Managing A Concussion

Shift Concussion Management Program

Shift provides an advanced approach to concussion awareness and management.

Initial Steps To Recovery

Once a medically trained doctor has assessed a concussion the injured person must follow certain guidelines to help assure a full recovery. The best medicine in the early stages is REST, and this does not just physical rest, but COMPLETE rest. Your brain needs time to heal and like all injuries that time will vary with the person, the intensity of the injury and the frequency.

Complete rest is recommended in the first few days following injury to help ameliorate the metabolic energy crisis that’s taking place in the brain. Complete rest is not something that should go on for weeks on end. If the symptoms are not clearing up in the first 7 days an individualized management strategy is needed – for example: from an organization like Shift Concussion Management or a Healthcare Professional to help guide recovery and identify any specific areas that need to be addressed.

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Avoid

  • TV
  • Computers
  • Video Games
  • Text Messaging
  • Cell Phones
  • Radio
  • Bright light
  • Loud Music or Noise
  • Reading
  • Studying
  • any other strenuous brain exercise

School Aged Individuals

Rest should be continued until all signs and symptoms have resolved. Rest in this demographic should and would include exclusion from school. When trying to learn the brain is working, thus not resting. Even if the kid went to school the bright lights, the loud noises and the exercise the brain needs to just navigate the hallways is enough to impede progress in resolving this injury. As a reminder, it may be good to take the cell phone, computer and video game systems from the kids. They should return to school when all signs and symptoms have resolved.

Return To Activity

Current graded return to play guidelines for athletes that have sustained a concussion. This particular model was adapted from the 3rd International Conference on Concussions held in Zürich in 2008. Important to note is there are no guarantees on timelines so always consult a proven medical doctor who has taken training in dealing with concussions before returning.

The Steps To Return

  • 1. No activity, only complete rest, proceed to step two only when symptoms are gone.
  • 2. Light aerobic exercise such as walking or stationary cycling. Monitor for symptoms and signs. No resistance training or weight lifting.
  • 3. Sport – specific activities and training (eg. skating in hockey). No contact or risk of contact.
  • 4. Drills without body contact. May add light resistance training and then progress to heavy weights. The time needed to progress from non-contact to contact exercise will vary with the severity of the concussion and player.
  • 5. Begin drills with body contact.
  • 6. Game play.
As stated above each step should be only attempted if there is NO signs or symptoms as they relate to the concussion. It is also important to realize that a concussion or head injury, in general, will not resolve in a typical linear fashion. Meaning that “on day one you have this and by day 7 you should be here,” as is common with other general orthopedic injuries.

The head is mysterious and responds differently for each individual person. Set-backs will be common and should be expected. When they do occur you should regress to the previous step in this process and begin again. They should not return to school until symptoms have improved significantly. At the start, school days may need to be modified (ie. Half days, frequent breaks, etc.).

Keys To Recovery

After a sports concussion physical and mental (e.g. cognitive) rest are keys to recovery, says Dr. William P. Meehan, which means no video games, homework, or other activities that tax the brain and force it to work extra hard.

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Deciding To Return

When it is safe for a youth or high school athlete to return to play contact or collision sports after symptoms of concussion clear depends on many factors, says Dr. William Meehan, including the athlete’s age, baseline test data, time symptoms take to clear and severity, and concussion history. Once symptom free, it is recommended that each athlete undergo a graduated program of exercise testing. Similar to weight training, athletes recovering from a concussion should not skip to 100% exertion from 0% in a short time frame. Physical exertion testing is important not only for physical re-conditioning, but to guard against symptom relapse and help prevent premature return-to-sport. It is well known that concussive symptoms can be aggravated with exercise and even though you may feel well, running, jumping, or stick handling are things that may cause your symptoms return.

The return-to-play process is gradual. The first stage typically involves light cycling or jogging to elevate your heart rate a moderate amount. If no symptoms are aggravated either during or for 24 hours after this exercise session, you may progress to a more difficult workout routine. Eventually you may advance to on-field or on-ice practice and finally full game play (with proper medical clearance). The whole process could take anywhere from 5 days to 2 weeks depending on your specific situation or the stipulations of your governing sport organization. At any time if your symptoms return, you must return to a lower level exertion (or modified activities) depending on the advice of your health professional.

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Please note: The above list is not exhaustive nor does having one or more of these symptoms mean that someone has a concussion. It is merely a guide to possible concussive symptoms. It is important to seek medical attention.

Be mindful and remember that if you suspect a head injury/concussion that you should consult a medical professional, preferably one that has experience with concussions and return-to-play.