With spring sports fast approaching, Orthopaedic & Neurosurgery Specialists (ONS), a provider of sports medicine care in Connecticut and Westchester, has launched a Sport Concussion Center to evaluate and treat concussions in youth athletes. Located at the ONS Wilton office in the Wilton Wellness Center (249 Danbury Rd.), the ONS Concussion Center is a resource for coaches, trainers as well as parents who are concerned that an athlete may have suffered a concussion.
According to the Centers for Disease Control (CDC) estimates, 1.6 to 3.8 million sports and recreation-related concussions occur each year in the U.S. A concussion is the most common type of traumatic brain injury and is generally caused by a sudden, significant blunt-force trauma to the head or body or a fall, bump to the head or other type of accident.
“Getting prompt proper treatment can help individuals recover as quickly and completely as possible,” said ONS Sports Concussion Center Director Dr. Benjamin R. Greene. “At ONS, concussion evaluations are highly personalized for each patient. The goal of the evaluation is to identify the particular symptoms from the history and physical exam, and when necessary, tailor treatment toward those symptoms,” he said.
Symptoms
Symptoms of a concussion may be obvious, such as headache or blurry vision, or may be as subtle as simply not feeling quite right. Signs and symptoms of a concussion may not appear until hours or days after the event. While most patients will recover without issue within a couple of weeks, some patients may experience prolonged symptoms.
Greene advises that individuals experiencing any of the following symptoms following a head trauma visit a nearby emergency room as these may indicate a more serious condition:
- Unequal pupil size
- Drowsiness or inability to wake up
- Persistent or worsening headache
- Slurred speech, weakness, numbness, or decreased coordination
- Repeated vomiting or persistent nausea
- Convulsions or seizures
- Unusual behavior, increased confusion, restlessness, or agitation
- Loss of consciousness
Diagnosis
The evaluating physician will base his or her diagnosis on the details of the injury, cognitive evaluation and neurological examination. Tests to evaluate thinking (cognitive) ability include several factors such as memory, concentration and recall of information.
Neurological exams will evaluate vision, hearing, strength, sensation, balance, coordination and reflexes. If a patient is experiencing severe headaches, seizures, repeated vomiting or worsening symptoms, brain imaging tests such as an MRI or CT scan may be recommended.
Treatment
Following a concussion, it is recommended that patients rest for approximately 24 hours, avoiding any excessive physical and cognitive exertion as well as screen time. They should then slowly progress back to normal life as permitted by their symptoms.
“Early initiation of sub-symptom threshold light physical activity can be very helpful in speeding recovery. It is extremely important to avoid any further head trauma before patients are fully recovered,” Greene said.
Some student-athletes require academic adjustments to ease their return to school. All student-athletes must fully be back to school without issues before doctors can initiate the return to play protocol, a six-step progressive return to athletic activity that is typically overseen by the school ATC (certified athletic trainer). Some patients with persistent symptoms may require referral for physical therapy or evaluation by sub-specialists such as neuropsychologists, headache specialists, neuro-ophthalmologists, etc.
Prevention
- Use helmets or protective headgear approved by the ASTM for specific sports
- Replace damaged and old sporting equipment or protective gear
- Always supervise younger children, and do not let them use sporting equipment or play sports that are not age appropriate
- Don’t allow dives into water less than nine feet deep
- Don’t permit athletes to participate in sports when tired or not well
- Don’t rely solely on protective equipment to prevent concussions. Tell athletes good sportsmanship is always expected, both on and off the playing field. Ensure that athletes avoid unsafe actions such as:
- Striking another athlete in the head
- Using their head or helmet to contact another athlete
- Making illegal contacts or checking, tackling or colliding with an unprotected opponent; and/or trying to injure or put another athlete at risk for injury.
“When evaluating a patient for a sport-related concussion, it is important to understand and recognize the many ways in which the symptoms of a concussion may manifest. When a patient with a suspected sports concussion is seen by a physician on the ONS concussion team, they will receive a thorough evaluation to identify the particular symptoms and triggers so that a tailored treatment plan can be created,” Greene added.
Dual board-certified in pediatrics and primary care sports medicine, Greene graduated from the University of Wisconsin with a bachelor’s degree in human development and family studies. He received a medical degree from Tulane University School of Medicine and completed his pediatric residency at New York-Presbyterian Columbia University Medical Center Morgan Stanley Children’s Hospital followed by fellowship training in primary care sports medicine at New York University Langone Health.
Greene has sports team coverage experience at the high school, collegiate and professional levels, including Long Island University, College of Mount Saint Vincent, New York University, Yeshiva University and New Jersey’s Metropolitan Riveters Professional Women’s Ice Hockey Team. He is a member of the American Medical Society of Sports Medicine, the American Academy of Pediatrics and the American Medical Association.