Let’s Talk About Concussions
Cami Smith:
Welcome to Centra Scripts. Here, we talk about health, wellness and practical tips for your everyday life. I'm your host, Cami Smith. Hey everyone and welcome to Centra Scripts. My name is Cami Smith and I am your host. So today, I am here with Krista Leake and she is a physical therapist. We're going to be talking about concussions, something that I would say many people have had experience with, especially in this season. We're headed into fall. We're headed into the school year, the new sports season, where there is a lot of knocking around happening.
Cami Smith:
So for parents, but also for athletes and for just the public in general, it's so important to know the things that will help you that can be preventative, but then also for care after the fact. So Krista, I want you to tell us a little bit about your role here at Centra. Before we jump into all of that, how did you get into this field?
Krista Leake:
Well, by trade I'm a physical therapist and I'm also a certified athletic trainer. So both of those are involved in concussion care. But my role at Centra, I am the clinical coordinator of quality. So I really focus on making sure that everyone is performing evidence-based treatment and that we are giving the best quality care that we can.
Cami Smith:
I love that. So what is a concussion, like a clinical perspective? Because I know when I hear a concussion, I hear somebody got hit in the head and you need to be very careful. But from a clinical perspective, how can you define that for us?
Krista Leake:
So the official definition of a concussion is that it's a type of a traumatic brain injury. It is caused by a bump, a blow or a jolt to the head, or by a hit to the body that can actually cause the head to shake and the brain will either go forward or back side to side or even turn inside of the skull.
Cami Smith:
Oh, okay.
Krista Leake:
That sudden movement can cause the brain to bounce around, twist and then it causes a chemical reaction.
Cami Smith:
Oh wow.
Krista Leake:
Sometimes it can even some stretching or damaging to the brain cells. But the important thing is is that chemical reaction. It's not where you get a severe traumatic brain injury where you may have a bleed in the brain, which is a structural thing. This is something that's very difficult to see. Sometimes I like to explain it like it's a sprained brain versus a bruised brain or a cracked skull. What's interesting, it is kind of an invisible illness. You can't look at someone, say, "Oh, you have a concussion." So it is very much a clinical diagnosis. We go by signs, we go by symptoms and how someone is feeling. There are imaging that you can do. They rarely show anything. [inaudible 00:02:57].
Cami Smith:
Yeah. That was so surprising to me when I saw that an MRI or a CT scan, this will not detect a concussion.
Krista Leake:
Right. Occasionally, if it's super severe, you may see some changes on there. But for the most of the time, like I said, if it is a chemical injury, you're not going to see that structural change in the brain. It's still very real. The symptoms are very real. They're not to be discounted, not to be lightened, but it is difficult to see. There are some newer tests out there, but a lot of them... There's blood tests. There's eye tests. But at this time, they're not super valuable in helping to figure out when someone sustained a concussion. It may say they have one. It doesn't tell us how severe, it doesn't let us know how long it's going to take to recover.
Cami Smith:
Wow. So there's no picture that can be produced of what's happening inside because of it's a chemical reaction.
Krista Leake:
Right. It's a clinical picture.
Cami Smith:
Which I've never heard that, a chemical release or reaction, which explains a blood test, but that's new knowledge for me. That's so interesting. So how common would you say it is? I mean, I think it's pretty common in some sports, like you mentioned, and I'd love for you to share that. But outside of sports even, how is it very common for people to get a concussion?
Krista Leake:
It is. Obviously, sports I think is what gets the greatest media coverage. That's what we talk about most. We see professional football players. Our knowledge base is growing, but you also can get concussions with car accidents. A big one is falls, especially in an older population. People fall, they hit their head. There was one study that looked at people that were in long term care facilities and they tracked falls. What they found is that 30% of people that fell actually hit their head.
Cami Smith:
Oh wow.
Krista Leake:
So when we do see these populations, you have to make sure that we are doing a screen and we are checking for concussion. Because a lot of times someone falls, they have a broken hip, we focus on that broken hip and we forget that there may be other things that are going on.
Cami Smith:
Yeah. Unseen things. I mean, you just have such a wealth of knowledge. I mean the ease at which you talk about this, I love that. So it makes me feel so much better knowing that because there is that focus on maybe a main injury and a concussion can be a secondary injury that people don't think about.
Krista Leake:
Right.
Cami Smith:
So what are symptoms, or how do you tell? Let's say someone does fall, they do have a hip injury. What causes you to take alert, that maybe there's something else going on, maybe a concussion?
Krista Leake:
Well, anytime someone hits their head, that's the first thing is we want to figure out did you hit your head. If they hit their head, there needs to be further assessment. Your assessment, you do immediately, is very different than what you may do a day after or a couple days after. So the first thing you do is you always check someone for a loss of consciousness. That's kind of obvious. If there is a loss of consciousness, there is some sort of head injury, concussion.
Krista Leake:
If someone is unconscious, first thing we do is we make sure that there's not a neck injury and we treat them like they have a neck injury. But if someone is awake, you start asking questions, "What happened?" Because sometimes they forget what happens. If they don't know what happened, they had a concussion. We want to ask them how they're feeling. Are they having a headache? Are they having dizziness? Are they experiencing nausea, vomiting? All these different things.
Cami Smith:
So I'm sure many of us are thinking about that, like how many fingers am I holding up.
Krista Leake:
Yeah.
Cami Smith:
Or you always see doctors kind of shine the light and pull it away. Are those things that actually happen or is that just what the entertainment industry is telling us?
Krista Leake:
Yeah. Those things actually happen. You do want to look at eye movements because that is very indicative of how the brain might be working. We want to see, can you track things? Are your eyes following? Are you seeing double vision? We want to look at balance because it is very common to have balance issues afterwards. We may have an athlete come out and we're like, "Okay, I want you to remember these five words," and we may give them five words to remember. Then we do an exam and then we come back and say, "Can you remember these five words?"
Krista Leake:
We want to challenge their brain to see, it's not obvious, we may say, "Okay, I want you to count backwards from a hundred by sevens. List the months of the year, but start in December and go backwards." these are things you're talking to the athlete and they seem to be okay and then you challenge their brain a little bit, make them think hard. One thing I remember is someone, "Okay, I want you to say the months of the year backwards." They said, "December, January, February, March, April, May," and you are like, "Okay, good." Then you go on and you're like in your head, you're like, "That's not backwards."
Cami Smith:
That's not good.
Krista Leake:
I need to keep going. I need to ask more questions. There is a concussion going on here.
Cami Smith:
Yes. Yes. So as you're talking, I'm thinking of just maybe even misconceptions or, and I don't know that I want to call them myths because it's not that they're completely false, but incorrect, things that we are believing or told. So for example, I have young kids and a lot of times when they fall, my first question is, "Did you hit the front of your head or did you hit the back of your head?" I don't know where I heard that or if that is even relevant, but I ask it every time. So I think as parents who don't have this clinical training, we're just wanting to tell, is this serious? What should I do next? So it's good to hear these symptoms, but are there any myths that you have heard that you can just debunk for us now?
Krista Leake:
I'm all a certified athletic trainer, and I haven't done this in a while, but I used to work on the football field and a lot of times what we would hear all the time is, "Oh, they just got their bell rung. They just got their bell rung. They're okay. They just got their bell rung." Well, that is a concussion. So to me it's not they just got their bell rung. Then one big myth, and I don't know if it's a myth, because this is what I learned to do is we used to tell people when you get a concussion, completely rest. We want you dark room, shades down.
Cami Smith:
Yeah. I've heard that.
Krista Leake:
Do nothing, nothing. They've actually found if you do absolutely nothing, you take longer to recover. So instead of doing nothing, we want I would say active rest. We do want you resting. We don't want high activity. We don't want a lot of physical activity. We don't want doing schoolwork or doing a very difficult work project. But it is okay to do some light activity. How do you know how much? You kind of base it on your symptoms. If you are watching TV and it is making your symptoms worse, that's too much brain activity, too much cognitive activity.
Krista Leake:
But if you're lying down and you are watching TV and it's not bothering you, then that's okay. Or if you get up and you take a walk around the house and that's not increasing your symptoms, that's perfectly fine. We want you doing that. If you're going for a walk outside and your symptoms gets worse, that's too much. So I usually say about 48 hours, we want to shut down and rest, but not complete rest, just slightly rest. Then we'll gradually increase activity, further assessment. We base this all on symptoms.
Cami Smith:
Yeah. So trust your body. So how long do symptoms typically last?
Krista Leake:
So there it's highly variable. Sometimes it's minutes. Sometimes it's hours. It can be days. It can be weeks. It can be months. Sometimes it's very long term. There was a study done on football players that looked at how long symptoms typically last, and 80% were completely recovered in three weeks.
Cami Smith:
Oh, okay.
Krista Leake:
So that's good. It's very positive. 90% were completely recovered in a month. So the chances are you're going to be recovered quickly. But there was that small percentage that took longer than a month to recover. So they've looked at what things kind of predict what takes longer to recover. So not just football players, but if you look at everyone, the very young and the older tend to take longer to recover. If you think about someone that's older, there usually are a lot of other medical conditions. There may be a history of migraines or there may be high blood pressure. There may be diabetes, heart disease. So these things kind of contribute. But if you look at someone that's had a concussion on field, what things can predict how long it can take to recover? If they are not taking out of play, they are 8.8 times more likely to take that longer than three weeks.
Cami Smith:
Oh wow.
Krista Leake:
If they're not taken out of play, even if they're just running and doing things, it doubles their recovery time. So when in doubt, take them out. But then if you look at symptoms like headaches or dizziness and vomiting, loss of consciousness, there's only one thing that they found on field that showed that this person was going to take longer to recover and that was dizziness. So that was the most common. I think what's fascinating to me is loss of consciousness, immediate seizures did not predict longer recovery.
Cami Smith:
Really?
Krista Leake:
Those football players, they actually recovered quicker, which means it varies.
Cami Smith:
It's just everybody's body is going to respond in a different way.
Krista Leake:
Yeah. So that was surprising to me. Because I would think if someone was knocked out or unconscious that that would mean a lengthy recovery.
Cami Smith:
Yeah. Or a seizure, that would cause alarm.
Krista Leake:
And vomiting.
Cami Smith:
Yes.
Krista Leake:
Vomiting is very alarming, but that was one thing in this study that showed that was not a worse prognostic factor.
Cami Smith:
Okay. So I'm curious, is it common for someone to have a longer recovery period if they get concussions more often, specifically in the case of sports? Is there long term damage that's done?
Krista Leake:
There was another study. They looked at factors in someone's life that caused longer recovery when they got a concussion. That was one thing, if they recovered in between each concussion, that it was not a risk factor for longer recovery.
Cami Smith:
Oh wow. Okay.
Krista Leake:
So things that are risk factors, history of depression, history of migraines, anxiety, different kind of mood disorders. Obviously, they are a brain issue and so those things predicted longer recovery.
Cami Smith:
Okay. So let's talk about treatment. So you are a physical therapist and I would assume that's a big part of treatment, but what does treatment look like for someone who has had a concussion on any level?
Krista Leake:
So it's definitely has to be individualized because we talked about concussions present so many different ways and it's a team approach. There are multiple clinicians that are involved in this. We like to break it down into the different kind of categories of symptoms. So if someone is presenting with physical symptoms, such as balance disorders, we're going to focus on balance. We have what we call vestibular specialist. If someone is presenting with visual, a lot of times trouble focusing, dizziness, vertigo, we're going to have a balance vertigo specialist, vestibular specialists treat this patient, and that is a physical therapist.
Krista Leake:
If they're having cognitive issues as the main issue, the treatment will maybe be speech therapy. If there are mood disorders, we may want a neuropsychologist or psychologist to help with the mood disorders. Sleep dysfunction is very common. So we may send them to someone that specializes in sleep. The other thing is the same mechanism that causes a head injury tends to cause neck injuries. So if there's a neck component, neck injuries can cause dizziness, can cause headaches, can cause nausea, all these things. So we want a physical therapist that specializes a neck to treat that.
Krista Leake:
Another big thing is exercise intolerance. People when they're recovering, they feel fine until they exert themselves. So there's some thought that the brain is now no longer regulating well the circulation in your brain or regulating your heart, and so there is an endurance or a cardiovascular type of treatment that we do when people are having these symptoms where we gradually increase cardiovascular conditioning. So we're actually bringing on some symptoms, but we are monitoring the whole time to know how far to push and how much to kind of back off to help speed that recovery.
Cami Smith:
Wow. Do you find that everyone will seek treatment? In a sports case, you're there and so you're going to get treatment. But when I think about other injuries that may happen at home, they may happen at work, they may not be something where you immediately think, "I should go get this checked out." You think you're okay. Is that common? What would you do?
Krista Leake:
That's very common. It's even common in sports. They looked at high school kids that played sports, 40% of them that had concussions did not report them.
Cami Smith:
Oh wow.
Krista Leake:
Because what is the treatment? It's take you out of play and so-
Cami Smith:
A lot of ambition.
Krista Leake:
Yeah. As someone who works, or someone works, you don't want to be taken out of work.
Cami Smith:
No.
Krista Leake:
So I think a lot of that is not reported for fear because you don't want to take out of work. Part of that is education. If you don't stop what you're doing, it's going to take you longer to recover. But I also think people don't realize they have a concussion, or realize maybe some of the symptoms that you're having or related to a concussion. Mood disorders. Did you hit your head? You think, "I'm fine," but are you snapping at your family? Are you now cranky? Did you chew someone out over something small where you never would've done that before?
Cami Smith:
Okay. So pay attention to mood swings, pay attention to things that are outside of your normal behavior.
Krista Leake:
Right. Do you feel slow? Do you feel tired?
Cami Smith:
All the time.
Krista Leake:
Yeah. After you've hit your head or after you... I think a lot of times you don't have to hit your head to have a concussion. So people don't think this is related to my head or my brain. You fell on your butt and your head jerked and you're having some weird symptoms. Well, that could be related.
Cami Smith:
This has been so incredibly helpful. Just the thought and the visual of your brain moving inside your skull and that is what's causing it. It just opens my eyes to seeking care when I probably would not normally for myself or even for my family thinking that everything's just fine. So I hope this is very helpful for everyone. I do want to talk about preventative steps, which is difficult, because you don't know when you're going to bump your head. So how do you prevent something like this, this type of injury?
Krista Leake:
I think it is difficult to prevent. There is maybe small amounts of research that if you are stronger around your neck in football players, that this can help prevent some injuries. Obviously, helmets. That's why they're there to protect the brain. When you look at injuries in football, there's not a lot of concussions anymore from helmet to helmet contact. So rules have helped prevent that. They have changed rules in football that's not legal. They really have cracked down on that and that has reduced the most common way that people get concussions now in football are hitting their head on the ground. So wearing a helmet. Being smart. You can't always prevent things, but obviously if your balance is off or you have an injury, working on your balance, working on your coordination, so you're less likely to fall.
Cami Smith:
Yeah. I imagine it's also so important in this case to just take care of yourself, because as you mentioned, things like anxiety and tiredness and other even issues that can be going on with our mental health can play into the length of recovery, which of course we all need to get back to our lives after any type of disruption like an injury or a concussion. So take care of yourselves, take care of your mind, take care of your body. That can be preventative.
Krista Leake:
And sleep. Because if you don't sleep, you're more at risk for having an injury or a fall or all [inaudible 00:20:16] of health issues.
Cami Smith:
Yeah. Well, is there anything else that sticks out to you that you think would just be really important for us to know that I didn't ask you about or that has come to mind?
Krista Leake:
I think the most important thing that there is help out there and there is treatment and there's multiple things you can do. There are medications. There are exercise. But it's very hard to do this on your own. You need someone there to help kind of manage the whole treatment plan and the treatment process. Give yourself a break. It's okay. You're having an issue. Your brain is sprained. Doesn't look like anything's wrong. So you have to communicate to people, "Just letting you know. I've had this injury to my head. I really want to hang out with you, but maybe is there any way we can go to a quiet place instead of hanging out where there's a large band?"
Krista Leake:
Or at work, "I'm having a little trouble. Is there any way that I can definitely take an hour lunch break and let my brain calm down?" Or, "I'm having trouble with three computer screens? Is it okay if I delegate this task to someone else and I take this task where it's only going to require me to look at one computer screen?"
Cami Smith:
Yeah. So advocate for yourself.
Krista Leake:
Yes.
Cami Smith:
Very cool. Well, thank you so much, Krista.
Krista Leake:
Thank you for having me.
Cami Smith:
This has been so informative. You can check out our social media channels as well as centratoday.com where we have a lot of information including an article that was written on concussion so that we can educate ourselves and be ready, not just for the fall sports season, but also just to take care of ourselves overall. So thank you for joining us today again on Centra Scripts.