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April 23, 2020 - TCO

Concussion Care: The Complete Guide

Hey everyone!!

Hope you are staying safe during this crazy and stressful time.  Thanks to everyone for doing what they can to “flatten the curve” in our community.  The medical professionals and other essential workers all thank you.  Hopefully soon, we all will be gradually getting back to things we want to be doing.

While we all have a bit of a “new normal,” many people continue to stay active.  This is a good thing for overall physical and mental health.  With our improving weather in Minnesota, we continue to see a lot of the usual injuries people come see us for at Twin Cities Orthopedics.  One of these issues are concussions.  These can happen from a variety of activities.  Motor vehicle accidents, biking, playing in your yard or other work activities are common activities still causing head injuries.  Sports related concussions are something we see a lot of in the clinic and on the sidelines.  I work with the Minnesota Vikings, Minnesota Twins, University of St. Thomas and Bethel University.  Even though sports activities with these teams are quiet right now, people are still getting concussions from everyday life.

Concussion Symptoms & Self-Treatment

FAQ: What should I do if myself or a family member sustained a possible concussion injury?

  1. You do not necessarily need to be immediately seen for evaluation by a physician.
  • You should monitor your symptoms over the next 24-48 hours for any significant changes and watch for “Red Flags.”
  • “Red Flags” are a list of symptoms which may indicate a more serious injury. Should any of these symptoms arise, seek emergency medical attention. These include:
    • Significant Headache (10 out of 10 pain)
    • Slurred Speech
    • Lack of Coordination
    • Vomiting (more than 2x)
    • Seizures
    • Stumbling/Loss of Balance
  1. We expect a myriad of symptoms associated with a concussion injury. It is important to understand that every concussion is unique and each person may have different symptoms and symptom severity.

Common symptoms to expect after a concussion include:

Headache Blurred and/or double Vision Sadness
Head Pressure Fatigue Nervousness
Nausea Trouble Falling Asleep Feeling More Emotional
Mild Balance Problems Sleeping More Than Usual Feeling Slowed Down
Dizziness Sleeping Less Than Usual Feeling Mentally “Foggy”
Sensitivity to Light Drowsiness Difficulty Concentrating
Sensitivity to Noise Irritability Difficulty Remembering

 

  1. There are some activities or strategies you should and should not be doing in the first 24-48 hours after a concussion injury.
    • IT IS OK TO:
      • Use Tylenol (Acetaminophen) for headache and neck pain
      • Use an Ice Pack on the head/neck
      • Eat and drink fluids as tolerated
      • Try to get a good night of sleep (7-9 hours)
      • Complete school work to symptom tolerance
      • Use a computer, tablet, or smart phone to symptom tolerance
      • Do light activity, such as walking & light daily chores, to symptom tolerance
    • THERE IS NO NEED TO:
      • Check the eyes with a light
      • Wake up every hour
      • Stay in bed or a dark room
    • PLEASE AVOID:
      • Drinking alcohol
      • Driving
      • Strenuous physical activity, such as running, weight lifting, sports, heavy yard work
      • Taking NSIADs for your headache, such as Advil, Aleve, Aspirin, etc.
  1. What exactly is “symptom-limited” activity?
    • This is a term we use in the concussion world to advise patients how much activity is “OK.”
    • Think of it like Goldilocks… Too little or too much activity can cause increases in concussion symptoms or a longer recovery.
    • We use a scale of 0 (none) – 10 (worst ever) to measure symptoms & “symptom-limited” means we stop activity after symptoms increase by more than 2 points.
      • For example, if your headache is a 4/10 and you start an activity like working on the computer, you are okay to work until your headache reaches a 7/10 – then take a break until your symptom settles to 4/10.
      • Same goes for symptoms like dizziness, nausea, sensitivity to light, etc.

When to Seek Professional Treatment

FAQ: When and how should I be seen for evaluation of a concussion injury?

  1. You should plan to schedule a visit with a physician who specializes in the treatment of concussion injuries 3 to 4 days after the injury.
    • If your symptoms have been ongoing for more than a few days, you should schedule a visit at your earliest convenience.
  1. Yes, this is a visit that can be done utilizing Virtual Care!
    • Due to the need for clearance for return to sport, concussion visits have been done via telemedicine over the last few years. Typically, this has been for patients in rural areas who may not have access to a provider who specializes in concussion injuries. This has become a successful strategy during the COVID-19 pandemic.
  1. What to expect during your telemedicine visit for a concussion evaluation?
    • Review of your current symptoms, including what makes your symptoms feel better or worse.
    • Review of personal and family medical history that impacts concussion treatment options.
    • Limited physical examination possible via Zoom, if indicated. This may include:
      • Cognitive exam evaluating orientation, memory, & concentration
      • Coordination & limited balance exam
      • Vestibular & Ocular Motor exam

About Concussion Treatment

FAQ: What should I expect as part of treatment for a concussion injury?

  1. The first step is to review appropriate behavior modifications, symptom management strategies, and establishing a good routine (even if quarantined)
    • Review good sleep hygiene strategies
      • 7-10 hours per night – too much or too little sleep can impact recovery
      • Consistent bed time and awake time is very important, but is different for each individual and family
      • Try to limit napping – if needed, no more than a 20-30 minute nap per day
      • Too much napping can disrupt your normal sleep pattern
  • Review appropriate nutrition for recovery of your concussion
    • Avoid skipping meals
    • Nauseous? Try dry foods (crackers & toast) or cold foods (sandwiches). Avoid very sweet, greasy, fried, or spicy foods.
    • Make sure you are hydrating with clear liquids
    • Avoid or limit caffeinated drinks & supplements
  • Guidance for appropriate light aerobic exercise
    • Recent research shows light, symptom-limited aerobic exercise can help with concussion recovery.
    • Early exercise may include exercise bike or walking activity at a target heart rate.
    • Daily exercise helps manage our level of stress, improve our mood, and help with good sleep regulation.
  • Specific symptom management strategies
    • This may include suggestions such as utilizing blue light blocking or computer glasses during screen time to help decrease symptoms.
  1. For some patients, there is a role for medications to help manage symptoms
    • We will discuss possible medication or supplements to help manage your symptoms
    • If indicated, these recommendations are specific to symptom profiles and vary from patient to patient
  1. Other patients may need a formal rehabilitation program. At TCO, we have sub-specialized physical therapists who will guide you through your rehabilitation program.
    • Vestibular Therapy – helps address issues with dizziness, balance, & other symptoms
    • Ocular Motor Therapy – helps address issues with vision, focus, & other symptoms
    • Exertion Therapy – helps in the overall recovery of concussion injuries
  1. Finally, we can provide Return to Play Guidance specific to the sport or activity you would like resume, when appropriate
    • If you return to sport activity before your concussion is healed, you are at risk for re-injury. This may result in a much longer recovery.
    • Ensuring that you are symptom-free and have a normal exam.
    • Providing a sport-specific, step-wise return to activity progression.

Conclusion

Concussion is a complex problem with no two concussions really being the same.

I just want to thank everyone for doing their part to help fight this COVID-19 pandemic.  I know how tough, and at times tragic, this has been for people in our community and across the world.  I work in the area of sports medicine, and there are currently no sports, which is tough.

People are without work, have loved ones’ sick, or worse. Our community is amazing! That gives me hope every day as we go through this tough time.  Our medical community is second to none. Our leadership is stepping up. We will get through this everyone!

Just remember that even during this time, we here at Twin Cities Orthopedics are still here for you. Virtual visits/telemedicine visits, in-clinic visits for urgent needs and PT are all still available. Other medical concerns, like concussions, continue despite COVID-19 being the prevailing concern for everyone.

If you have concussion issues or other concerns, don’t hesitate to contact us. We are here for you all during this time!!

Be safe and be well!!

David Olson, MD and Chris Ashton, ATC