Most casual play, unlike competitive leagues, is non-contact. But injury is always a possibility. Jonathan Maister explains the cause and effect, symptoms and treatment of one injury in particular – concussion.
With the onset of winter, our arenas are full of hockey players of all levels. Unfortunately, injuries will be a constant companion for many.
For a number of reasons, the most bedevilling are head injuries. Firstly, a definitive diagnosis, unlike a muscle or bone injury, is more difficult for the medical practitioner. Cognitive changes are less clear compared to muscle weakness or loss of range of movement at a joint.
During the recovery period, the player often looks and feels healthy. As a result, withholding a player from activity is more difficult – for the player, as well as the overseeing coach or health care practitioner.
Persuasion is easier when pain or weakness prevents a player from skating. The symptoms associated with concussion are often easily masked and thus the player may appear fine. Many of us, me included, recall having our ‘bell rung’ or ‘getting dinged’ while playing sport. Back then coaches knew little about player care, especially regarding head injury. Up-to-date research has revealed some interesting points, most importantly, that neglecting a concussion has serious consequences.
Players usually recognise when they have sustained a concussion. They remember the knock and the brief disorientation. Loss of consciousness, if it occurs, will be obvious to those nearby. But in fact, only 10% of concussions involve losing consciousness. The player may have difficulty completing physical tasks such as balancing, and mental tasks such as math sums and confirming the date, but often mental tasks are completed, albeit more slowly.
Regardless, the player must be removed from the game. A few years ago, medical thought considered the absence of symptoms the main indicator of whether a player was ready to return to play. No longer. He or she may feel fine, but they must still leave play until after a medical examination.
Although the player may feel fine, at the brain level there have been changes. Damage has occurred, but performing mental tasks is usually possible – albeit via different brain pathways. It’s like having your usual walking route blocked by debris, with the alternate route being longer and bumpier: you get to your destination, but less efficiently. The concussed player may ‘feel slower’ and may complain of headaches, nausea, poor balance, fatigue, drowsiness, poor concentration, and in the hours following, sleep disturbances.
Not all cases are the same and concerns may vary in severity.An initial concussion, if neglected and the player allowed to continue, can have dire consequences. A concussed brain, even slightly so, is predisposed to a secondary concussion. Its resistance to concussion has been compromised. The result? Further injury to an already precarious situation.
It is wise to be wise! If your child, you, or another player experiences a concussion, participation should cease. If the player loses consciousness, it is a medical emergency and an ambulance must be called. If the injured person is conscious but symptoms deteriorate, urgent medical help must also be sought.
During recovery, the player must be as passive as possible. Jogging, cycling or any other strenuous activity must be avoided. Intense intellectual activity should be off limits as well. Studies have shown that stressing the body in any of these domains will actually inhibit the recovery process. The brain needs all the body’s resources to recover faster and properly. A brisk walk to clear the mind and that second language class are on the backburner for at least a few days, if not longer.
From a nutrition intake standpoint, alcohol must be avoided absolutely. Alcohol decreases the oxygen available to the brain, and brain recovery from injury requires an abundance of oxygen.
Parents, coaches and players must all be mindful of concussion. Testosterone in the bleachers and win-at-all-costs attitudes have no place in sport. We are dealing with flesh and blood – and grey matter as well.
Concussion – be warned, be wise and be aware.
Jonathan is an athletic therapist, massage therapist and sport massage therapist in the Markham area. He teaches sport massage and sport medicine courses across Canada, and writes extensively on a variety of topics. Contact: firstname.lastname@example.org; tel: 905.477.8900; www.JonathanMaister.com