Heads Up (or Down) Local Doctors, Coaches & Others Focus on Concussions

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With the start of the football and hockey seasons – pro and amateur – concussions are much on the minds of many doctors, coaches, athletic trainers, players, teachers and health professionals nationally and regionally.

It turns out that our region is at the line of scrimmage (so to speak) in the training professionals to handle these injuries and in the exploration of ways to better protect athletes and others from concussions and their potential long-term consequences.

Kirsten Henk, a recent graduate from the College of St. Scholastica’s master’s program in athletic training, made concussions the focus of her studies. A concussion is a type of brain injury that can be caused by a blow to the head, by a fall or other means of jarring the brain inside the skull. To illustrate what happens, Kirsten suggests thinking of an egg, with the skull as the egg shell and the brain as the yolk. “When you get a concussion, the egg gets shaken.”

According to a recent article in the Journal of Pediatrics and Child Health, concussions have reached epidemic proportions, with nearly 4,000,000 sports-related concussions reported each year in the United States. The article points out that the dramatic rise in the number of reported concussions may be due to increased public awareness sparking better reporting.

Kirsten spent hours during her studies watching football games, hockey and soccer matches, always on the lookout for potential injuries. Kirsten, who is now a certified athletic trainer at Spooner Physical Therapy and Rehab Specialists in Wisconsin, worked with high school athletes in every sport during clinical rotations around the Duluth-Superior area.

Others can keep an eye out for potential injury to players on the field or on the ice, she says, but it’s up to the student to report symptoms.

“The student will report a headache, sensitivity to light, sensitivity to noise,” she says. “If you have one sign of a concussion – just a headache – the trainer can take the player out of the game at the high school level. I really like that one because the adolescent brain is still developing and it might take them longer to recover.”

Besides training students entering the profession about concussion, St. Scholastica, thanks to its football coach, has also been at the forefront of creating a tool for teachers and coaches to answer questions about head injuries.

Head football coach Kurt Ramler developed headsmartfootball.com as a comprehensive preventative and post-concussion plan for football programs.

“At St. Scholastica, we have an overarching promise to our players that we care about them as people first and as athletes second,” Kurt wrote in his first blog on the site. The site outlines a nine-part prevention plan using an “always report” philosophy for players, coaches and trainers and training strategies that feature neck exercises and other ways to target potential vulnerabilities in athletes.

St. Scholastica associate head coach George Penree says he adopted Kurt’s philosophy and it’s become part of how he teaches tackling.

While safety concerns him, George fears current research into the short- and long-term affects of head injuries may be one-sided, based in part on a University of Minnesota doctor’s similar concerns about how data is being collected and interpreted.

“I am worried we are jumping to conclusions without understanding the whole picture,” George says. “I am worried about parents and youngsters being scared off from the game. Football is a great sport that teaches so many life skills.”

He adds some advice for parents entering their children into sports. “Parents should ask their children’s coaches about their concussion plan and how they are teaching tackling and cut blocking. If the coaches do not have a plan, the parents should demand one. Concussions heal, like any other injury in sports with proper recovery, and the issues subside.”

At Thunder Bay’s Lakehead University, meanwhile, there are two programs – The School of Kinesiology Research Lab and the Sports Medicine Concussion Clinic – targeting reduction of concussions and better treatments them when they occur.

In the kinesiology lab, Dr. Carlos Zerpa  actually developed a helmet testing tool, which the university’s engineering department then created, that not only measures the effectiveness of a helmet from a straight-on blow but how a weak neck may contribute to a concussion.

“It’s really been exciting because now we are moving into more sophisticated analysis,” Carlos says.

Current helmet testing leaves much to be desired, he contends. “They are testing in a way that I feel is not robust enough.”

The machine that he and others at Lakehead developed offers more subtle testing. For example, it can be adjusted to measure a strong- or weak-muscled neck and how that would affect the outcome of a blow.

They are also developing ways to replicate how an injury occurred, which may lead to the most appropriate treatment. As Carlos explains, in some cases, doctors may be allowing those with concussions to return to activities like driving or returning to play too early. A concussion can slow response time even days after the initial injury. The testing being done in the lab may help clinicians to better understand the full range of immediate and delayed consequences of a concussion.

Ultimately, this kind of work might show more ways to strengthen neck and other muscles to avoid injuries. It even might help soldiers in the field, he says, offering an example: “Soldiers wearing heavy helmets go on really bumpy roads and are exposed to blast impacts. They have to use the neck muscles a lot to hold the helmets; as the neck muscles strength diminishes due to fatigue, it is possible to get a concussion while wearing a helmet when impacted with a rotational acceleration.”

The kinesiology lab partners with both the University of Ottawa and Lakehead’s own Concussion Clinic under the direction of Dr. Dave McKee, Thunder Bay’s leading concussion expert. The Concussion Clinic provides services to assess and treat sports-related head injuries, including pre-and post-concussion care. It is available for self-referrals for anyone who has or suspects they may have a sports-related concussion. It hosts a Concussion Hotline. The clinic employs ImPACT Concussion Management software, technology that allows clinicians to evaluate post-concussion recovery and ensure the athlete’s safe return to play.

Short-term symptoms may including headaches and problems with memory, concentration, coordination and balance. In some cases, a person can lose consciousness. It’s also possible to have a concussion without symptoms at all or none appearing for up to 48 hours.

A single concussion can be dangerous if subsequent head injuries occur, which is why there is such a great concern with physical sports. People who suffer multiple brain injuries may be at greater risk for lasting, progressive damage to brain functions. There is also something called “second impact syndrome,” where a second concussion soon after the first may result in rapid and fatal brain swelling.

Baseline testing is a vital tool to ensure proper treatment in the case of a concussion. Young athletes take a rigorous test before the season starts to record a baseline of cognitive activity. In Ontario, all students playing in Superior Secondary Schools Athletic Association high school football are required to undergo a baseline test before stepping on the field so that comparison data is available should a concussion occur.

Many schools around the Lake, including high schools in the Twin Ports, and all colleges and universities, implement baseline testing for athletes in contact sports.

“If you’re concerned your ninth-grader is going into hockey, football, soccer, you have a right to go ask that coach if there’s a baseline test,” Kirsten says, adding that if the school doesn’t do testing, “you can always ask your family physician.” In her experience, even parents with kids in non-contact sports like cross-country running have requested baseline testing.

Rural schools with limited funds are finding innovative partnerships to make testing available. A three-year-old concussion testing program uses Lake Superior State University athletic training and psychology students to do baseline testing for the Eastern Upper Peninsula Intermediate School District in Michigan. The school district’s goal is to provide baseline assessments for as many student athletes as possible and increase post-injury education.

Educating athletes and their families about concussions is critical.

Should a concussion occur, strict protocols track monitoring of symptoms and recovery. While recovering, the student athlete is not allowed to play sports and must rest – this may include refraining from schoolwork and screen time.

“Schools are awesome about this,” says Kirsten, explaining how athletic trainers, coaches and teachers work together for a student’s recovery.

St. Scholastica employs the help of the campus Center for Equal Access to make sure the student is given extra time to complete assignments while they are recovering. “The biggest thing is rest,” says Kirsten. “You definitely don’t want to rush it.”

During recovery, a student reports daily to a clinician or athletic trainer. Once they are symptom free, they begin exercising, but monitoring continues to make sure symptoms don’t re-emerge.

Teaching the students not to try to get back into the game too quickly is key, Kirsten says. “The athlete has to report the symptoms they experience. That’s the biggest thing we preach to them – they have to be honest with us.”

Regional Resources

Through the College of St. Scholastica, headsmartfootball.com was developed by coach Kurt Ramler, left, to answer questions about how to coach football responsibly and offer a program for avoiding head injuries.

The Lakehead University Concussion Clinic has resources for parents, coaches, athletes, teachers, articles and latest research, return-to-play programs, baseline testing and medical advice.

You can access the clinic online at lusportsmedicine.wixsite.com/concussionclinic.

Freelance writer Felicia Schneiderhan, of Duluth, is a frequent contributor to this magazine.