Your Athlete’s Concussion Isn’t Treated Like It Was 10 Years Ago

If your child is an athlete, this is information you cannot afford to miss.

Concussion treatment has changed significantly over the last decade, yet many parents, coaches, and even athletes are still following outdated advice that can delay recovery.

In this episode, I sit down with Dr. Paul Cohen to talk specifically about concussions in youth athletes. From soccer to football to cheer to lacrosse, we break down what actually happens in the brain, why “rest until symptoms are gone” is no longer the gold standard, and how early, guided return to activity is changing outcomes.

We also get into the real-life pressure athletes feel to get back in the game, how to navigate return-to-play decisions, and what parents should be watching for on the sidelines and at home.

In this episode, we cover:
• How concussion treatment for athletes has evolved over the last 10 years
• Why complete rest can backfire and what to do instead
• The updated return-to-play approach for youth sports
• Signs your athlete is not ready to go back yet
• The overlap between concussion symptoms and emotional or behavioral changes
• What to say when your child wants to “push through it”
• When to see a specialist and what modern concussion care looks like

If your child plays sports at any level, this conversation will help you protect their brain, support their recovery, and make confident decisions when it matters most.

Resources & Links:
Learn more about Dr. Paul Cohen: https://orthonc.com/who-we-are/physicians/dr-paul-cohen

Instagram: @theconcussiondoc
More from me:
• https://rdutherapy.com

• https://drmelaniemccabe.com

Instagram: @drmelaniemccabe

@RDUTherapy

9/30/25

Transcript

SPEAKER_00 0:54

Today I'm joined by someone who I have known for a very long time, which we are not going to quantify because we both deserve some peace. I'm here with Dr. Paul Cohen, a neuropsychologist in the Wake Forest area who works inside sports medicine and orthopedic practice, which is actually a big deal because it means he's right in the middle of where concussions are happening, not just talking about them after the fact. We also went to graduate school together. So I can personally confirm he is both highly trained and has survived the same level of academic chaos that I did, and then some. He's a dad, which also always matters in the kind of conversations that we have. Paul, I'm really glad you're here.

SPEAKER_01 1:31

Glad to be here. Thank you for having me.

SPEAKER_00 1:33

Hey, before we jump in, I feel like we have to acknowledge that we've known each other for like forever. And we go back to when we were both much younger and probably thought we knew everything, or at least some of the things.

SPEAKER_01 1:45

It is. It's wild to think about.

SPEAKER_00 1:47

It is. Do you remember anything from grad school that would make our listeners question our credibility today?

SPEAKER_01 1:53

No, I remember going for runs with you and your dog more than more than I yeah, more than I remember some of the classroom stuff.

SPEAKER_00 2:03

That's valid. I do remember a presentation that I chuckled about often from one of our classmates who misspelled the word assess on repeat. Do you remember that at all?

SPEAKER_01 2:12

Now that you mention it, yes.

SPEAKER_00 2:14

Yeah, that brought me a lot of joy. Okay. All right. Perfect. Great. Strong start. Everyone feels very safe now that they know about our running history and presentations that we got to watch together. Let's start simple. When parents hear concussion, what does that actually mean in real life terms?

SPEAKER_01 2:30

Yeah, I mean, so obviously it's it's hard to turn on a game, turn on the media without without hearing about it. And there's a lot of scary misinformation out there. But a concussion, first of all, it's a brain injury, right? And so it's it's a brain injury on the spectrum of brain injury. It's more synonymous with mild TBI, which is good. But what I tell folks when I think of what a concussion is, it's essentially the brain is bouncing around inside the skull. So it kind of rests in some fluid and with enough force, it shakes around like an egg yolk. And when it does that, it sets off a number of chemical changes. Can't see them. CTs, MRIs, thankfully, are normal. But these chemicals change, and the result is we don't get enough energy. The brain doesn't get as much energy as it needs. So we want to try to figure out where that energy breakdown is happening.

SPEAKER_00 3:20

And so what makes the energy go back to normal?

SPEAKER_01 3:24

You know, that's a good question. So honestly, a lot of times it just goes back to normal on its own, just spontaneously. But then sometimes you're left with different residual symptoms and residual issues, and that's where targeted treatments come in.

SPEAKER_00 3:38

Awesome. Okay. So some people out there have different ideas as to what makes somebody what counts as a concussion or doesn't. What about losing consciousness? Does that make it count?

SPEAKER_01 3:49

I would say so. Yeah. I mean, usually it's a pretty telltale sign. But I think, I mean, if I remember the numbers, I think that only happens in about 10%.

SPEAKER_00 3:58

Oh, so most of them don't even have the loss of consciousness. Okay. Now, the field of concussions is like constantly evolving, right?

SPEAKER_01 4:07

Absolutely.

SPEAKER_00 4:08

How do you stay on top of all of that?

SPEAKER_01 4:10

Same way as you know, CEs, reading articles. I mean, because yeah, what we know now is so different than what we knew five years ago, and drastically different than what we knew even 10 years ago in terms of A, how the injury is, but then also just how you treat it.

SPEAKER_00 4:26

Yeah. What's the biggest myths you hear from parents about concussions?

SPEAKER_01 4:30

That's a good question. I back in my fellowship, I did a whole presentation just on myths about concussions. I mean, one is just kind of what I said that you have to lose consciousness to have a concussion, or that losing consciousness necessarily makes it, excuse me, a worse injury, which it doesn't. Um then I think the biggest one involves treatment in that the myth I would say is that rest is the best way to get better from concussion, which the research now is pretty pretty clear that's not the case.

SPEAKER_00 5:05

So when do people need rest or not? Or is it like a case-by-case basis?

SPEAKER_01 5:10

So broadly, 24, 48 hours after an injury, if you feel terrible, if you feel absolutely like garbage, fine rest. But then after that, the best thing to do is start to push and get back into our normal routine.

SPEAKER_00 5:23

On all the fronts, academics, sports, life, everything.

SPEAKER_01 5:27

Within limitations, yes. In terms of you're not necessarily getting back on a football field that day, but you might go for a jog or do some push-ups or crunches or something and start to get a little more active.

SPEAKER_00 5:38

Wow. Then things have drastically changed even since I've been in graduate since I was in graduate school. I know that was like a lifetime and a half ago for my children. And still, okay, in the relative field of concussions. All right. One thing that stood out to me is that you're working inside of sports medicine and orthopedic practice, which is not where most people expect to find somebody with a background in psychology. What does that actually look like?

SPEAKER_01 6:05

Yeah, I mean, so I'm basically I'm working parallel to my orthopedic colleagues and my sports medicine colleagues in the sense that we might share a pod together and every now and then we'll have patients overlap. But really, I'm just running my own clinic. So patients will come in, my system will bring them back, and they'll get some information. I'll do an eval, do some testing, look at balance, eye movements, things cognitive testing, and then basically try to put all the puzzle pieces together and come up with a treatment plan.

SPEAKER_00 6:33

Awesome. So how long will a family expect to hang out with you on their first visit with you, roughly?

SPEAKER_01 6:38

Yeah, so the first visit, maybe a little over an hour, hour and a half, and then subsequent visits closer to 45 minutes or so.

SPEAKER_00 6:46

Okay. All right. What kinds of kids and families do you see most often day to day?

SPEAKER_01 6:52

I mean, obviously, sports. Sports are a big part of it, and seasonally, depending on what sports are going on. But then also, you know, I think one of the things that sets my clinic apart is that we'll also see non-sports. So car accidents, assaults, unfortunately, slip and falls, workers' comms, things like that.

SPEAKER_00 7:10

Okay. All right. How soon after concussion are you generally involved?

SPEAKER_01 7:14

That's variable. I mean, I'd like to get involved as quick as I can because I think the sooner, and honestly, it's not just my opinion, the research says the sooner we can intervene and just get the right information out there, the time we can cut off recovery. And so I, you know, I've seen folks as soon as later that day after they were injured, or sometimes within a couple days. And then sometimes it takes folks a while, you know, for whatever reason, if they're going through other channels or didn't realize the symptoms were what they were, then see folks a couple weeks or a couple months after an injury as well. Awesome. Cool.

SPEAKER_00 7:51

So do you feel like you get a lot of referrals from pediatricians early on, or are those more slower to get to you?

SPEAKER_01 7:58

Both. It depends on the pediatrician, honestly. Some feel comfortable with it and they will manage probably most of themselves, and I'll never see them. And then I might only hear from them if there's some sort of prolonged recovery or some issues. And then there's other pediatricians that I've just worked with in the past that the parent will say, Hey, I called the pediatrician and they didn't, they just gave me your number. They didn't even schedule an appointment.

SPEAKER_00 8:23

Awesome. Good. So, what are the most common signs of a concussion that a parent might miss?

SPEAKER_01 8:31

That they might miss. I mean, it's interesting because it depends on on the age of the child, obviously. Older kids, much more verbal, able to tell you what they're feeling. But the most common symptoms are going to be your headaches and dizzy vision, things like that. But sleep issues. And it can be anything, it can be not falling asleep, not staying asleep, falling asleep too easily, sleeping too much, sleeping too little. I mean, it can kind of run the gamut. And then I think the emotional piece as well in a kid, you might just see more irritability or a shorter temper, just out-of-character behavior that could be from the injury itself, and or honestly, how it's been managed too.

SPEAKER_00 9:12

Tell me more about that. What do you mean, how it's been managed?

SPEAKER_01 9:15

Yeah, so what I was kind of talking about before getting back into the routine is really good. And one of the reasons for that honestly comes from, I think, just psych principles where if you're not in your routine, you have no outlets. So if you're not in school or socializing or exercising, you're just doing normal day-to-day things, there's nowhere for stress to go. You have more time to sit and think about all these symptoms that you don't feel that you don't feel well. You have more time to sit and think about all the stuff that you want to do or need to do, get sad, get anxious, and kind of spiral down the rabbit hole.

SPEAKER_00 9:48

While also being lonely and disconnected.

SPEAKER_01 9:51

While not having your outlets, while not doing the activities you want to do, and not feeling well from the get-go. And so that in and of itself, you know, I mean, I feel like for half the kids I see, and maybe some of the ones you see as well, if all of a sudden you just took away everything they do, if they never hit their head, they were totally fine. You just took away, they're gonna get irritable, their sleep's gonna get messed up, they're gonna have a headache. All of these things are gonna happen that overlap with concussion symptoms that they're without a concussion.

SPEAKER_00 10:23

Right. I tend to see the kiddos after they've had multiple concussions and now are looking at, you know, maybe the sport that I've really made my life all about is no longer an option. Or academics have struggled because of this because I've had these changes, or I'm showing up differently in terms of my personality.

SPEAKER_02 10:40

Yeah.

SPEAKER_00 10:41

And that's weird to my family, or I'm more argumentative. And then parents are like, what the heck do I do here? And how do I support? Yeah. What would you suggest to parents if they're like, my kid is behaving in a little bit of a different way? Should I call? Should I not call? What do I do? What would you say to that parent?

SPEAKER_01 10:58

Yeah, I mean, if there was a mechanism of injury, obviously, then yeah, I think if there's a mechanism of injury, call me. If there wasn't, call you, obviously. But yeah, if there was an injury and then you're starting to see any type of behavioral, emotional, physical changes, physical symptoms, yeah. There's there's so many things we can do. There's so many treatments out there. And and the bottom line, and I'll probably say this over and over, concussion is treatable. It's a hundred percent a treatable injury, just a matter of making sure we hit the right target. So yeah, call, try to get one with a specialist and try to get in the right lane.

SPEAKER_00 11:33

Awesome. There are some parents out there, I'm one of them, who will second guess themselves. Like, should I really be calling about this thing? When is the go-no go point? Or is there not a like, hey, don't call time? It's always pick up the phone and call and just rule it out.

SPEAKER_01 11:48

That's what I would do. Yeah. I think it's always better to err on the side of caution. And I mean, it's it's your brain. You're not your kid, you're not getting another one. So want to make sure we take care of it. And worst thing that happens, and it happens from time to time, I'll do an e-val and say, uh, actually, this is not a concussion. You know, there this that didn't happen. So yeah, I would always call and try to get checked out and make sure your you, your kid are good to go.

SPEAKER_00 12:12

Great. Now, there's merit in getting those evals, even if it turns out it's not a concussion, right?

SPEAKER_01 12:18

Oh, absolutely. I mean, sometimes, and as it relates to concussion or not, but there's other factors that could be contributing to those symptoms that we might identify. There might also be other behavioral things that we discuss that can help with maybe pre-injury headaches or academics or other things. You know, it's not necessarily fully exclusive to concussion.

SPEAKER_00 12:42

Yeah. And it also gets a baseline, right? So if there is ever a concussion, you know.

SPEAKER_01 12:47

Yeah, exactly. I mean, that's a separate concept altogether. But yeah, I mean, baseline testing, it's something we can offer in the clinic as well, actually formal baseline testing. But yeah, to have that apples to apples comparison, especially for a young athlete, super valuable.

SPEAKER_00 13:02

Awesome. I have some moms that I work with that more so than dads, and yet there have been some dads too, whose son really wants to play football. And they're like, oh, I don't know, because of risk of concussion. I honestly hadn't had the thought until right now. And so I'm really glad we're having this conversation. Baseline testing might be really effective for them.

SPEAKER_01 13:21

Oh, yeah, absolutely.

SPEAKER_00 13:22

So they know is there something going on?

SPEAKER_01 13:25

Yeah. I mean, the high schools more or less require it. Oh, cool. But you know, youth sports unfortunately just don't have the resources to do it. So yeah, having a baseline test on file is can give you good data and also peace of mind. Now, obviously, we there's testing we can do without a baseline, so it's not like if you have a concussion and no baseline, don't do anything about it. There's still ways we can look at it and ways we can treat it, but baseline just gives you that next level of to say. Especially for a kid with a learning disability or ADHD or some something going on pre-injury that we can say, all right, this is where they were before. This is where they are now. Is there any deviation?

SPEAKER_00 14:07

Yeah. I'm taking this all off script. I have a list of questions here, and I'm just I'm so intrigued by this conversation. I'm just gonna totally derail our entire conversation. So ADHD and concussions. Are kiddos with ADHD and adults with ADHD more likely to have more concussions? The reason I ask is because we know the data, right? They're more likely to have car accidents, they're more likely to break their pinky toe, you know, than the average population.

SPEAKER_01 14:33

Yeah. So I think the answer to that is is a definite maybe.

SPEAKER_00 14:38

You know, I would say Claire's Claire's mode, got it.

SPEAKER_01 14:40

Yeah, I think the ADHD in and of itself, in terms of the brain chemistry, I don't think makes them more likely. No, just behaviorally, I was curious. The behavioral and the maybe the impulsivity and some of the other things make them just more likely to make a decision that is gonna result in one. The other thing is what we know, one thing we know about concussion is concussion fights dirty. So that means if you've got something going on pre-injury and you get a concussion, not always, but oftentimes it's gonna make that thing worse. And so if you're a kid with ADHD and you've got just cognitive difficulties, memory concentration to begin with, concussion is not gonna help you. You know, it's gonna make it's gonna exacerbate that. And so that may be one of the factors driving the bus in terms of that symptom profile after the injury.

SPEAKER_00 15:28

Awesome. Not awesome, actually, not awesome at all. Um, and that might be a cue for parents to be on the lookout for, right? So, like my kid is generally impulsive, and then they're like, impulse is off the chain, like something's going on. Maybe they did not knock their noggin on something a little harder than we thought, or maybe not, and yet it still had an impact, which I think is one of the most tricky parts of concussion. I have such an appreciation for what you do because it's not like, hey, if we have three pounds of force on the head, like we're gonna just have a concussion. There's there's so much variance.

SPEAKER_01 15:59

I mean, there's no minimum force to have a concussion. And every brain is different, every injury is different.

SPEAKER_00 16:04

I remember I had a client when I was still a Duke, so this is 11 no longer years ago, and she had hit her head. She was sticking her head in the refrigerator to get a sandwich out of the refrigerator, and she like came up and popped her head and she got a concussion from that and like sidelined. Poor kid. I felt for all right. We're gonna go back to it. Okay. All right, so no minimum force that we're aware of that's been documented. As and I think that's probably one of the most frustrating things for me as an outsider trying to understand like what counts as a concussion or not, making it that much more important that your job exists. Thanks for doing what you do.

SPEAKER_01 16:40

Yeah, yeah. I mean, I what I think of is there a mechanism of injury of some sort, is there symptoms right away, slash shortly thereafter? You know, there's always adrenaline and stuff. And then are there still symptoms or or test data points or something that's sticking around that are different than this person's normal? And if you can check those boxes, then yeah, they're there. Usually it's a concussion because because there's no there's no image clinically, there's no head imaging that can clinically show a concussion, there's no blood test. There's a lot of really smart people working on it. So maybe in our lifetime we'll identify something or next week. Or next week, that would be lovely. But at this point, there's nothing that's really been approved for clinical use. So it's much more objective and trying to take all the points together.

SPEAKER_00 17:28

Moving target.

SPEAKER_01 17:29

Absolutely.

SPEAKER_00 17:31

Let's talk about the kid who says, I'm fine, and the parent who says, not so sure. What does safe return look like for that kiddo? To school, sports, whatever the thing is.

SPEAKER_01 17:42

Yeah, so in general, again, like I was saying, we want things as normal as possible. So I mean, I'll send, I'll recommend going back to school that day. The day I see them, the day after an injury, whenever it is. But there's not really a lot of benefit to being out of school. Now, if we're putting in heavy restrictions, heavy accommodation, that's fine. I would rather a kid be in school in the library with their head down than at home with their head down. Because at least now they've woken up, they're keeping a routine, they've got cognitive challenges, they've got social outlets, they're keeping that structure. And that in and of itself can help with recovery. So getting back into school, I mean, we're talking immediately, obviously not PE class or recess or anything like that. Uh getting back into sports, I would say there's four criteria someone needs to hit. Number one, symptom-free arrests. Number two, symptom free with cognitive activity. So school, homework, grades, normal, everything. Free, symptom-free with physical activity, which is a process generally for getting back to sports. It's kind of a systematic process with ideally supervision, starting walking, stationary bike, the dynamic exercise, working your way up to basically a full practice with contact. And so we're gonna do that, and that takes at least five days to do. And then normal test scores, normal ebout, contact testing, balance eyes, all the stuff we do in the office.

SPEAKER_02 19:06

All right.

SPEAKER_01 19:07

And so not until all of those are met, checked off, then are we gonna even talk about getting back to play?

SPEAKER_00 19:14

So people ought to expect to see you a couple of times before they're done with their concussion journey, if they did have a concussion.

SPEAKER_01 19:22

Yeah, I mean, usually twice, usually for that initial eval, get in the right lane, and then usually once more. And then depending on how they're doing, if they're good at that point, we put a bow on things. If not, then that's when we start talking about different treatments and what approaches we want to use. Yeah, it's usually not a one-time thing if they're symptomatic. If they come in symptom-free because they have already been doing stuff or whatnot, then it's a different issue. But if you're having symptoms, then yeah, it's usually more than once.

SPEAKER_00 19:53

So, Paul, Dr. Cohen, what do you want me to refer to you when we're talking here?

SPEAKER_01 19:57

Whatever you want.

SPEAKER_00 19:58

Okay, Dr. Paul Cohen. You are a dad. Yes. You know that there's parenting, there's parenting suggestions, and then there's the free will of children. Yes. What happens when you give recommendations? Parents hear those recommendations, and then the kiddo pushes too fast too hard. What how does that backfire? What are you likely to see?

SPEAKER_01 20:21

Yeah, well, what do you mean push push too fast too hard?

SPEAKER_00 20:25

Let's say, you know, they are not symptom-free cognitively, and they're like, I'm gonna do all my homework anyway, or you know, that whole advice not to go to practice. I got this. I'm gonna go anyway.

SPEAKER_01 20:36

Yeah, I mean, because the truth is, I actually don't think there is pushing too fast too hard.

SPEAKER_00 20:41

Oh, this is such different than such a different way than where when I was learning all about concussions back in the day.

SPEAKER_01 20:47

On the side of pushing too hard or not hard enough, I'd rather you push too hard because you know, quote, too hard, you're not doing damage as long as you're not getting hit or hurt. You're it's not doing any type of damage. I mean, the worst thing that happens is maybe you trigger a minor, you don't feel good. It's not ideal, but we can live with that. Natural consequence, okay. Yeah, but if you don't push hard enough, you kind of just sit around, don't challenge yourself, you won't get better, you'll get anxious, deconditioned, everything gets spiraled and worse. So I don't necessarily think there's a way to push too hard. Now, of course, that doesn't mean go back to contact practice, but school, we try to keep as normal as possible. Sports and exercise, more often than not, we kind of have a leash of just don't do anything where you can get hit or hurt. But if you want to start working out, I mean, honestly, especially for a lot of these youth athletes, which are type A to begin with, it's gonna help them a lot. Awesome.

SPEAKER_00 21:46

I love hearing this today, by the way. I feel like there's so much agency that we're giving back to kids who've had concussions or young adults who are trying to figure out how to navigate life at such an important time when things do change so fast for them.

SPEAKER_01 22:00

Oh gosh, yes.

SPEAKER_00 22:01

And we live in an area where there is so much competition too. I assume you work with a lot of competitive kiddos.

SPEAKER_01 22:07

Oh, absolutely. Yeah, absolutely. Okay.

SPEAKER_00 22:10

Any sport you don't work with, like that you haven't seen any athletes from in your work, that you can be like, oh, you know what? I've actually not seen somebody who does this thing.

SPEAKER_01 22:19

This point? Yeah. I don't think so. I mean, I've seen tennis, I've seen swimmers that have swam into a wall, you know, like sports that you by no means would think would be a high concussion rate sport that if some ended up in the office. Obviously, football, head and shoulders above everything. Last I checked, statistically, but also more just anecdotally, female side, women's soccer is by far the uh the number one sport there.

SPEAKER_00 22:49

I'm not excited about that statistic because the girls start headbutting next year, and so I'm a little Yeah, I actually'm not head butting. Sorry. That's roadbeat. My bad.

SPEAKER_01 22:59

I actually work with The Courage, which is kind of cool. Professional soccer team that we have here.

SPEAKER_00 23:04

Yeah.

SPEAKER_01 23:04

And yeah, but yeah, it's a physical game.

SPEAKER_00 23:07

It is a physical game. Shout out. We have season tickets and we love going. Anyone who's on the fence, go. They're great. They're a great fun team to watch. Yeah. The games are great for the kids to run around, though. Just a heads up.

SPEAKER_01 23:19

The four-year-old probably wouldn't care. The seven-year-old might care a little bit.

SPEAKER_00 23:22

Playing sports.

SPEAKER_01 23:24

Yeah, our first t-ball game is today.

SPEAKER_00 23:26

No pressure.

SPEAKER_01 23:27

The head coach.

SPEAKER_00 23:29

Oh, you are. Yeah. All right. That's gonna make it in here. I'm gonna bring it back when we start talking about coaching. All right. So you're also a t-ball coach, I just found out. Love it. Do you see a lot of t-ball injuries? I would assume there are a lot of you know stray bats getting thrown around with the littles.

SPEAKER_01 23:46

Not necessarily t-ball. Yeah, no, that was literally rule number one when we sat down with this team this year. Do not touch a bat unless a coach tells you to touch that bat. So I don't I see a lot of softball, more than I expected. And then obviously baseball at the higher levels, just in terms of uh catcher collisions, outfielder collisions, running into the wall, things like that.

SPEAKER_00 24:10

Yeah. Anytime you get a body or an object moving quickly and there's a lot of force, I guess you're gonna get called. How much about equestrians? Do you see a lot of equestrians?

SPEAKER_01 24:20

I don't see a ton. I think part of that is honestly just the sheer base rate that not a lot of people, it's not a hugely popular sport here because a couple years ago I was at a conference in Texas, and not one but two of the talks in the conference were about equestrian concussions. One was equestrian, one was rodeo. But I get a lot of that here. Like my colleagues in Texas see a lot more of it than I do just because it's more popular. So I've seen a few, and I think I do. I was talking about the five-stage return to play process. Yeah. I actually have one tailored to equestrian that I can give to folks.

SPEAKER_00 24:58

Oh, that's so cool.

SPEAKER_01 24:59

Yeah, just how you ramp that process up. But I I do see from time to time it's not overly common though.

SPEAKER_00 25:06

Okay. Did we get through the five stages of return to play? Or did I completely sideline us?

SPEAKER_01 25:11

Well, the four criteria to be cleared. Yes. One of which is the five stages. Okay, hold on.

SPEAKER_00 25:18

Say this all a little slower for somebody who's maybe named Melanie and tuning in right now.

SPEAKER_01 25:23

So symptom free arrest, symptom free with cognitive activity, symptom free with physical activity, and that is five stages. And then the office exam and cognitive testing and everything.

SPEAKER_00 25:34

Yes. Got it. Thank you. And we were talking about somebody pushing too fast, and you said there's really no such thing as long as they're not knocking their noggin again.

SPEAKER_01 25:42

I believe that.

SPEAKER_00 25:43

Okay. All right. Now, when is it okay for somebody to go back to more contact?

SPEAKER_01 25:49

After they meet those criteria.

SPEAKER_00 25:51

So it can be pretty darn fast for somebody.

SPEAKER_01 25:54

No, I mean, because it's usually at least five days to run through the physical workouts. So that gives us time because you can do one, they don't have to be consecutive, but you can't do more than one stage in a day. So stage one would be walking, stationary bike is pretty simple. Excuse me. Then more dynamic activity, more sport-specific drills, and then working your way up to a non-contact practice and then a full practice.

SPEAKER_00 26:20

I see. So we're really putting them through the paces to see can your brain handle this? Can you, as a body, handle your brain signaling to do these things in a way that still makes sense?

SPEAKER_01 26:31

Exactly. And are is it provocative for symptoms, especially?

SPEAKER_00 26:34

Okay. Got it. And do symptoms generally show up right after one of those workouts, or can they be delayed by a couple of hours? Could be either. So there's no, like, hey, this is definitely from this workout or not. If there's symptoms, it's time to slow it down a little.

SPEAKER_01 26:47

Yeah, I mean, I would say if there's symptoms and it's generally workouts that this athlete's been able to tolerate pre-injury, then we assume it's from the injury. And the truth is, that's when this this is going to sidetrack us a little bit too, but that's when things can get tricky because concussion symptoms overlap with other symptoms so much. People get headaches pre-injury. When you're stressed, you can't sleep well. And you have a headache. You know, there's so many other factors and variables that are at play. It's never in a in a vacuum. And so it's much more dangerous to assume something's not from the injury than to just err on the side of caution and say, this is from the injury, and we're going to make sure we work it out before you're back.

SPEAKER_00 27:31

Yeah. And what is the risk of going back before you are recovered from a concussion?

SPEAKER_01 27:37

So you're probably more vulnerable to getting another injury.

SPEAKER_00 27:40

And then we start hearing about the worry worrying about the things we see on the news, right? If we have compounding concussions over and over again on fresh concussions.

SPEAKER_01 27:49

Exactly. That after not fully recovering from the one before.

SPEAKER_00 27:53

So sending somebody back out on the field before in the same game. That's where the risks are.

SPEAKER_01 27:58

Yeah, and it's multifaceted too, because why are you more vulnerable? One, your brain's still recovering. And, you know, if you're any hint of dizziness or fatigue or anything, you're not going to be playing at your full capacity, which that in and of itself is going to put you more at risk of getting injured again.

SPEAKER_00 28:15

That makes so much sense. Things we don't think about from the sidelines when we're just watching our favorite team and we're hoping we're going to get a W that week, right?

SPEAKER_01 28:23

That's right.

unknown 28:23

Okay.

SPEAKER_00 28:24

When a family comes to you, what does working with that family actually look like?

SPEAKER_01 28:29

Yeah. So someone will come in, kind of like I was saying before, I'll do an eval.

SPEAKER_00 28:34

And what all do you do in that eval?

SPEAKER_01 28:36

Yeah. So it's I'll start with just a super detailed but targeted interview, getting a sense of the symptoms, but not do you have a headache, yes or no? You know, that doesn't tell me anything. I want to know what are the triggers, where in your head do you feel it? How bad is it? What makes it worse? What makes it better? Things like that for all the symptoms. After the symptoms, then we'll kind of go into the history. Because I want to know what is who is this person? What do they bring to the table pre-injury that may be impacting their recovery here? Then we'll do a little bit of cognitive testing, then I'll look at eye tracking movements, balance, things like that. Take all those different data points together and kind of come up with a treatment plan. And the treatment plan can vary any number of different ways. But after that, send them on their way, follow up with them in whatever time period, depending on what our treatment looks like. And then I'll just keep working with them serially until we get them back to what they want to be doing as quickly, but more importantly as safely as possible.

SPEAKER_00 29:37

Okay. And what kind of interventions or supports do you put into place?

SPEAKER_01 29:42

Yeah. So what I tell folks is I when I think of concussion treatment, concussion recovery, I'll generally break it down into two buckets. Bucket one are formal therapies and places where you go do things. Bucket two are more behavioral, just day-to-day strategies. Some folks just need bucket two. We get them in the right lane, we start pushing, doing the right things, they don't need anything else. Other folks, depending on the injury, depending on who that person is, they might need more aggressive treatment. You know, it's no different than like my mom broke her wrist and thankfully didn't need surgery, didn't need PT. But uh the next, I won't say hello my mom is, but the next person of her age might need unfortunately surgery or PT. You know, it's that just a different injury, same body part. It's not different, it's no different in the brain. And so there's a lot of different physical therapies we might use. There's maybe optometry, certain kinds of eye doctors, speech therapy for cognitive issues. Sometimes you're looking at medication for headaches, migraines, anxiety is a big thing. Honestly, referring to psych is huge in some of these populations. So there's a number of different tools we have in the toolkit here that can be helpful to supplement the behavioral strategies.

SPEAKER_00 31:01

Awesome. Okay. What's something parents can do to help get their kids back to normal life faster?

SPEAKER_01 31:08

Don't hold them back, which may sound like the simplest answer to your question. But oftentimes a lot of the anxiety is being driven by the parent and not the kid. And rightfully so. I mean, it's a scary injury, it's your kid's brain. So I definitely understand that.

SPEAKER_00 31:24

But everything you're saying goes contrary to everything I've heard in my life, right? That's true, right? Which makes my job hard sometimes. Oh, I'm sure.

SPEAKER_01 31:33

Because either folks have Googled or they've talked to, I mean, it depends on the pediatrician. Sometimes they're told rest, sit in a dark room, and and then they come see me, and I say, Well, actually, please don't do any of that. And they're like, Well, we don't even know, we don't know who you are. Like, what are you talking about? Right. And so, yeah, it's kind of an uphill battle. But yeah, what can they do? Don't be the one to hold them back in the sense that, and I know it's coming from a good place because they love their kid and they're worried about them, but don't ask them how they feel 10,000 times a day. You know, I mean, look, I mean, Melan, how many times do people ask you how you feel a day?

SPEAKER_00 32:08

I'm a mom and my husband works a lot, so maybe twice if a client asks me.

SPEAKER_01 32:14

Yeah, right, exactly. That's twice more than people ask me. I get zero. Right, you know, right? Because every time someone gets asked, especially when they're recovering, depends on the person, but then they take inventory and think, like, oh yeah, maybe I did have a headache earlier. Maybe I did. We don't want that. We want to start pushing through things. And so don't do that. Don't encourage your kid to go take a nap. You know, like encourage them to push and and do stuff with the knowledge that it's not doing any type of damage.

SPEAKER_00 32:46

And I would assume those naps in the middle of the day, if they're not needed, will also interfere with sleep at night and then confound the real symptoms of is this a sleep disturbance or is this just a kid who napped during the day?

unknown 32:57

Exactly.

SPEAKER_01 32:58

I mean, that's the main reason I'm telling folks not to nap, exactly.

SPEAKER_00 33:01

Awesome. Makes complete sense. So you're a dad now.

unknown 33:05

Yes.

SPEAKER_00 33:05

How has your work changed since you've become a dad?

SPEAKER_01 33:09

Yeah, I mean, it's a good question to think on that. I mean, first of all, I think I'm learning more. We're learning more about the injury over the years that I've been a dad in general, which has changed kind of the way I approach it and the recommendations I make. But I think I also I mean, my kids are young. My kids are younger than most, not all, but most of the kids I see in my office. But I think now just having more empathy, first of all, for some of these parents and what they're going through. I'm a very anxious dad. I'm not anxious in my work at all. Uh, because I, you know, I've seen the stuff a thousand times, thankfully, but I'm very anxious as a dad. So I can definitely empathize where a lot of these parents are coming from in that regard. So I'm able to hopefully spend a little more time kind of normalizing that, but then also explaining why the research suggests this is a treatable injury. These are the things that we need to do to help, these are things that you can do to help your kid help get better as well. And then I think it's also helped me understand some of you know, some of the younger kids that I see in the office. Understand where they're coming from and understand what their struggles might be. You know, I can try to imagine what my daughter would struggle with in terms of what can she do at school, what can she not do at school, what can she use socially, and to have a better understanding of that as well.

SPEAKER_00 34:32

Yeah, to know what they care about, both for the kids and the parents, right? I totally get where helicopter parents come from. I have the potential of being a helicopter parent. I have to fight it tooth and nail.

SPEAKER_01 34:43

I actually did a whole research study on this, though, as it comes to as it relates to congussion. And what'd you find parental anxiety rubbing off and prolonging recovery time?

SPEAKER_00 34:54

Oh, so there's stats on this.

SPEAKER_01 34:56

There's data to support it, yeah.

SPEAKER_00 34:59

So bubble wrapping children is not what we want to do. No, despite okay, all right, despite every urge that we ever feel as parents. Got it. Okay, understood. Do you think you're more cautious now in your own parenting? I know we talked about T-ball a little bit.

SPEAKER_01 35:17

I don't think so. Honestly, perhaps less cautious.

SPEAKER_00 35:22

I was not expecting that. Okay, tell me more.

SPEAKER_01 35:24

Well, I mean, in the sense that, and this is not fully fair to say, but the I don't want my kids to get a concussion, obviously. I don't want any kid to get a concussion, but I also thankfully, just from the work, know that it's not like some boogeyman, it's not like some death sentence. And so no, when I'm practicing t ball with my daughter, I'm not throw firing the ball at her either, but I'm not as concerned as I might be otherwise.

SPEAKER_00 35:54

Awesome. Good. Okay, let's see. Lightning round. You ready?

SPEAKER_01 36:01

Ready.

SPEAKER_00 36:01

I want you to keep these short if you want to.

SPEAKER_01 36:04

Okay.

SPEAKER_00 36:05

Myth busting. It's coming.

SPEAKER_02 36:07

Let's do it.

SPEAKER_00 36:08

I told you I got contact, so I'm trying to wait for it to go back in the right spot. If they didn't pass out, it's not a concussion. True or false? False. Screens are totally fine right after. True or false.

SPEAKER_01 36:18

True.

SPEAKER_00 36:19

Oh, didn't expect that one. Kids bounce back quickly. It's not a big deal.

SPEAKER_01 36:23

That's not as straightforward. It is a big deal because it's still your brain. Kids do bounce back fairly quickly, but only if we're doing the right things and putting the right steps in place.

SPEAKER_00 36:33

Okay. Rest means staying in a dark room for days.

SPEAKER_01 36:36

That is what it means, but I don't recommend either of those things. Yes, I'm guessing sentence is true, but it's we don't want that.

SPEAKER_00 36:43

Sentence true, not applicable here. Please don't do it. Got it. Okay. If a parent is listening and thinks, my kid hit their head recently and something just feels off. What do you want them to do next? Thinking they live in our area. What do you want them to do?

SPEAKER_01 36:56

Give us a call. Let's get them in. Let's do an eval and let's try to get you in the right lane.

SPEAKER_00 37:01

Okay. Awesome. What's the best piece of advice you've ever received in anywhere?

SPEAKER_01 37:06

Anything, not completely.

SPEAKER_00 37:08

Yeah.

SPEAKER_01 37:08

Gosh. You know, I hear like famous people talking about this. That oh no, no one's ever asked me that question.

SPEAKER_00 37:16

Dr. Paul, you're famous in the area. Let's hear it.

SPEAKER_01 37:19

Yeah. What is the best piece of advice I've ever received? It's probably generic. Do what, you know, do what you love. Push, be persistent, advocate for yourself, and do something you enjoy.

SPEAKER_00 37:32

Amazing. I think that is maybe generic advice. And yet I wish all of the teens that I work with would keep that at the front of their mind. Some of them need to keep it a little further in the back. Most of the teens I work with then. Okay.

SPEAKER_02 37:48

Developing frontal lobe right there.

SPEAKER_00 37:49

Uh-huh. What's one takeaway you want listeners to remember from today?

SPEAKER_01 37:54

Concussion is treatable.

SPEAKER_00 37:56

Okay. Awesome. What's one question you wish I would have asked?

SPEAKER_01 37:59

Honestly, you did a very good job.

SPEAKER_00 38:01

Well, thank you. Yeah. I've done this before.

SPEAKER_01 38:05

Yeah. I see the equivalent here. What's something I wish you you would have asked? I'm trying to think. We took covered obviously what's a concussion. We covered basic treatment approaches. I mean, I think this. I would say, I don't know that this is necessarily the a question, but uh I think the most important thing is we want things as normal as possible as as quickly as possible. So the normal sleep schedule, the appetite, staying hydrated, generally athletes hopefully good at those three things, getting exercise, and then managing stress. And that that's one of the biggest things, especially for kids. So we don't really want to take their phones away. Obviously, the limitations that a parent might have in their house to begin with, keep those but from a concussion. We most likely, except in certain cases where there's ocular issues, we don't need extra limitations. We want kids to have their phone, we want kids to have their social hours, we want kids to be doing within moderation their normal activities because that's gonna help fight off stress and anxiety and honestly help them get better quicker.

SPEAKER_00 39:13

Awesome. Great. Seems like the holistic approach, right? Eat well, sleep well, move your body, stay connected, work on your goals, don't hit your head again until you're cleared for it, and then even then try to avoid it.

SPEAKER_01 39:27

Exactly.

SPEAKER_00 39:28

Okay, awesome.

SPEAKER_01 39:29

When I was a fellow, they used to call them grandma things. It was like things like your grandma would tell you to do to just live a healthy life.

SPEAKER_00 39:36

I absolutely love that. Maybe my grandma wouldn't. She smoked until she was like 97. Um well, her she did try to quit and her doctors were like, please don't for 93. Why would you quit now?

SPEAKER_01 39:47

It's kind of true.

SPEAKER_00 39:49

So she enjoyed that for four more years or suffered through it, one or the other. If you are a parent listening, especially if your kids are active in sports or just living a life full at full speed, this is one of those areas where having the right information and the right support really matters. Dr. Paul Cohen is someone who is not only trained in this, but is working alongside medical teams, seeing this day in, day out in real time, and also a real human and a real dad. If you want to learn more, connect with him. How can they reach out to you, Paul?

SPEAKER_01 40:20

Yeah, so they can call the office, be the main number, 919-562-9410. And then my assistant would be star five five seven or just send an email, not a scheduling email, but just a if there's questions, just Cohen assistant at orthonc.com.

SPEAKER_00 40:38

Awesome. Now, Dr. Cohen, I know you also do talks from time to time, and you will also drop by different organizations if they have questions or want to really learn things. Is that something you're still doing?

SPEAKER_01 40:49

Yeah, absolutely. Awesome.

SPEAKER_00 40:51

So schools who are listening, feel free to reach out.

SPEAKER_01 40:54

Definitely. No, I'm happy to. I can really professionally only talk about one thing at this point in my career, but it's concussions. So I'm happy to do it.

SPEAKER_00 41:02

Okay. Are you still unfortunately a UNC fan?

unknown 41:06

Yes.

SPEAKER_00 41:07

Okay. I'm sorry to hear that. So, and as always, if this episode helped you feel more clear or more confident and gave you language for something you've been worrying, wondering about, share it with someone who needs it. Paul, thank you so much for being here.

SPEAKER_01 41:21

No, thanks for having me. This is fun.

SPEAKER_00 41:22

Awesome. It was fun. I appreciate it.