Sports medicine

JOHN DOHERTY: Timing a key to concussion recovery

2013-06-10T16:30:00Z 2013-06-10T17:49:12Z JOHN DOHERTY: Timing a key to concussion recoveryJohn Doherty Times Correspondent nwitimes.com
June 10, 2013 4:30 pm  • 

Over the past five years, there has been a steady increase among players, parents, coaches, and medical professionals in the understanding of the need to sit in the immediate aftermath of concussion. Despite the improved appreciation for the initial gravity of the situation, the question from victims remains the same.

“When can I play again?”

The answer from medical professionals during that initial visit is almost always, “I don't know.”

A research study published yesterday in Pediatrics acknowledged as much. In their introduction, the authors — emergency room physicians at Boston Children's Hospital — wrote, “(A) lack of prognostic data has led to significant uncertainty among patients, families, and healthcare providers as to which patients would benefit from specialist follow-up, extended academic accommodations, prolonged abstinence from athletic participation, and even cessation of high-risk activity.”

Consequently, the researchers took a closer look at the history and subsequent progress of 235 concussed patients, aged 11-22, who visited their emergency department over the course of a year.

Among their findings, 64 percent were athletes, 43 percent were female, 29 percent had had a previous concussion, and 22 percent were knocked out.

The girls took longer to recover, 15 days on average as opposed to 12 days for the boys. However, according to lead author Matthew Eisenberg, M.D., the girls also had greater symptoms initially than the boys did. For girls with symptoms comparable to the boys', the recovery period was also comparable.

Not surprisingly, those who had a previous concussion took longer to recover than those who had never had one, especially if the earlier episode had occurred within the previous 12 months.

Counter-intuitively to some observers, though, those who were knocked out recovered faster than those who were not, 14 days versus 11. Eisenberg wasn't entirely surprised, but wasn't sure why loss of consciousness seemed to be an advantage. One possibility is that those who blacked out took the diagnosis more seriously and therefore better complied with the instructions they received.

“This (study) opens the door to more questions,” Eisenberg admitted.

Still, there were several definitive findings. Those who had never had a concussion took an average of 12 days to become symptom-free. Having had one previous concussion increased that recovery time to 14 days.

Change the word “one” to “multiple” and symptoms didn't entirely clear until 28 days.

Worst of all was having had a concussion within the previous 12 months. Symptoms then lasted an average of 35 days.

Pre-existing diagnoses of ADD/ADHD, anxiety, and/or depression also significantly lengthened recovery. So did having an abnormal neurological exam (e.g. balance problems).

As for answering the questions this study generated, Eisenberg and his colleagues are now enrolling new concussion patients in MRI and blood chemistry studies.

Meanwhile, rather than relying on the statistics his study generated, Eisenberg cautioned fellow clinicians “to individualize each patient's care.”

I would concur because any medical professional or sports organization who, as a result of this study, routinely withholds a concussion victim from sports for a full year won't be hearing about many concussions.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at ptatcsport@sbcglobal.net. Follow him on Twitter @JDohertyATCPT.

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