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
