By Jessica Russell, DAT, MS, ATC, CSCS, Instructor in Logan’s Master’s in Athletic Training Program
Fall sports season is fast approaching, and one of the hottest topics we circle back to every year is concussions. From the time I started my career as a certified athletic trainer to present day, many things have changed in how we diagnose and manage concussions in athletes and physically active populations of all ages and levels of competition. One of the most important changes I’ve seen during my time as a practicing clinician is a growing awareness. Rarely will you hear the term “bell-ringer” or “just a bump on the head” being used to downplay a potential injury, something that I heard over and over in the past. The NFL has even introduced “spotters,” which are certified athletic trainers who view the game and may call a medical time out if they suspect an injury, like a concussion, has occurred.
During my time as a clinician practicing sports medicine at the NCAA Division I level, concussions were one of the most frustrating injuries to help navigate athletes through. Unlike many other injuries, a concussion is not tangible and cannot be diagnosed with imaging. Despite some research on blood test biomarkers,1 nothing has yet to be validated and widely accessible. There is no set recovery time frame that we can divulge with any certainty, since every concussion is different from the last, and until recently, rest was the method of choice for recovery. The uncertainty combined with lack of active recovery was frustrating not only for the athletic trainer, but most importantly, for the patient.
Thankfully, there have been many advances in how athletic trainers and other health care professionals diagnose, assess and manage concussion injuries. Multiple tools are now widely accessible for diagnosis and assessment such as ImPACT, BESS, SCAT5 and VOMS to name a few. In terms of rehabilitative management, recent research has indicated that exercise can help facilitate a faster recovery than rest.2-5 Why is that so important? We know that when athletes cannot participate due to injury, it has a negative effect on mental health.6,7 Keeping athletes connected to their teams through physical activity is good for their physical and mental well-being, and we are now finding that it is also safe and effective to do so with patients suffering from a concussion.
We know why it is important, so how do we do it safely? The most widely accepted methods are the Buffalo Concussion Treadmill Test or Buffalo Concussion Bike Test. The tests involve gradually increasing intensity while utilizing heart rate to determine a sub-symptom threshold (the maximum heart rate in which concussion symptoms are not exacerbated) so health care professionals can safely prescribe cardiovascular exercise regimens. As time goes on, athletes are re-tested to determine new sub-symptom thresholds.2 It is important to note that exercise prescription should always be done under the supervision of a physician, certified athletic trainer or other qualified health care professionals.
Other forms of active recovery and rehabilitation following a concussion are vision and vestibular therapies. As the awareness of concussions has increased, so has our realization that concussions can cause vision and balance disorders in our patients.8-10 Understanding this can lead to more timely diagnosis of such issues because detection leads to appropriate referrals and more efficient resolution of symptoms.
Health care is always evolving. The way injuries and illnesses are diagnosed and treated changes and improves over time. Concussion management is just one small example. The importance of utilizing evidence-based practice to stay current with the standard of care has never been more important and is a skill that students in Logan University’s Master’s in Athletic Training program will learn and develop on their journey to become certified athletic trainers.
About Dr. Russell
Dr. Jessica Russell is an instructor at Logan University, a health sciences university located in St. Louis, Missouri. Dr. Russell earned her Doctor of Athletic Training from Temple University. Among other certifications, Dr. Russell is a National Athletic Trainers’ Association Board of Certification (NATABOC) Certified Athletic Trainer and a National Strength and Conditioning Association (NSCA) Certified Strength and Conditioning Specialist.
- Papa L. Potential blood-based biomarkers for concussion. Sports Med Arthros. 2016;24(3):108-115.
- Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is medicine for concussion. Curr Sports Med Rep. 2018;17(8):262-270. The effect of exercise intensity on brain derived neurotrophic factor and memory in adolescents. Environ Health Prev Med. 2017;22:27. doi:10.1186/s12199-017-0643-6
- Kurowski BG, Hugentobler J, Quatman-Yates C, et al. Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: An exploratory randomized clinical trial. J Head Trauma Rehabil. 2017;32(2):79-89. doi:10.1097.HTR.0000000000000238
- Lal A, Kolakowsky-Hayner SA, Ghajar J, Balamane M. The effect of physical exercise after a concussion: A systematic review. Am J Sport Med. 2018;46(3):743-752. doi:10.1177/0363546517706137
- Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: A randomized clinical trial. JAMA Pediatr. 2019:E1-E7. Doi:10.1001/jamapediatrics.2018.4397
- Sheinbein S. Psychological effect of injury on the athlete: A recommendation for psychological intervention. Journal of the American Athletic Medical Association. 2016:8-10.
- Morris M, Steinberg N, Sykes E, Salmon P. Effects of temporary withdrawal from regular running. J Psychosom Res. 1990;34(5):493-500.
- Murray DA. Can vestibular rehabilitation exercises help patients with a concussion? A systematic review of efficacy, prescription, and progression patterns. Br J Sports Med. 2017;51:442-451.
- Alsalaheen BA, Mucha A, Morris OL, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. JNPT. 2010;34:87-94
- Gallaway M, Scheiman M, Mitchell GL. Vision therapy for post-concussion vision disorders. Optom Vis Sci. 2017;94(1):68-71.