Wednesday, July 30, 2014
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Concussion Treatment: Returning to play

Earlier this week, we discussed the process by which football players are evaluated for concussion symptoms on the sideline during a game. But what steps must be taken before returning to the huddle?

Concussion Treatment: Returning to play

By Robert Senior

On Monday, we discussed the process by which football players are evaluated for concussion symptoms on the sideline during a game. But what about returning to play the following game, or weeks later? What steps must be taken and what goals must a player meet before returning to the huddle?

“When I get a referral, the first thing I’ll do is their ImPACT test,” says Robert Franks, D.O. at the Rothman Institute. “So if it’s a high school player who gets hurt on a Friday night, it’ll probably be Monday morning when I do the test.”

ImPACT assesses any changes in brain function while evaluating an individual’s current condition and tracking recovery.

Dr. Franks says that overall, he looks at concussions in five domains:

  • Somatic Symptoms—“These are the symptoms I’m told the person has.”
  • Cognition—“These are the results of their ImPACT test—how good or bad does it look?”
  • Vestibular/Balance Testing—“This is the BESS (Balance Error Scoring System) test, like the one we did on the sideline. In the office, we can be more thorough and do the full test.
  • Sleep Issues—“Usually, they’re going to be tired—we’re looking for disruptions or differences in their sleep patterns, such as difficulty falling asleep, or whether they’ve been sleeping all day.”
  • Emotional—Dr. Franks says that specialists will keep an eye out for increased anxiety or signs of depression—but acknowledges that such signs are very unlikely to be present during an initial evaluation.

As mentioned on Monday, Eagles quarterback Michael Vick sustained his second concussion in as many years on Sunday. Dr. Franks says that evaluating concussion history is critical. “How many concussion has the person had in the past? What kind of symptoms did they have, and how long did they last? You need to establish treatment patterns from the past. Did they lose consciousness, or have retrograde or post-traumatic amnesia?”

Dr. Franks puts his student-athletes on what he calls complete mental and physical rest. “No video games, no texting, no cell phones—we allow nothing that can stimulate the brain. Then we assess whether we need to alter their academic setting, in terms of reducing homework or other factors.”

The decision to return to play requires a symptom-free athlete who is no longer on any medications. ImPACT testing needs to return to baseline or average, and a full return to activities must be made for 24-48 hours. “That’s when we’ll start a return-to-play program,” concludes Dr. Franks.

About this blog
Kelly O'Shea Sports Medicine & Fitness Editor, Philly.com
Robert Cabry, M.D. Team Physician for U.S. Figure Skating, Assoc. Team Physician for Drexel; Drexel Sports Medicine
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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