Below is another article written by Dr Kenneth Ransom exclusively for the Buckeye Prep Report. Dr Ransom has a son who plays AAU basketball and has continued to provide our readers with a series of health related articles of the past couple of years. Enjoy!
In a hard fought 3 on 3 tournament game a player is “taking it to the hole” when he gets a hard elbow to the top of his head by a defender. He is a little dazed but not knocked unconscious. On the way home, he doesn’t remember anything about the tournament; where it was, what teams played or even who played on his team. At the Emergency Room he is diagnosed with a concussion. This is a true event that happened to my son on Presidents Day. He missed over a week of school and was not able to return to physical activity for two weeks.
Basketball is not considered a “contact sport” like football or hockey but we all know that there is a lot of physical contact. Young athletes are getting bigger, faster and play more aggressively than ever consequently concussions are becoming more common in the sport of basketball. Since there is no protective head gear it is essential that a concussive injury is detected early and the player protected from further injury. Not only is a player more susceptible to any type of injury because of the impaired mental condition but more importantly, a repeat concussion could significantly worsen the initial brain injury, resulting in a longer recovery and possibly permanent problems. Developing brains in young players are especially susceptible to injury and long term problems.
It’s very important for parents and coaches to have a low threshold for suspecting a concussion and recognize early symptoms. Loss of consciousness, by definition, is a concussion! However, the player does not have to be knocked out in order for the brain to be shaken sufficiently to cause injury. Memory loss is the most sensitive sign, especially for recent events. The player may also feel light-headed or have problems concentrating which could manifest as deterioration in his performance. A headache is also a very common complaint immediately following the trauma. Nausea or vomiting can be a sign of a more serious injury. It is critical that the player NOT RETURN to PLAY the SAME DAY if suspected of having a concussion. The player should be taken to a health care professional for a complete neurological evaluation as soon as possible.
Treatment for a concussion is to rest the brain, both mentally and physically, with a gradual return to full function. The player will usually need to miss at least a couple of days of school and possibly a week or more. School work may cause headaches and the student can find it difficult to concentrate. Test taking can be especially frustrating for someone with a concussion. Almost all schools require a note from a medical professional before the student is allowed to return to class.
As far as physical activity or playing basketball again, the International Concussion Consensus defines a five step process to:
“Return to Play Progression”
Step 0: As a baseline step, the athlete needs to have complete physical and cognitive rest and not be experiencing any concussive symptoms for a minimum for 24 hours before starting any physical activity.
Step 1: Start with light aerobic exercise only for about 5 to 10 minutes with just enough activity to increase the heart rate. Activities like stationary bike, walking or light jogging, shooting free throws or threes are acceptable but no weight lifting, running or jumping.
Step 2: The athlete may engage in moderate exercise at a reduced duration and level from their usual workout. Some running and shooting drills, ball handling, light weight lifting or core training are good.
Step 3: Non-contact practice otherwise a typical workout at a full speed. May also add more cognitive challenge as focus should be near normal. There should be no scrimmaging, one-on-one drills or pick-up games where there is physical contact.
Step 4: Full contact practice is next in order to make sure the player is really ready for game play.
Step 5: Return to game competition.
Symptoms and cognitive function need to be monitored during each increase in the level of exertion. Besides headaches or light headedness, the player may have difficulty focusing or experience earlier fatigue. If any symptoms return, the activity should stop as this may be a sign that the athlete is pushing too hard. Only after additional rest and there have been no symptoms for 24 hours, should he start again at the previous step during which symptoms were experienced.
The “Return to Play Progression” should ideally be under the guidance of a qualified medical professional and the training conducted by an experienced person who is knowledgeable about concussions and knows the athletes physical abilities and endurance. In some cases, the athlete may be able to work through one step in a single day, in other cases it may take several days to work through an individual step. It could take days, to weeks or even months to complete the entire 5 step progression depending on the severity of the injury. Do not to rush through the “Return to Play Progression” process. The concussion has not healed sufficiently until the athlete can successfully complete of all 5 steps, otherwise there is risk of superimposing a second concussion making recovery even more difficult and prolonged.
Remember it is essential, especially in youth basketball, for parents and coaches to be familiar with the early signs of a concussion in order to take immediate steps to prevent further injury and get appropriate medical attention for the player.
Reference: A “Heads Up” on Managing Return to Play from the Center for Disease Control (CDC): http://www.cdc.gov/concussion/headsup/return_to_play.html
By Dr. Kenneth Ranson