comparison to be made following a suspected head injury. Without pre-injury scores, it is not possible to accurately determine how the brain has been affect. MRI's are not accurate enough to be able to determine the brain's function following injury. Base-line testing looks at a number of parameters such as balance and coordination, cognition, memory, reaction time and so on. Some of these tests are available on-line, but the best baseline tests are a combination of online and in-person tests with a trained professional. Having something to compare to following an impact to the head or neck allows the player and his/her medical team to be able to accurately determine if the player is at risk of the possible lethal "second impact syndrome", and safely decide how the player should be rehabilitated and returned to play. Completeconcussions.com has more information and 110 clinics across Canada.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- Joy 24 April 2015
  
  Baseline testing is becoming mandatory in children's minor hockey leagues. I think it is a great idea. I did not know it was a good idea to have it repeated at the beginning of every season.
- Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 13 April 2015 Vitality Clinic, Downtown, Vancouver, BC
  
  @KMichael- yes! Anyone who plays an impact recreational sport should definitely have a base line test performed at the beginning of each season. I would recommend you seek out a health care practitioner proficient in administering testing versus doing an online test.
- K. Michael 13 April 2015
  
  Would you suggest that anyone that plays recreational sports do an online base line test ?
Alison O, B.Sc. 29 March 2015

It is extremely important for sports teams, whether children or adult, to have coaches trained to assess concussion and head injuries. My husband obtained a head injury while playing rugby. He returned to the game after sitting out for 10 minutes. one week later, when he was still vomiting frequently and unable to work due to the headache he received an X-ray and 3 broken vertebrae were discovered. 14 years later he still has difficulty with his head and neck and is no longer able to play team sports. The outcome could have been significantly worse

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- ShirleyG 01 April 2015
  
  Is there a protocol in place for a team member to be assessed after an injury occurs ? Should the coach / trainers not suggest a person be checked out when an injury happens - especially a head injury ?
T.Brown 26 March 2015

I have started hearing about baseline testing for athletes - some of the children - in case of concussion. Is there any validity to this practice? What does having a baseline help with?

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 21 March 2015 Vitality Clinic, Downtown, Vancouver, BC

Working as a former trainer for rugby and hockey players, I have seen some pretty significant concussions in my day. The gold standard for on-field assessment is the SCAT2 Evaluation system. There are also rigid return to play (RTP) guidelines that should be followed by athletes who have suffered concussions. It is extremely important in an attempt to prevent second impact syndrome and post concussive syndromes. I also highly recommend the athlete be seen by the same health care practitioner over the course of a few months so proper monitoring can ensue.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- K. Michael 27 March 2015
  
  I think this is great advice. These days it's common for people to NOT have a family doctor. Which means that follow up on an injury can involve multiple physicians. Continuity is vital to make sure nothing is overlooked.
Michelle Kaarto, BScK, CSEP CEP 17 March 2015

I'm curious as to the various field tests that are used to diagnose a suspected concussion in the field. I know we have done some research on the impact of balance testing and concussion, which can potentially be used to monitor recovery from a concussion (i.e., balance getting progressively stronger as injury resolves). @Dr. Johnston, what field tests are you aware of that are used in these situations? Are all trainers/coaches adequately knowledgeable on how to assess for concussion?

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
K. Michael 03 March 2015

Two summers ago my daughter fell on vacation and cut her temple open. The doctor glued it shut but didn't really do any further exam, just advised we take it easy for that day. She had headaches and dizziness for a month after. Our family doctor suspected that she had a minor concussion that was never diagnosed. It happens a lot easier than people assume and is really something that should be taken seriously

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- ShirleyG 23 March 2015
  
  It seems many concussions go untreated, as the patient does not express much concern and the doctor treats what they can see. We had a family friend fall off a swing and hit his head on the wooden deck. There was a small bump and a bit of redness, which he didn't think anything of. Another friend who is a nurse took a quick look at it and said to put some ice on it and he would be fine. Later that night he started to feel dizzy and vomit but didn't put two and two together and thought he might have a tummy bug. This continued through the night until his wife suggested he go to the ER and have it checked out. The ER doctor did an exam and told him he may have a mild concussion and to monitor it. Several months later he was playing hockey with a group of friends and hit his head pretty hard and was taken to the hospital. They did some tests and the doctor asked if he had a concussion before and he explained the previous situation. The doctor was not pleased as there appeared to be some damage and he was told not to play physical sports for the time being. He is now being monitored for head injury.
Dr. Cirelle K. Rosenblatt RPsych PhD, CIC Psychologist, Vancouver, BC 02 March 2015 Advance Concussion Clinic

This Case Study touches on a number of navigational challenges for the average concussion patient. While it can be clear that the athlete must not return to sport in the immediate aftermath of the injury, the return process can be difficult to manage. How long should an individual rest? What happens if symptoms don't resolve spontaneously? And, for students for whom return to learning should begin within 3-5 days post-injury, how can this be balanced with ongoing recovery? Concussion rehabilitation to address commonly affected systems--preferably by an interdisciplinary team--can be valuable in supporting healthy recovery, successful return to learning, and a guided return to normal exertion tolerance and sport.

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- K. Michael 15 March 2015
  
  Many times patients receive conflicting advice which makes the situation more difficult to manage their recovery.
ShirleyG 02 March 2015

Once a person experiences a concussion, are they more susceptible to having another one ? What are the consequences related to multiple concussions ?

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- Michelle Kaarto, BScK, CSEP CEP 17 March 2015
  
  @Shirley, concussions can definitely recur more easily if one returns to sports prior to being completely rehabilitated. It is so important to have the post-concussion period monitored by the appropriate medical team and ensure that the coaching team is on-board with the return-to-activity plan, if applicable.
ShirleyG 02 March 2015

Concussion are becoming more and more common not only in sport but in the playground as well. There is a concussion protocol at the school where a student must see a doctor if they have a severe bump to their head. They are not allowed back into the school without a signed form from the doctor stating they are ok and do not have a concussion. Is there signs that can appear after the 24hr mark or are the individuals in the clear once 24hrs has passed ?

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "
- Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 26 March 2015 Vitality Clinic, Downtown, Vancouver, BC
  
  @T.Brown if a child bumps their head in additional to physical signs of bumps and bruises, you should look for any changes in their behaviour. This includes, but isn't limited to loss of appetite, lethargy, inability to focus on an object, and emotional changes. For the next few hours after, keep their activities limited to very low stimulants- NO technology. If the child still exhibits unusual behaviour after a few hours, I would always err on the side of caution and bring them to the ER. A quick tip for minor bumps and bruises is to place a cold spoon directly on the site for 2-4 seconds, remove, and repeat again a few times. It's as effective as ice without the mess. :)
- T.Brown 26 March 2015
  
  What should we look for when a child bumps their head? That happens a lot! and it would certainly crowd up medical waiting rooms if we went to the doctor/ER for every head bump. But you wouldn't want to miss a concussion either. So what should parents look for?
- Michelle Kaarto, BScK, CSEP CEP 17 March 2015
  
  That's great that the school has a protocol like this in place. I hope we will see more of this when a student falls at school. I know my daughter experienced a bad fall at school and hit her head, and I was contacted. She hadn't lost consciousness, but the school said they simply weren't comfortable making the call on whether she needed assessment so I had her seen by our physician immediately. It's one of those injuries where earlier intervention is ideal.
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 February 2015

Dr. Johnston, I am wondering what the treatment is in those initial 24 hours at home. Is it best for the person to just sleep, or stay active but calm? Would they take any medication, like Advil or Tylenol? thanks

Reply to: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "