CONCUSSIONS - Are You Following an Appropriate Return To Play?

Concussions are an injury we as cheerleaders know well, unfortunately there are always going to be fluke accidents that we cannot stop, and concussions will happen. That being said, there are many things that we can do to prevent concussions, just like any other injury.


The KEY factors to preventing concussion are:

  1. PROPER PROGRESSIONS

  2. TECHNIQUE

  3. SPOTTING


What we are going to discuss today however, isn’t as much about how to prevent concussions, but, understand HOW a concussion occurs, as well as the appropriate return to play.


CONCUSSION: A concussion is a form of brain injury that causes temporary disturbance in how your brain functions.


How you sustain a concussion; your head and neck needs to accelerate (start) or decelerate (stop) quickly, as a result this will cause your brain to move within your skull, thereby shearing and stretching the nerves that make up your brain.


With every concussion there will likely be an associated whiplash, however, it is possible to sustain a whiplash without incurring a concussion. This is because it takes less force to cause whiplash than it does to cause a concussion.


As a result of the difficulty in assessing and diagnosing a concussion, it is important to pay close attention to the symptoms of the athlete, and any “red flags”, while being extraordinarily cautious with the return to play. The dangers of a concussion increase significantly if the injured athlete is to return to play too early and sustain another concussion.


Symptoms to look out for:

  • Headache

  • Neck pain

  • Sensitivity to light/noise

  • Visual problems

  • Dizziness

  • Balance issues

  • Nausea

  • Vomiting

  • Memory issues

  • Difficulty concentrating

  • Feeling slowed down

  • Feeling “in a fog”

  • Trouble thinking clearly

  • Anxiety

  • Nervousness

  • Depression

  • Sadness

  • Irritability

  • More Emotional

  • Fatigue

  • Low Energy

  • Sleeping more or less

  • Difficulty falling asleep


Complete Concussion Management. (2020). What You Need To Know About Concussions [Handbook]. Oakville, ON: Author.


The learning here, regarding return to play is to slowly reintroduce everyday activities symptom free, progressing to activity, and then back to sport - all symptom free. It is important to understand, when a symptom returns during a certain activity, that does not mean the athlete needs to return to doing nothing, they just need to take one step back, and progress slightly slower.


One of the many myths regarding concussion recovery still being widely implemented today is to lock yourself in a dark room and do nothing. This isn’t the most up-to-date advice. Current guidelines recommend returning to any normal daily activities that do not increase your symptoms.


Example:


Susie Q. sustained a concussion at practice by bailing in a running tumbling element. She is experiencing headaches, irritability, fatigue and dizziness. Day 5 of recovery, Susie Q decides to try and read her book. After 15 minutes of reading, she notices some of her symptoms returning. For the next 3 nights, instead of not reading at all, Susie will only read for 10 minutes, as she is able to do so symptom free. Eventually, Susie will work her way back up to 15 minutes symptom free.


These steps are the steps required for each return to play element. The same can be with walks. If after a 15 minute walk, Susie starts to experience headaches, she will stop walking. The following days, she will walk for 10 minutes, working her way back up to 15 until she can walk longer than 15 SYMPTOM FREE.



Okay I think you get it now..


What is important to grasp here is to work your way back to sport or activity slowly, testing where your limits are, and working within those limits, without contact. Believe it or not, SAFELY testing your limits of symptom free activity is the best way to help your brain recover. Always seek medical advice from a qualified healthcare provider with concussion training.


Along with the advice and supervision from the appropriately trained healthcare provider, we recommend referring to the Complete Concussion Management Return to Play Protocol. (full CCMI Handbook here). The Return to Play/Learn has been recently modified due to more scientific findings and will be updated on the Complete Concussion Management website soon.


Here is the latest recommended protocol. You may still reference the CCM handbook for now.


RETURN TO LEARN/WORK


1. MODERATE, SYMPTOM LIMITED ACTIVITY

You should rest and avoid any physical and cognitive activity that could increase symptoms. Remain at this stage until symptoms go away from 24 hours to 48 hours (up to max of 3-4days). If you are still having symptoms at rest for longer than 4 days, book a visit with your healthcare provider.


DO: Light walks (15-30 minutes), household chores, limit screen time

DON’T: Physical or Cognitive activities that make symptoms worse, or risk another hit to your head


2. LIGHT COGNITIVE ACTIVITY

You can gradually increase your cognitive activity such as light reading, homework or working from home. If your symptoms come back, take a break and try again another time. Once you can tolerate up to 1-hour of activity without getting symptoms, you can move to stage 3.


DO: Light reading, homework, texting or emails, work from home

DON’T: Physical activity that makes symptoms worse, risk another hit to your head


3. HALF DAY OF SCHOOL OR WORK WITH RESTRICTIONS

You can go back to school or work for one-half day - morning or afternoon. Keep in mind that you should have some restrictions in place. Speak to your health care provider.


DO: Lower your school or job workout (modified duties), adjust screen and monitor settings (light sensitivity)

DON’T: Physical activity that makes symptoms worse, risk another hit to your head, participate in recess or gym class, take quizzes or tests, complete homework assignments


4. FULL DAY OF SCHOOL OR WORK WITH RESTRICTIONS

You can now attend a full day of school or work with certain restrictions.


DO: Attend class or go to work (desk job), and gradually increase cognitive activity, complete small homework assignments, take frequent breaks.

DON’T: Physical activity that makes symptoms worse, risk another hit to your head, participate in scress or gym class.


5. FULL DAY OF SCHOOL OR WORK WITHOUT RESTRICTIONS



RETURN TO PLAY


1. SYMPTOM LIMITED PHYSICAL ACTIVITY


You should be evaluated by your healthcare provider with a graded exercise to determine your ability to exercise and tolerance. Once completed, your healthcare provider can provide recommendations for you.


DO: Light walking, jogging or weight training

DON’T: Physical activity that make symptoms worse, risk another hit to your head, sport-specific activities


2. LIGHT SPORT-SPECIFIC ACTIVITY

You can return to non-contact practice in your sport. This is your first step to safely returning to sport.


DO: Remove academic restrictions, individual drills and exercises

DON’T: Another hit to your head, increase your heart rate too much, practice if you have symptoms


3. NON-CONTACT TRAINING DRILLS (HIGHER INTENSITY)

You can gradually increase intensity and participate in some team-based drills at practice. NO CONTACT!


DO: Individual drills and exercises at a higher level of difficulty and intensity, some team drills

DON’T: Participate in contact drills, risk another hit to your head


4. HIGH PHYSICAL EXERTION PROTOCOL

This step includes a high-intensity physical exertion test, overseen by your healthcare provider, to determine if you are ready for a full contact practice.


5. FULL PRACTICE

You can participate in full practice and contact drills.


DO: Participate in practice at high level, including contact.


6. FULL GAME (COMPETITION)

Once you get clearance from your doctor or healthcare provider, and feel ready to return, you can go back to full game play.



PLEASE NOTE: EVEN IF YOUR SYMPTOMS ARE GONE YOUR BRAIN MAY STILL NEED TIME FOR RECOVERY. THIS IS WHY IT IS SO IMPORTANT TO VISIT A HEALTHCARE PROVIDER WITH CONCUSSION MANAGEMENT TRAINING WHO CAN HELP YOU NAVIGATE THROUGH THE RETURN TO PLAY/LEARN PROTOCOLS.


Complete Concussion Management Inc. is a great resource for all things concussion. Dr. Scott is a CCMI certified concussion clinician and has vast experience treating concussions specifically within the cheerleading industry. If you have any questions regarding RTP adaptations specifically for our sport, do not hesitate to reach out. CCMI has certified clinics all over North America, Australia and various locations in England and Ireland.


Again we remind you, although the process of RTP seems long, it is imperative for your athletes safety. When everyone follows proper RTP protocols, the long term effects and risks from concussions are dramatically decreased, and athletes will be better off and on the mat more permanently in the long run.


Our understanding of concussions, and the proper protocols based on scientific research has changed over the last number of years, and it is important as coaches, gym owners, parents and athletes to know what to look for and the appropriate steps to returning safely!


Please note; ‘concussion helmets’ are great for protecting athletes from superficial head trauma; however, will not protect the athlete from sustaining a concussion. The same goes for mouthguards. Although they will protect the teeth, they will not prevent concussions. Helmets and mouthguards are highly recommended to use but not to prevent concussions.


Are there other topics you want to learn about? Injuries you see in your gym, questions you’ve always wanted answers to but weren’t sure who to ask? Send us an email, chances are if you want to know, someone else may too!


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