• Wednesday, January 06, 2016 8:59 AM | OATA Admin (Administrator)

    So we've now read about the RECOGNITION of concussion, and the REMOVAL FROM PLAY of athletes who are suspected to have sustained a concussion. But what do you do next?

    The old advice was for anyone who sustained a concussion, or had concussion-like symptoms to rest, both cognitively and physically, until symptoms subsided. This included ZERO activity, mental or physical, and the advice was to stay in a dark room, with no visual, auditory or cognitive stimuli. It is very difficult for anyone to follow these guidelines, especially if they are a young child, or must return to work.

    While this advice has not yet been debunked, and there is still great research being done to validate it, there are also other theories surfacing! Studies as recently as last year indicate that complete rest may actually prolong recovery and increase symptoms. 

    So what do we do during recovery?

    During the first week following concussion, the rule is that rest is best, unless otherwise indicated by a health care professional. However, a qualified Health Care Professional will be able to assess an athlete as soon as 1 day post-injury to determine what kind of concussion symptoms are being experienced to target rehabilitation and treatment.

    Type of concussion? This is all new!

    There are four major systems that are affected by concussions. A concussion can have symptoms effecting just one system, but it is more common to affect two or three. Severe cases of Post Concussive Syndrome can cause symptoms affecting all four systems for many years.

    Autonomic - Relating to the autonomic nervous system, which controls all the background processes of the body. Immediately following concussion, there is a rapid cascade of chemical changes in the brain which can alter the internal rhythms and the ability of the body to regulate things like sleep and wake schedules, hunger, concentration, and other metabolic processes.

    Vestibular - Relating to the balance systems, and the vestibule system of the inner ear. The inner ear contains fluids and space that are used by tiny receptors to help the body to know where it is in space, and achieve compound movements without feeling vertigo or dizziness. Concussion can shift the delicate control of this system, and it needs to be retrained just like a strained muscle or sprained ankle to work properly again.

    Visual - Studies have shown that between 50 and 90 percent of all mTBI or Concussion patients experience some sort of visual disturbance. These symptoms include loss of peripheral vision, poor convergence (seeing double), difficulty fixating on objects, or tracking with moving objects, or sensitivity to light and stimulus. If left untreated, these symptoms can persist, effecting every day life, and potentially reducing sport performance.

    Cervicogenic - Relating to the cervical-spine (head and neck). The mechanism that causes a concussion almost always also produces a whiplash mechanism, which can cause dysfunction of the many joints and muscles in the neck. These dysfunctions can be the cause, or a major contributor to symptoms such as headache, dizziness, ear discomfort and face/eye pain. Treatment to the neck can help decrease symptoms, and help to make more clear what other systems require treatment.

    So whats all this 'Treatment' you're talking about?

    When a patient comes to me in the clinic following a concussion, I complete a thorough history and assessment. The history includes a discussion of the mechanism of injury, symptoms experienced, and a comparison to baseline testing (if available). From this history and assessment, I recommend one of three things: Immediate referral to a medical doctor, complete rest, or entry into a treatment program. This decision depends on the number and severity of symptoms, and if any red flags are encountered indicating that imaging and further medical testing is required.

    Once a patient is ready to enter into a treatment program, a more thorough physical assessment is completed. This may include just one or all four of the systems that can be affected by concussion. For example, if the patient is experiencing headache, dizziness and difficulty sleeping, I would assess all four systems as they all could be contributors.

    Treatment programs can commence prior to Return to Play and Return to Learn protocols, but require close monitoring and evaluation. There is a delicate balance between working hard enough to lessen the recovery time, without pushing too hard to lengthen it. The key is sub threshold activity to stay out of the "danger zone".

    Dangerous Activity Pattern

    Target Activity Pattern 

    So who can provide this treatment?

    Depending on the severity of symptoms of a concussion, or of Post Concussive Syndrome, experienced by a patient, their team may consist of many professionals.

    A sports medicine doctor may refer a patient to a neurologist for further examination, especially if physical damage to the brain or skull is suspected.

    Consultation with an Ophthalmologist, or eye surgeon may be recommended if visual disturbances are extreme, especially if assisting devices or corrective glasses are required.

    A hearing specialist may be consulted if there is suspicion of damage to the inner ear, or the nerves that lead between the ear and brain. Sometimes specialized ear plugs may be indicated that reduce ambient noise to allow a patient to function.

    There are many other types of medical professionals that may be consulted during the journey of recovery from a complex or simple concussion. These can be very confusing or intimidating to athletes and families of athletes who are playing at the recreational or youth level of sport.

    Athletic Therapists are trained in the recognition and treatment of many facets of concussion rehab. ATs are also very knowledgeable about the other professions and how they can help treat various conditions.

    Take Home Message?

    An Athletic Therapist should be your first line of defense against concussion, and once sustained your tour guide and treatment specialist to help over come symptoms. From baseline to return to play, AT's are specialists who care passionately about your health, and performance!

    by: Alana Gulka CAT(C), BAHSc-AT, BSc
    Certified Athletic Therapist
    First Responder

  • Wednesday, December 23, 2015 9:40 AM | OATA Admin (Administrator)

    So we've read about the RECOGNITION of concussion, but what about what to do next? Players may be so symptomatic that referral to the emergency room becomes obvious, or symptoms might be so mild that parents are not sure if they should even go to the doctor.

    Over the years, I have worked with many contact sports, and have cared for thousands of athletes! Because of this I am able to make quick decisions, and give parents concise information with little to no grey areas. My experience has helped me to come up with a list of simple rules to follow when dealing with a concussion. This "choose your own adventure" type list depends greatly on your current level of training, and I urge any individual who is not comfortable with making a decision to refer an injured player to a qualified medical practitioner (such as an Athletic Therapist!).

    Removal from the Playing Surface

    Often a player will go down on the playing surface following a mechanism of injury, and stay down. If an AT is on duty, they are able to quickly rule out severe injuries (spinal cord injuries, fractures, cranial nerve disruption, skull fractures etc.) however this responsibility often comes down to a volunteer trainer, coach, or parent when AT's are not on staff.

    There are many things that I am not able to teach through a blog post, or even give advice on, so I would encourage anyone in this position of responsibility to take an advanced course such as First Responder through the Red Cross to help to make the tough decisions about when removal from the playing surface is safe, and when an ambulance should be called and spinal precautions taken.

    These ARE some things that I can share that would indicate that I need to stabilize the player and immediately call 911: (bear in mind that this list is not complete by any means)

    • The player is unwilling to move
    • There is deficiency is movement or sensation in the fingers or toes
    • Any deformity to the head, face, or neck (fractures or 'dents')
    • The players is bleeding or leaking fluid from the ears
    • ANY loss of consciousness, even if just for 2 seconds
    • Bruising behind the ears (known as battles sign) indicating a skull fracture

    Again, I would urge anyone who is unsure if a player is able to leave the playing surface or not, to stabilize and call for assistance!

    Sideline Assessment

    There are several high-tech and well respected computer based programs that are used to identify and assess concussions. The most well-known example is the ImPACT test. These tests are very useful, however they are expensive and inaccessible to many athletes, especially in youth or recreation sports.

    Studies have shown that in youth and recreation sport, the Sport Concussion Assessment Tool, or SCAT3 is extremely useful at identifying concussion, and can be used at any time with just paper and a pen! There are two versions of the SCAT3, designed for athletes above age 12, or 12 and under.

    Anyone who is responsible for athletes should be familiar with the SCAT3, and have a few copies on hand in case of injury. This tool can also be used by trained professionals to complete baseline testing, so that onsite trainers have something to compare to in case of injury (Alana Gulka Athletic Therapy offers this service!).

    Immediately following injury, the most important part of the SCAT3 is the symptom score. If an athlete reports ANY symptoms (even just one!), and sustained a mechanism of injury, they should be removed from play, and referred to a medical professional (Certified Athletic Therapist, or a Sports Medicine Physician). No athlete should return to play during the same day!

    The SCAT3 has very clear instructions about how to report findings and has a handy letter to send home with parents and players to bring to the doctor or Athletic Therapist.

    SCAT 3 Child-SCAT3

    What then?

    If you have removed a player from the playing surface safely, recorded their signs, symptoms, and noted their mechanism of injury, and referred them for follow up, then you have done your part to keep the player safe!

    It is also important to educate players and/or parents on the importance of managing their concussion, and the dangers of second impact syndrome.

    Watch for the next blog post, outlining ways to help rehabilitate a concussion, and what resources and treatment methods are available.

    Be sure to check back for our next post about how to REHABILITATE a concussion in the clinic.

    by: Alana Gulka CAT(C), BAHSc-AT, BSc
    Certified Athletic Therapist
    First Responder

  • Wednesday, December 02, 2015 12:16 PM | OATA Admin (Administrator)

    One of the greatest struggles in concussion management is the initial recognition that something may be wrong with an athlete, and that they require further evaluation. The subject of concussion has been scrutinized recently, and new science is being published almost on a daily basis. In fact, the Google dictionary defines a concussion as a temporary loss of consciousness, which could not be a more limiting and misleading definition!

    While the scientific understanding is increasing, it means that there are many layers to dig through when attempting to self-educate on the topic. By Googling concussion, you find conflicting advice, myths and confusion. The purpose of this post is to help take away some of the confusion, and provide you with the simple yes/no questions that I ask myself when identifying a concussion in an athlete.

    What is a Concussion?

    Parachute Canada defines concussion as a change in brain function, which can be caused by a director or indirect force to the head. This means that a direct hit to the head is not always required; a concussion can result from a blow to the body or a fall on the bottom. Because it is a functional or "invisible" injury, often tests like MIR or CT scans appear normal.

    The actual mechanism of injury results when the brain moves in the scull, and makes contact with the inner surface of the bone. This can cause physical damage such as bleeding or trauma to the fibers and tethers that hold the brain in place. More commonly, there is no physical damage, however a chemical cascade and inflammation occur that alter the function of the brain.

    What Does a Concussion Look Like?

    Since everyone's brain and brain chemistry are very different, each person reacts to a concussion differently.

    The Consensus Statement published in 2013 helps to summarize the potential symptoms in different categories:

    1. Reported Symptoms including headache, dizziness, inability to focus eyes, sensitivity to noise or light
    2. Physical Signs including loss of consciousness, or difficulty staying awake
    3. Behavioral Changes such as irritability, personality or emotional changes
    4. Cognitive impairment such as a slow reaction time, or alterations in short and long term memory
    5. Sleep disturbances such as insomnia, drowsiness or slowness to wake

    That being said, any change to the normal following a mechanism of injury should be viewed as a sign of concussion.

    So What to do if an Athlete has Sign or Symptoms?

    When an athlete displays signs and symptoms of a concussion, the most important thing to do is to remove the athlete from play until they have received appropriate medical care. The scariest part of concussion is not the initial injury, but rather the risk of Second Impact Syndrome, which occurs when a second impact is sustained before one is completely recovered. Second Impact Syndrome most often results in a critical injury, leading to permanent damage or death.

    Athletic Therapists are specialists in field side evaluation of concussions, and in making quick decisions regarding removal from play, and referral to appropriate health care professionals. Sometimes the most important decisions have to be made in the blink of an eye, if a coach or athlete does not notice the most subtle of signs and therefore the athlete is subjected to subsequent contact.

    To ensure that the correct decisions are made for your children, players, student, or for yourself, an Athletic Therapist should be present at all high-risk activities to act as a third-party activity for all athletes.

    by:Alana GulkaCAT(C), BAHSc-AT, BSc
    Certified Athletic Therapist
    First Responder

  • Thursday, November 05, 2015 4:03 PM | OATA Admin (Administrator)

    Athletic Therapists, as defined by the Ontario Athletic Therapist Association, are health care professionals who specialize in the prevention, assessment and care of musculoskeletal disorders, especially as they relate to athletics and the pursuit of physical activity (OATA, 2009).

    If you watch professional sports on television, you’ve seen Athletic Therapists jump over the boards, or on to the field, to respond to an emergency or injury. You have likely seen someone on the sidelines of a local football or rugby tournament with a first aid fanny pack slung over their shoulder or around their waist. And if you have been in a busy sports medicine clinic, they are there too!

    Athletic Therapists (ATs) are usually the first to respond to an injury or emergency typically in a sports setting. All levels of active people and teams use ATs for their knowledge of acute injuries. With advanced first responder skills, an AT will confront the emergency and can assess for the injury onsite. This leads to a faster diagnosis and treatment time. All athletes and active people want “rapid return to work and play” (OATA). Once the diagnosis is made, the AT will treat and manage the injury. What separates ATs from other health care professionals is the keen awareness of acute injury management, biomechanics, strength and conditioning and manual therapy. This, along with advanced first aid, makes an Athletic Therapist a great choice for athletes of all levels.

    The sporting world is dealing with a new awareness of concussions. Athletic Therapists are trained to recognize the signs and symptoms of mild traumatic brain injuries (concussions). Managing these injuries can take a coordinated effort among health care professionals and an Athletic Therapist can be your quarterback. Athletic Therapists use advanced assessments, for instance, cranial nerve testing and the SCAT test, to determine if a concussion may have been sustained. Manual therapy and working alongside sports medicine physicians are also in the scope of athletic therapy.

    All Certified Athletic Therapists write a nationally-standardized, written exam and must successfully complete four components of practical testing. Candidates are tested on assessment and rehabilitation of musculoskeletal injuries, as well as medical emergencies and non-emergencies in the field. Once the national exams are passed, certified therapists must continually update their sports medicine education and first responder certifications. So, go ahead, give athletic therapy a try!

    For more information about Athletic Therapy, read the OATA's White Paper HERE

    To find an Athletic Therapist near you, use our AT Search Feature HERE

    by:Alana GulkaCAT(C), BAHSc-AT, BSc
    Certified Athletic Therapist
    First Responder



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