Concussions & Primary Care
image: @tjump
It’s been some time since I’ve written a blog, so I thought it would be time to write one again.
I was looking for some inspiration and with concussions being one of my passions, I figured I should spend more time educating on the subject.
Currently, there has been no organized sport participation across Canada (although this is slowly changing as the government eases on restrictions), therefore the frequency of certain injuries has reduced.
This, however, doesn’t mean that all injuries have reduced in number. Lots of chronic & work-related/ postural issues are arising as a result of many people’s work situation changing over the past several months.
Concussions for one, have seen a significant drop in prevalence over the few months COVID locked everyone down since there were fewer people driving, fewer people cycling, fewer people playing contact sports, and less people working in general.
The easing of restrictions has lead to an increase in concussions prevalence as more of us are heading outdoors & starting to resume those pre-COVID activities, if not picking up new ones.
Cycling for example, has seen a drastic rise in numbers. But with that, there has also been an increase in frequency of injuries as a result. Most have been non-traumatic & training related (too much, too soon). While the remainder have been a result of traumatic incidents such as collisions with other riders, pedestrians, & vehicles. One such incident resulting in trauma but not from colliding with an object while riding, is when riders cross streetcar tracks & have their wheels get stuck, resulting in the rider being dislodged from the bike & hitting the ground.
Now you’re probably wondering what this has to do with concussions. Well, with all the collisions & contact with the ground, the head takes quite a hit, & for some insane individuals that decide that it’s “cool” to ride without a helmet, the consequences can be quite severe.
When these accidents result in visits to the ER or a GP’s office, it’s important that these injuries are managed accordingly to prevent long-term & chronic symptoms.
I teamed up with Dr. Andrew Sim, a family physician and adjunct professor at McMaster University’s Department of Family Medicine. Dr. Sim also has a special interest in sport medicine & is the assistant team physician for the Hamilton Tiger-Cats of the CFL & lead physician for the Hamilton Forge FC.
Dr. Sim is also a Sport Medicine practitioner affiliated with Tulip Health, an online/ virtual health platform for Ontario residents to receive medical assistance from the comfort of their homes. For more information, please feel free to check out tuliphealth.ca.
Dr. Sim provided me with how he helps manage individuals & athletes following acute concussions on & off the field.
Dr. Sim writes:
“Various factors can affect return to work or play including previous history of concussion, mental health and medical issues. Any athlete or individual who is suspected of having a concussion should be evaluated by a health professional. If a loss of consciousness is suspected, typically an evaluation in the emergency department is indicated.
After a diagnosis of concussion, the individual may benefit from a period of physical and cognitive rest (24-48 hours). It’s very important to limit reaggravating symptoms such as headaches, dizziness, light sensitivity or nausea. However Ontario Neurotrauma (2018) guidelines advised to avoid complete bed rest in excess of 3 days as prolonged rest may worsen outcomes. However, it is important to avoid activities with high concussion exposure risk in the first 7-10 days.
For individuals who are returning to work or school, it is important to minimize activities associated with significant mental strain including problem solving or screen time. For both physical and mental activities, patients should be advised to sustain subsymptom threshold levels of activities. If symptoms flare up, the patients should be advised to rest until symptoms resolve and then temporarily reduce their physical or mental activities to prevent flare up of symptoms. Their treating health care professional should be notified so that the return to sport or activity can be resumed at a slower pace. Usually recovery should continue to occur over a few days or even a few weeks. However reintegration into school or sport is ineffective at 4 weeks, a referral to be seen by a neurologist and/or neuropsychological specialist should be considered.
The above graphic is a table that outlines various stages of returning to activity & the aims/ goals of each step.
I thank Dr. Sim for his contribution & hope that this information can help educate not just those that work to re-integrate themselves back into work/school/sport life after suffering a concussion, but also those in the medical professions that help treat & manage concussions throughout the various stages of rehabilitation.
Concussions are a complex injury to rehabilitate. One of the most important steps is education on how best to manage them, along with prompt & adequate care.
Should you be interested in more information on the topic, please feel free to reach out to me via email at (arasruslys@gmail.com) or via IG / twitter – @ahh_rass_physio. You can also reach out to Dr. Sim at http://tuliphealth.ca or on IG/ twitter @tuliphealth.md.
