Terry Defreitas, MD, CCFP (CASM) Family Physician Diploma in Sport Medicine
Dr. DeFreitas completed her medical training with honors in 1995. She is very active in the practice of sport medicine, having developed a keen interest in tae kwon do and other full contact martial arts throughout the years. She has served as the Team Physician for Tae Kwon Do Alberta since 1997, and the National Tae Kwon Do team since 2000. She was appointed as the Medical Director for the World Championships in Tae Kwon Do in 1999, and currently sits on the PanAm Tae Kwon Do Union Medical Committee.
Dr. DeFreitas is recognized for her knowledge of head injury in sport, establishing a policy for management of head injury in the sport of Tae Kwon Do.
Dr. DeFreitas practices family medicine at the Leduc Family Medicine Clinic. She has been a consultant at the Glen Sather Sports Medicine Clinic since 2003.
Concussion… everyone has heard about it but do you really know what to do when it happens?
You and your best friend attend a try out together. Your buddy is across the field and is moving fast, he gets hit from behind…HARD.. He drops to the ground. He gets up slowly and holds on to his head for a moment. He continues to play. In the next few minutes you notice your bf is not behaving normally, he misses an easy pass; he misses a simple play that he can normally do.
Could this be a concussion ? ABSOLUTELY. Your best friend needs to be assessed by medical personnel.
Concussion: either a direct blow to the head, face or neck or a force to the body that can transmit enough force to the head or neck, such as a whiplash action, may cause a concussion. Following the injury the person suffers changes in function, such as headache, dizziness, amnesia, confusion, sensitivity to light, nausea, slowed reaction time and occasionally seizure or loss of consciousness.
You do not have to be knocked out to have a concussion
When an athlete has a concussion they may not realize it, in fact many athletes still try to continue participating with symptoms of concussion unaware of the danger.
If an athlete who already has symptoms of a concussion returns to play to early several things can happen; if they get hit again even with a lesser force, they may get another concussion or worse the can suffer SECOND IMPACT SYNDROME .SIS although rare, this can result in permanent brain damage or even death. It is therefore important for every athlete should be aware of the signs and symptoms of concussion. Team medical staff, coaches and teammates need to be alert and be able to recognize the concussed athlete early
How do you evaluate a possible concussion?
If you have trained medical staff with your team they will probably use a SCAT2 (Sports Concussion Assessment Tool) to evaluate your friend. In November 2008 a team of medical experts from all over the world came to a consensus: the SCAT2 would be a standard tool recommended for use when evaluating an athlete for concussion on the sidelines. This tool includes a symptom scale, balance testing, several memory-screening tests and a screening neurological exam. At present it is the best evaluation instrument we have for concussion at the field of play. Following the sideline test the athlete is further examined by a medical doctor.
We do not have any medical people with our team. What then?
If you do not have trained medical staff with your team when the concussion occurs that athlete will need to be taken to a Medical Doctor as soon as possible.
Once the concussion is diagnosed it is best to be followed closely by a sports medicine physician in order to determine when it is safe for the athlete to get back into the game.
How do you treat concussion?
Once the diagnosis of concussion is confirmed, the treatment is very simple… REST REST and more rest until the athlete no longer has symptoms. This rest is both physical and mental. So there is physical rest as well as no TV watching, computer use, texting or other mental activities until the symptoms go away.
For many people the symptoms are gone the next day, for about 80% of people who suffer concussion the symptoms are gone within 7 to 10 days. The majority of single concussions have no long-term effects.
Once the symptoms are resolved then the athlete must be re evaluated to determine if it is safe to start the return to play process. The SCAT2 may be used again to help detect unresolved concussion. Some teams have access to Neuropsychological testing either as a web based or pen and paper test. These tests can be extremely valuable when the athlete has completed a pre season test, and then a repeat test once the athlete is symptom free after concussion. Examples of these tests are available at Impactest.com and cogsport.com.
If your team does not cover the cost of access you can still take the test online on your own for a small fee. If you happen to suffer a concussion sometime in the season, then a repeat test can be compared to the initial one. When evaluated by a trained sports medicine physician or neuropsychologists this information can be used to help determine when it safe for the athlete to return to sport.
My friend has had a, concussion and all his symptoms are gone, can he play in the game tomorrow?
Not yet.
Return to play Guidelines are progressive. An athlete may be symptom free but often as soon as the athlete exerts himself or herself the symptoms return. If this happens, the athlete is not yet ready to return to sport.
At least 24hrs after the concussion and when the athlete is symptom free, on day one he will be asked to do some light exercise simply to increase his heart rate. Then the medical staff will re evaluate him for any signs and symptoms of concussion. That is all for day one.
On day 2 and the days that follow, the exercise is a little more intense and sport specific. At the end of each day the athlete is evaluated for signs and symptoms of concussion. The entire process takes about 5 to 6 days. If on any day the symptoms of concussion return then the athlete does not progress but is allowed to exercise at the last symptom free level that was achieved.
For our prospect athletes, coaches and parents it is important to recognize what concussion is.
Any altered brain function after trauma to the head face or neck or a force to the body that transmit a significant force to the head to cause the athlete symptoms or change in behavior
It is also important to know that the number one treatment for concussion is … REST.
Return to Play is progressive and must be done under medical supervision
A Sports medicine physician is an excellent resource when an athlete is concussed and return to play decisions have to be made.
Here are some great resources to learn more about concussion
HEADS UP ON SPORT CONCUSSION by Solomon, Johnston and Lovell
HEADS UP: Concussion in Youth Sport; cdc.gov/concussioninyouthsports
Consensus statement on Concussion in Sport, 3rd International Conference on Concussion in sport held in Zurich, November 2008; Clinical Journal of Sports Medicine 2009; 19; 185-200
