Ortho on the go
Ortho on the go
Discussion on how to evaluate and treat concussions
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Welcome to the Ortho on the Go podcast. My name is Chuck Dowell, host of the podcast. This is an educational orthopedic podcast focused on discussing both clinical and functional orthopedics. We will discuss a variety of topics within the field of orthopedics, including reviewing interesting cases, hearing from different professionals throughout the orthopedic profession, and discussing common musculoskeletal injuries and complaints. This podcast is meant for anyone that wants a better understanding of orthopedics, including all levels of practitioners, coaches, parents, and athletes themselves.
SPEAKER_01Well, thank you for having me. My name is Emily Kosderka, and I'm currently an assistant professor of health and human performance at Linfield University, just outside of Portland, Oregon.
SPEAKER_00Yeah, thanks for coming on, Emily. Thanks for joining the Ortho on the Go podcast. Um Emily was my mentor, basically, right? You taught me everything I know.
SPEAKER_01I don't know. I think there was some of the other way around going on.
SPEAKER_00Yeah. My first athletic training job was with Emily. So um she definitely taught me most of the things I know, but we thought it'd be good to have you on to discuss concussions. Concussions is a big topic. Um, and so there's definitely a lot of concern regarding concussions and a lot of new literature. Um, and and you've kind of stayed up with that. So I guess start from the beginning. Let's say I'm a practitioner, just seeing somebody, athletic trainer on the field, don't have very much experience with a concussion. What are kind of the first things or first steps if a patient comes in and has kind of concussive-like symptoms? What are you looking for? What are you doing?
SPEAKER_01Yeah, so typically whether it's an acute injury evaluation when right after the injury happens, or if it's the first time the patient is presenting in your clinic, really what we want to be doing is evaluating a number of different things. So when we think about the multifaceted problems that could happen from a concussion, it really stems back from what parts of the brain could potentially be affected. So when we're evaluating, we're looking at things like memory and orientation. We're looking at both long-term memory, short-term memory. We like to test uh concentration, we like to do some oculomotor testing, looking at things like balance and coordination. And there are a number of tools that are widely available for a wide variety of healthcare practitioners to learn about and be comfortable using. Probably currently the most widely accepted is going to be what's called the SCAT six. And that came out of the most recent concussion and sport group meeting that was held in 2023. Um the other thing that came out of that meeting from an evaluation standpoint that it's really important for, I think, especially the population of providers who don't see the patient right when the injury happens, is what's called the scope. And so that's really meant to be a tool that is used in the office in the days following the actual injury.
SPEAKER_00Yeah, and that's the nice thing. I feel like, you know, I work in an orthopedic urgent care clinic, but I have an athletic training background, so I'm somewhat familiar with concussions, but um, we don't have the SCAT or the scope in the office, but they're pretty easy to find online. You can Google it, print it off. Um, you can have the patient fill out the first part of that aspect, and then a lot of it just kind of walks you through very simply on um how to fill out the rest of it. It is a bit time consuming, so those are definitely longer um appointments, but let's say we didn't have access to a scatter a scope and or you didn't have the time to fill them out. What are, you know, what are the concerning symptoms? What are some of the misnomers? Do we still have to wake people up once an hour to kind of make sure that they're cognitively there? You know, what's something from a simple perspective we can do for an evaluation?
SPEAKER_01Yeah, great question. And I think it's an important one because you're right, not everybody has the availability of the scope or the scat or the time needed. It's really about 25 to 30 minutes to conduct those evaluations. So I think asking some basic questions about memory and orientation is a good way to start trying to get a sense of the patient's recollection of what happened, what they were doing, when the injury happened, as much information as we can get about how they're doing with just understanding what happened to them and where they are currently. There are some other really simple tests that we can look at when we're wanting to evaluate concentration. And um I'm smiling as I'm talking about these because I just used these in class yesterday, and it's always fun to do with the students. But just doing things like serial sevens. So we ask them to count backwards from 100 by sevens. We'll get that, have them give us the days of the week in reverse order, the months of the year in reverse order. The other thing that we like to do is have them remember a list of about five or six words. We'll ask them to repeat those back to us. And then at the end of the evaluation, we'll ask them to tell us as many words as they remember from that list that we gave them in the beginning. So those are some really simple tasks that can be done, really by anyone. And then depending on the level of training, um, I think that it's it's really good for healthcare practitioners that will see concussions, like in an urgent care setting, to become more familiar with the bombs testing. So the vestibulo oculomotor screen is is an excellent tool to use. And then also some basic balance testing. And for for the old school out there that are similar to myself, we remember the Romberg test. And um, currently there's the best test. So have them balance on two feet and close their eyes and see if they can hold that position. So those are really some easy ways that I think anyone could get a pretty good assessment of how the patient is doing. As for your other question about the red flag symptoms, so there's going to be a little bit of a difference between whether we actually see the injury happening and then that injury coming into a clinic later. But really, the red flag symptoms that we look for are obviously loss of consciousness. Um we'll also look for the posturing. And so um, if you if you're familiar with the fencing response, or if you Google the fencing response, or if anyone out there is familiar with uh the football player Tua Tagliovera, um, that was a a pretty significant series of injuries that really the world got to see what the fencing response looks like. So those are a couple of our red flag symptoms, but then also vomiting. Vomiting is actually less common in a sport-related concussion than I think people think. Um, and then really just the biggest one is do they deteriorate? So they may have no loss of consciousness, but within 10 or 15 minutes, they're really complaining of a significant headache, or they start to vomit, or they start to really have a difficulty walking or keeping their balance. Those would be some of the red flag symptoms that we would definitely want to be referring to emergency room or urgent care.
SPEAKER_00Yeah, I think it's always difficult because um, you know, not a lot of us get a witness the concussions unless they're the athletic trainer on the sidelines. And then let's be honest, even if they're the athletic trainer on the sidelines, oftentimes it's hard because you're distracted by other players getting injured and things like that. So a lot of that you have to rely on their description of the mechanism and potentially who brought them in and/or who's with them. So family members and uh from a neurocognitive standpoint, I always ask the family members if they think there's some concern as far as their ability to remember things or the way they're acting. Um I definitely think that information. And as you said, the best, um, you know, it's easy to do kind of balance activities in the office, um, single leg, um, you know, tandem balancing where they have right foot in front of left and left foot in front of right, and we all have one weak side where we're gonna have more corrections on. Um nystagmas, I think is a hard one. Um, we've discussed this before. I think we all have some level of horizontal nystagmus just, you know, when evaluating. And so what's your thoughts on those when evaluating for concussions? I know it's not necessarily a reliable indicator.
SPEAKER_01Yeah, I think it's one of the many things that we want to look at. And it's something that I really try to emphasize is currently, if you think about it, the best diagnostic tool that we have for concussion is a well-trained healthcare provider. And so I think when it comes to looking at oculomotor function and astagmus in particular, a lot of that expertise is going to be garnered by a lot of experience. So people who see concussion frequently, who who do look for an astagmus, who do a lot of oculomotor screening, a lot of bombs testing, are going to become much more comfortable with learning to see what those dysfunctions look like. So what's happening with saccades, what's happening with smooth pursuits. And so it's a hard one to just uh give a real quick tip to. Um, but it's one piece of the puzzle. And so if everything else is looking good, then we may have a situation where potentially, as you said, that may be normal for them and they may or may not have known that piece. So that's it's it's both uh, I think the the difficulty of managing concussion and evaluating concussion, but also the puzzle and kind of what keeps us all intrigued is how do we put all of these pieces of the puzzle together and come up with as accurate of a diagnosis as we can, given that we don't have any imaging. We're just relying on clinical evaluation.
SPEAKER_00Yeah, and that's that's always the difficult part. And I know sometimes, you know, when patients are sent in for me to evaluate them from concussions, it's always hard because I've never met them before. And so a lot of the times I'll call the athletic trainer who sees them on a daily basis. Like I said, I'll require, you know, I'll ask the you know, parent that's with them. Um, the other thing uh is a lot of towns and or you know practices have concussion clinics. And so if you're somebody that's not familiar with concussions, it's nice to know if there's a concussion clinic, somebody that specializes in in town, and that could possibly be a referral source for you if you're not familiar with them, which I think can be helpful as well.
SPEAKER_01Definitely.
SPEAKER_00So we see the patient in clinic. Um we kind of diagnose them with a mild traumatic brain injure concussion. Um, what are your recommendations as far as you know, uh there's obviously a lot of tools out there. We have impact testing and neurocognitive testing to kind of return to sports. We have, you know, progressive return to sports. We were talking the other day about the importance of blood flow and kind of movement. Um, so what's your like spiel that you give that that athlete, that patient that comes in with a concussion, and you say, This is your take-home message, this is your take-home instructions.
SPEAKER_01Yeah, great question. I think uh the best news is that we just now have so many different interventions to help people recover from concussion. And so typically the the take-home message that I will give to a patient or an athlete or their family is um, especially if the injury has just happened, really the evidence says take one to two days and really dial back your activities. Um, don't do anything that exacerbates symptoms. And the most recent evidence does show that there's a good relationship between decreasing screen time for that first 24 to 48 hours and improved recovery. So I usually tell them as much as possible stay off your phone, you know, don't do anything that you're using a computer screen, maybe just uh watch TV, watch Netflix, anything that doesn't make those symptoms worse. And if they do start to get worse, don't panic. Just dial back what you're doing at the time. What we want to make sure that they uh don't do is sit in a dark room, be cut off from all social networking, from their people in their family. We want them again to just have a level of activity that they're comfortable with that doesn't really provoke the symptoms or make their symptoms any worse. And that's one of the biggest things in in that acute phase, that first couple of days after the injury. Other things for that acute phase I try to remind them of is um eating. So oftentimes with concussion, it can really have an effect on the appetite. So I really encourage them to eat a little bit at a time, whatever they can eat. Um one of the questions that comes up all the time is treating headache. And the guidelines are pretty clear on this, that it's okay to treat headache with Tylenol, acetaminophen. And I don't think that that's a bad idea. I'll be honest. One of the things that I recommend is, especially in that first day, unless, you know, their headache is really bothering them. I I try to stay away from medication just because I want to know what those symptoms are doing. I want to know if that headache is actually worsening. Um, you mentioned, do we wake them up? So this has been one of the great advances in our understanding of how to best manage concussion. And what we have come to realize is that sleep is great for the healing brain. So we really encourage our patients to sleep. Uh, we want them to sleep as much as possible. So that's okay. We no longer need to wake them up every two hours. And I have been doing this long enough that I remember those days. And I remember having very grouchy athletes the next day, as well as their roommates were now very grouchy. Um, so yeah, so we want them to sleep. So sleep, eat, don't do anything that really exacerbates symptoms, and really just dial things back for a couple of days.
SPEAKER_00I I too have been doing it long enough where I remember those days. And you basically took two athletes out of the equation because the roommate had to wake them up once an hour, and then that athlete was out for, you know, so yeah, you you took two athletes out, which you didn't realize until after the moments. But yeah, I think one of my biggest things that I feel like is is understanding the neurocognitive component of concussions and you know the the screen time. I mean, you know, unfortunately we're in a social media generation. We all have phones and we all spend a lot of time on our phones, but that does create some stimulation to the brain. And sometimes that's over-stimulation, it can exacerbate symptoms, and sometimes that stimulation can help the brain stay in a healing process. And so I think that's great advice. You know, um, have them still be participants, don't go lock themselves in a dark room, but depending on their symptoms, right? Some sensitivity to light, sensitivity to noises, you know, um, could require some kind of um alone time if necessary. And then sleep in general, right? I mean, sleep helps recovery from athletic injuries and it helps recovery from concussions. Um is there any specific, you know, so so diet has been a big thing, especially across the orthopedic community, as far as recovery from injuries. And, you know, we just did a discussion on diet prior to surgery and the importance of a protein-based diet after surgery as far as tissue healing. Is there anything specific from that recommendation that you know of? Do we do we recommend a high protein diet? Do we recommend carbohydrates? Um, is there any specific recommendations there?
SPEAKER_01Yeah, so it's interesting that you bring this up because this area of understanding with concussion, I think is just wide open. I think we know very little about the true effect that nutrition can have on recovery from concussion. There are some things out there there for a little while, there was a recommendation to take fish oil. Um, and there's not really any compelling evidence to do so, but on the flip side, there probably wouldn't be a negative to it. I do try to recommend carbohydrate intake, uh, because as we know, that that source of glucose is really important for brain function. Hydration is also really important. So I look at at water as being a food group. Um, sometimes that that battle for just getting them to eat something, I I will honestly just fall back on whatever sounds good, whatever has calories in it, get it. And again, we just don't have a lot of great research evidence. I will say there's some emerging evidence looking at the role of creatine, both as a preventative measure and as well as recovery, but it's really early in that area of research. And so I couldn't uh go on record as recommending it one way or the other. So for those out there that are listening and interested in nutrition and um looking to do a master's degree or maybe another PhD, we could really use some uh some more information in this area.
SPEAKER_00Yeah, even just for tissue healing or post-surgical or post-injury, I think it's a growing kind of uh area where a lot of research is being done and definitely a modifiable area. I think anything that's a modifiable area as far as in sport medicine orthopedics, we're always interested in because those are things that we can change that potentially can have better outcomes. Some things are non-modifiable and we can't necessarily control. So um, those are always areas of research that are good. So we we've seen the athlete or we've seen the you know the individual in clinic, we kind of went over the concussive symptoms, we ran a SCAT exam on them, we gave them the recommendations as far as you know, uh 36, 48 hours or so of cognitive rest. Um, there's multiple return-to-play protocols and different um states and different districts may have their own specific return to play protocol. But what's a general guideline regarding that? We know as we get the heart rate up, we could cause increasing symptoms, correct?
SPEAKER_01Correct. Um, but that's really the the biggest message that we're trying to get out right now is get them moving. So it doesn't necessarily mean return to play, and they shouldn't return to play as long as they have symptoms. And so we kind of have I look at it as three distinct stages. We have that acute phase after the injury, that 36 to 48 hours, and then we have the the middle recovery before all of their symptoms have resolved, and then we have that return-to-play protocol that we use once symptoms have resolved. And so oftentimes it's it's that second phase or that middle phase where there are a lot of questions about what the patient should and should not be doing. But really the evidence has become pretty overwhelmingly convincing that they do better if they move. So you mentioned increasing heart rate and we want to do that. There's actually some pretty good studies that show that the sooner that they start exercising and using aerobic exercise after the injury occurs, the the shorter their recovery time. Um we really hope that they're recovering better, not just faster by implementing exercise early. And this, to be clear, is during the symptomatic period. So a lot of research has shown that we can actually exercise and primarily in an aerobic fashion. So going for a walk, riding a stationary bike, even for some patients that can tolerate it, doing some like jogging. And as long as we don't exacerbate symptoms to to really the where the point that they feel sick, exercise has been shown to be very safe and effective during this stage. I also want to be really clear that this is really exercise that does not put them in harm's way or put them in a situation where they could receive another blow where they could get another concussion. So it's really a a safe, controlled exercise that we want them doing in an environment where preferably there's some supervision, but where they're not pushing themselves to a point where they really exacerbate themselves. And then along those same lines, uh for the young patients that we have, we we are really encouraging them to get back to school and get back to their social activities. That piece is has also been shown to be really important for recovery. And you mentioned a little bit ago where there's this balance that we're all trying to find between protecting the brain and allowing it the time that it needs to heal. But also we know that through all of the physical injuries that we rehab, that some level of stress is good. So finding both the cognitive stress as well as the physical stress that can actually benefit the patient is still an imperfect science, but one that's really important. So those are really my two big messages during that phase where they may still have a little bit of a headache and they're not ready to go back to play yet, but they're in that recovery mode. And it it definitely remains to be seen. We don't know exactly how long somebody's gonna take to recover. And for reasons that we also don't know, we might have some patients that recover within a few days. And some that take a few weeks. And they started with a relatively similar symptom burden. So we want to be creating an individualized approach for each patient, but some things are the same. And those things that are the same are get them moving and try to work them back into their social and academic roles as well as those patients out there that are returning to duty. So for our military personnel and then folks who are trying to get back to work and being on the job. And so determining is it safe for them to be back at work and doing what they can be doing to work while recovering from their concussion are all really important.
SPEAKER_00Yeah, it's interesting. I remember for a while we would write notes off of school for some extended period of time because we thought that neurocognitive stimulation would exacerbate symptoms or delay the healing process. And so it's, it's, it's interesting how as research comes out, um, we're able to dial in kind of a better protocol, but you know, it's always ever changing. Um, but I think, you know, like you said, that's very important. Getting them active, getting them some blood flow, getting them exercising, even within some mild symptoms and getting them back to the social environment of school because that will help them to improve is also very important. So interesting outfits have continued to progress. So as far as a gradual return to play protocol, I know um that could be very strict or not very strict. I think uh, you know, the general recommendation from all of us would be hey, I have no symptoms on a Friday, don't go play in a game on Saturday, right? It's not necessarily inappropriate because you know, despite the fact with a low level or no activity, you have no symptoms, you could then have symptoms with activity and or get another contact, which could cause some concerns. Um generally, do you say five days, seven days, gradual progression as far as return to play? Is there specific protocols that are better utilized than others?
SPEAKER_01Yeah. Um, so first I think one thing that I would, I guess, raise awareness on is there just is no firm timeline for concussion recovery. So it's very difficult to see a patient in the clinic and say, you're out for two weeks and then you can go back. We really want to make sure that we're taking an individualized approach. That said, having a graduated return to play protocol, meaning we're gonna take what they're doing and increase it, adjust it, make it a little bit more challenging day by day in a controlled environment, is really the most widely recommended way to return an athlete safely to play. And again, I would I would also put in returning people to work, returning our military personnel to duty. It's it's all a very similar process and many use the same guidelines regardless of which population we're addressing. But basically, what we want to do is just see how the brain does when we challenge it in different ways. So if the patient has been doing exercise on a regular basis and and they're finding that that is going well. So they're riding a stationary bike, maybe they're going for a run, and they come back and they're reporting no symptoms. At that point, really what we would do is is kind of up the ante a little bit. Um, in in the athletic world, that's my cue to put them through a pretty hard workout. Um, I like to use high-intensity interval training. So they do some sprints, they do some push-ups, they do some burpees, they do some more sprints. Um, and I'll do about a 30-minute workout with them. And again, if you think about it, what we're trying to do is challenge the brain in different ways to see if it is ready to tolerate the demands of the sport. And we're doing it in a safe and controlled way rather than putting them back at a basketball game or a lacrosse game or a volleyball match where they could sustain another injury and and really have some long-term consequences for that. So they've done their aerobic, then the next day they come in, I put them through this high-intensity interval training program. If if you look at the graduated return to sport protocol, they'll call that sport specific day. All of that goes well, they come back the next day, they report no symptoms, then we put them through what we call a non-contact practice. And sometimes I get funny looks from people because they're like, but it's a football game or it's a football practice. Um, and this is really where I rely on the coaches heavily, like to be creative with me. How can we keep this athlete moving for an hour and a half to a two-hour practice, keep them busy, keep them doing the things that they need to do while protecting their head from another impact? And I found the sport coaches to be extremely helpful with that. But really the point is, is we just want to keep them going. So now we're testing again that neurocognitive ability. Can they concentrate? Can they turn their head? Can they run their routes? Um, can they do all that safely without symptoms coming back? If all of that goes okay, then we do typically want and a whoever the state has determined can clear an athlete play. This is really where we would like that person to engage in the clearance process because ultimately they will be clearing for them to return to contact. And we do recommend that they have a full contact practice prior to going back to a game. And that can be a difficult one to explain to people. But if again, if we turn to the research, we can see really clearly that the concussions are more likely to happen in competition. And I think we understand that, right? They're going harder, they're going faster, this isn't my teammate, this is about winning. And so they have a higher risk of getting a concussion in a game situation. So we want them to go through a full contact practice before they're actually cleared for a game. Am I gonna say that sometimes that doesn't happen or there's a gray area? Of course not. Um, but that's really up to the physician, the team physician, again, whoever the healthcare provider is that has been designated by that particular state that is able to clear the athlete for full contact. So the idea behind that protocol is we're gonna increase what they're doing a little bit every day. We're gonna do it in as controlled of an environment as we possibly can to protect their safety. And then that way, if symptoms do return or if they're not feeling so good, they can report that. And then all we do is we just wait another day or two. And we just keep them going through that protocol until the brain is really ready to handle all of the demands that is being placed upon it by that sport.
SPEAKER_00Yeah, I think I think that's good as far as uh, you know, general recommendation. Um so not to open up necessarily a big can of of worms, but I remember distinctly when I was working with you, you know, and um I was working at the orthopedic practice there in Portland, you we had a soccer athlete that had had multiple concussions, and there was like some concern regarding are we going to get some cumulative effect from these multiple concussions? And this was a while, you know, 20 years ago. So prior to a lot of the research on CTE and these concerns, but there was literature coming out of you know, Europe saying, hey, a lot of these soccer players with multiple headers are having some long-term cognitive deficits. Um, so what's what's the general recommendation regarding this? You have a young athlete that comes in and has had two concussions in a short time period. Um, I know it's a difficult conversation, it's a long, prolonged conversation, but what's the general recommendations in that circumstance?
SPEAKER_01Yeah, so when we look at multiple concussions, some of the things that we try to evaluate are obviously how many concussions have they had. And often this should have a con there should be a conversation about what is a concussion. Because a lot of us, I think as healthcare providers, we take that for granted. But the research is really clear on this, and people widely do not understand exactly what a concussion is. So helping them to understand what a concussion is, um, identifying how many they've had. And then one of the key components is to really look at recovery. So in my clinical practice, as well as in the research evidence, we see a pattern where typically the more concussions that someone has, the more complex or prolonged the recovery. So when we start to see that pattern in patients who have had multiple concussions, that can start to lend itself to a conversation about um either changing to a different sport or retiring from that particular sport, how can we decrease the risk in their sport? But there's no magic number. And I think if you had 10 physicians who commonly manage concussion, you might get six or seven different responses to what is the number where we need to talk about I I use the word retire, but I want to say retire from that activity and redirect. And this was a big thing that came out of the last concussion in sport group consensus, which I was happy to see is we don't want to just shut somebody down. We want to redirect them. So how can we find them something that they will enjoy that they'll be a little bit safer doing? But yeah, it's the million-dollar question right now. We don't we don't have a number. Um, but I do think that it's really important to ask a lot of questions about how the recovery has gone each time. Are the concussions getting eas like easier to sustain? So, you know, the soccer player I think that you're re referring to, she got to a point, and I think this is um maybe the year when a year after you were gone. But she got to a point where they were just tossing a ball 10 yards apart, doing working on headers, and she came in full of symptoms. You know, and that that just shouldn't happen. And so that those are the situations that we start to get pretty concerned. But that again, I can't stress enough, it's just where it's so critical to be working with a provider who has a lot of training and a lot of experience in concussion. And I'll be really transparent, say one of my frustrations is when providers who don't have a lot of experience but are identified by that particular state as being someone who can clear, um, maybe don't have a lot of training and don't have a lot of experience and make some pretty big decisions on returning to play, and maybe should probably refer to somebody who does have more experience. So, like you said, somebody that works in a concussion clinic or has that extra amount of training and concussion.
SPEAKER_00Yeah, we got to know our limitations, right? And even though you know the state says that I can clear an athlete based on being a PA, I don't necessarily take that as, hey, I'm the appropriate person to clear this. If it's somebody comes in with a you know simple concussion with minimal symptoms and kind of has gone through the return-to-play protocol, then maybe it's a reasonable thing to do. But someone that has a complex case that's had multiple concussions, uh maybe that's somebody that needs to be referred to these specialists to kind of fully evaluate and get more of an appropriate clearance. Cause like you said, we don't know the long-term ramifications. We're starting to understand them for sure, um, because of the high profile nature of some of these cases, but we don't completely know. And I wouldn't feel comfortable as a provider and I wouldn't feel comfortable as a parent um kind of you know having my my my my child clear necessarily without seeing the the specialist in that area, especially if if they're having those multiple uh concussions with symptoms. And so yeah, that's always a difficult topic.
SPEAKER_01Yeah, and the other thing I'll add to that is one of the things that we're we've really been learning over the past five to ten years is there are there really is a link to multiple hits to the head that are not necessarily resulting in concussion and some potential long-term consequences. And this is a huge area of study, and I I hope that we have better answers in our lifetime, but it could potentially take longer than that. And so these sub concussive flows, as we call them. So being hit on the head a number of times, and you know, I think I I think that most of us agree that this is not a good idea over long periods of time. What does that mean? What should we do about it? What rules should be in place? All of those are are big questions. But but yeah, I do think that it's important to note, you know, these repeated hits to the head, they may have some consequences that we may or may not be aware of at this point. And that's, you know, really one of the main things that they're looking at with things like CTE. And while that science is imperfect, it's important, I think, to stay on top of and and keep an eye on.
SPEAKER_00Yeah, I mean, these combat sport athletes, right, that are receiving these blows. And then, you know, as I mentioned earlier, um, there, you know, there's a I I remember reading distinctly some papers out of Europe coming out of some of the soccer leagues there. And I mean, let's be honest, if you take a 50-yard header, I mean, that's coming at a high velocity. That's going to create some damage. That's almost like getting in a car accident going 30, 40 miles an hour. And yes, it may not cause necessarily concussive symptoms, but you do that repetitively, that has to have some, you know, long-term effects or detrimental, you know, impacts to you. So definitely things that require continued litter, you know, research. Um, anything we haven't discussed, anything else you you kind of like to discuss with your students regarding concussions themselves or kind of the topic around it?
SPEAKER_01I think we've hit a lot of the big things. Um I think my my key take-home points, I hope, that your audience gets from this is that um our understanding of concussion is uh quickly evolving. But at the at the same time, we have so much to learn. And uh especially for the healthcare providers who are listening and and doing their best to stay on top of everything and it as it's changing, um kudos to you and kudos to you for continuing to care for your patients. And for those of you that are working in the concussion world and um are doing your best to take care of our patients. Um it's complicated and things are changing, and I think changing for the better, because when we know better, we do better. And so doing your best to stay on top of what's happening, what's current, um understanding that as things change, hopefully we have some evidence behind it. So the the paradigm has shifted considerably from 10 years ago when we were telling people to do nothing until all of their symptoms resolved. And now we're telling people two, three days out to start low-level aerobic exercise. Um and so, and then for those who are, you know, wondering what about the do's and don'ts. And then finally, you know, I guess the one thing we haven't really talked about is technology and gizmos and everybody wanting to sell you something. So whether it's the concussion collar or the guardian cap or uh something that lights up if you get hit a certain way, um, really just be critical consumers of those products and remember that people are out to sell you something. And so, as I tell my students, show me the data. I want to see the data. I want to see data from somebody who tested it that had nothing to do with selling the product. Um, and really, you know, look at the research and look at the evidence behind these before making a decision to put that on your child. Um there's exciting, I think, ideas out there. And I always love uh people thinking outside of the box. So what can we do to prevent concussion? What can we do to better treat concussion? Is there a nutritional intervention? Um, but but just really being critical consumers of that information, which is hard these days because of the information super highway and fire hose that we're all on the other end of. Um, so relying on folks who do have a lot of training and education in concussion, asking them important questions. And that's whether you're a parent, whether you're a coach, whether you're a healthcare provider, whatever your role is, is really just doing our due diligence to seek the best information that we can to answer the question the best way we can.
SPEAKER_00Yeah, I mean, social media is good in an aspect where I think some of these high-profile concussions and CTE cases have brought a lot of awareness to concussion research and a lot of support regarding the research. But again, on the flip side, as you mentioned, a lot of the athletes wearing these concussion collars and these newer technologies, um, you know, they they promote them, but necessarily don't have independent peer-reviewed literature that that shows that they can be effective. And so it's a double-edged sword for sure, um, but it does definitely bring awareness to the field of concussions and and helps promote the research regarding it. Um, so thank you. I appreciate your time uh coming on today. Um, it's an important topic, it's a difficult topic. Um, any quick resources that you would recommend if somebody just needs to look up as far as concussions, what's your go-to resources for that?
SPEAKER_01Um, the CDC has some good information on there. Um, really, if you if you want the higher level stuff, again for the healthcare providers that might be listening, looking up the concussion in sport group consensus on sport-related concussion. They're there volumes of reading there for you, but they also do a really nice job summarizing the key takeaways, kind of a lot of the things that we've talked about today, actually, are found in those. Um those would be probably my my two big ones. Um what else do you use?
SPEAKER_00Yeah, I think that's the big one that I use. Um, you know, regarding what you said, uh I think, you know, whenever I Google the SCAT, it always comes up with the concussion support group. Um we have up to date, uh, which is kind of, I don't know if you guys have access to that, but it's a peer-reviewed kind of website that provides some, you know, uh up-to-date information and that that has some some literature regarding concussions and recommendations. So I think a lot of you know providers have access to that, which is quite helpful.
SPEAKER_01Yeah. And I think again, looking at your um professional organizations, so again, for the healthcare professionals out there, um, I know the APTA has put out um best practice recommendations, um, AMSSM has put out best practice recommendations. And so I I really lean heavily on all of those. So whatever your professional organization is for the healthcare providers, um, they are pretty up to speed. Um, so I have used those in a number of classes as resources for my students. Um, and so those can be very helpful. It's just looking at the position statements for your organization. And for those who may not be healthcare providers that are listening, looking depending on where you're competing. So, what does your state high school association? So I'm in Oregon and the Oregon State Athletic Association is very much up a speed on all of this and has protocols for all the high schools. The NCAA obviously has protocols for the university system. So those are all uh good resources that are that are very up to speed at this point.
SPEAKER_00Yeah, and again, as we reiterated, just don't be afraid to phone a friend andor um refer the patient to the to the specialist if you're uncomfortable, just because the state says that you can be a provider that clears the patient. Um if you're uncomfortable with the situation, then you know, refer them to the appropriate people because um, you know, we don't want long-term ramifications from returning too early or um, you know, whatever it may be.
SPEAKER_01Yeah. Great advice.
SPEAKER_00Well, I appreciate your time. Thank you so much. Um Thank you for having me.
SPEAKER_01I really appreciate it.
SPEAKER_00Everything I know. Um Thank you, everyone, for joining us on another episode of the podcast. I hope you enjoyed this episode. I thought it was a good episode uh regarding concussions. Um, please again feel free to follow us. on social media, both Instagram and Facebook. Please don't hesitate to leave any comments regarding possible topics or episodes you would like to see covered. Thank you again. Have a good day.