The world is watching athletes in Sochi compete in sports such as hockey and downhill skiing. Concussion poses a risk, not only to the highly trained individuals competing in the Olympics, but also to ordinary Canadians who play sports occasionally.
Concussions are the result of a blow to the head, and are the most common type of mild traumatic brain injury. In the past decade, there has been growing awareness and research about how often concussions occur and about their long-term effects. A 2006 study found that about 1 out of every thousand Canadians have a concussion each year. Concussions are especially common among young people and account for around 10% of all injuries in young athletes.
To learn more about concussions, view this video narrated by Mike Evans, a family physician at St. Michael’s Hospital, Toronto.
With increased awareness of concussions has come increased demand for treatment, especially from those suffering from prolonged symptoms related to their injury.
Increasing awareness of concussions
In the past, concussions were considered no more than a brief bout of ‘seeing stars’. Athletes with a knock to the head returned to play almost immediately, both in recreational and professional sports. However, a growing body of research evidence demonstrates that the effects of a concussion, especially multiple concussions, can be long lasting and result in permanent brain damage with a decline in cognitive and sensory and motor abilities.
“The seriousness with which the public considers concussions has been ratcheted up considerably,” says Charles Tator, a neurosurgeon at the Toronto Western Hospital. “People now know it’s not just a ding or a bell ringer – it’s a brain injury.”
In Canada, much of this awareness has been raised by the experience of hockey superstar Sidney Crosby. Crosby sustained two concussions in quick succession, and had lingering symptoms which kept him out of play as captain of the Pittsburgh Penguins for nearly an entire season.
Martin Mrazik, a professor in clinical neuropsychology at the University of Alberta points to Crosby’s high profile, and time off the ice, as helping to increase awareness of concussions. “Crosby’s experiences probably have done more for education than we could have ever hoped for,” says Mrazek. “He took it seriously, he didn’t come back to play before he was ready and that is the approach we want young athletes to take.”
Rumours flew about what treatment Crosby sought out for his concussion. However, the information publicly released by the National Hockey League stated only that he was taking time off the ice to rest and recover.
What are evidence-based treatments for concussion?
Current evidence points to physical and mental rest as the main treatment for concussion. Athletes are encouraged to stop playing sports until they are free of symptoms. Mental rest is more difficult to define, but has been described as refraining from any activities that can trigger symptoms such as headaches. This can include reading, looking at a computer screen or doing homework.
The vast majority of people with concussions, perhaps 80 to 90%, are symptom free about 10 days after the injury.
However, about 10 to 15% of people experience lingering symptoms for months, or even years after their injury. Those who have had more than one concussion in quick succession, like Crosby, are especially prone to have prolonged, complex symptoms – this is known as post-concussion syndrome.
Symptoms can include headaches, insomnia, dizziness, difficulty concentrating, fatigue and mood changes. All of these symptoms are subjective, however, which makes it difficult for clinicians to diagnose, assess and treat post-concussion syndrome.
Patients suffering from post-concussion syndrome are often referred to brain injury clinics, which would ideally offer an evidence-based approach to the assessment, diagnosis and management of concussions. However, there are anecdotal reports from patients and experts that growing numbers of health care providers are offering unproven and expensive treatments, including hyperbaric oxygen therapy, acupuncture and homeopathy.
Tator says “there is no evidence based treatment to accelerate recovery from concussion.” He acknowledges that “it’s distressing for parents to watch their kids who are still suffering from post-concussion syndrome.” While concerned parents are desperate for treatment, Tator emphasizes that “there just isn’t anything other than the passage of time.”
Allison Haggart knows firsthand how difficult it can be to wait for concussion-related symptoms to resolve. She was a competitive snowboarder when she suffered a concussion in January 2012. While on the slopes practicing with her high school team, Allison swerved to avoid a teammate, and slammed into the ground, falling backwards and hitting her head.
Even though Allison was wearing a helmet at the time, she began to feel symptoms immediately, including dizziness, fatigue and headaches. Following several assessments by physicians, she was diagnosed with a concussion. Unfortunately, Allison has had persistent symptoms, including trouble with her vision and headaches.
Allison had no clear indication of how long full recovery could take and felt frustrated with the absence of evidence-based treatments to alleviate her symptoms. “When I was going through the medical system, no one could give any assurance on the number of days it will take to feel better, or to tell me to take this pill and I’ll feel better.”
Allison tried a whole range of treatments – physiotherapy, massage therapy and acupuncture – to try to alleviate and reduce the lingering concussion symptoms. She says full recovery took 18 months.
Allison hasn’t snowboarded since her concussion, and she has no plans to return to the slopes. She says she’d rather “err on the side of caution” given the risks associated with a recurrent injury and “that there is so much that we do not know” about the long-term impact of concussions.
Motivated by her experiences, and the frustrations around absence of treatment options and a timeline for recovery, Allison’s family has partnered with the Toronto Western Hospital to establish a fellowship to support research in head trauma, with a focus on concussion diagnosis and treatment.
‘Buyer beware’ of quick fixes for concussions
Allison’s experiences underscore the challenges for health care providers struggling to manage expectations of patients suffering from concussions. Martin Mrazik cautions that “the reality is that concussions can be complex, require a multidisciplinary approach – and if someone offers a quick fix, it’s a concern.”
For athletes in particular, there is a desire to return to play as quickly as possible. Current guidelines for return to play follow a six step process, where after a period of rest, athletes can resume exercises within their sport, and avoid contact, and if symptoms return they drop back to the previous step.
However, there are many clinics across Canada that promise those suffering from post-concussion syndrome that they can hasten their return to play, and try to alleviate prolonged symptoms of a concussion. Clinics from coast to coast staffed by physicians, exercise therapists, physiotherapists, chiropractors and other health care providers, promise to improve and hasten recovery from post-concussion syndrome.
A 2013 research article reviewed all published clinical trial data available on such treatments, including acupuncture, acupressure, creatine, homeopathy, hyperbaric oxygen therapy, mindfulness practices, music therapy, neurotherapy, Tai Chi and yoga. This study found a high risk of bias in the published trials on these treatments, and the authors of the study concluded that the evidence for these treatments for traumatic brain injury was inadequate. These conclusions echo the findings of previously published studies on complementary and alternative treatments for concussions.
“The best evidence suggests that with cognitive and physical rest, people will get better” says Mrazik. He cautions Canadians that clinics offering a quick fix ought to come with a “buyer beware label – they charge a lot of money for non-proven treatments when people are desperate for some relief.”
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You all are absolutely right. I have been treated with acupuncture and massage machines for a concussion for five weeks, and nothing has improved with my symptoms. I, also, had taken pills and powders to help with my tension headaches and dizziness. Most of the time they numb your body for minutes, then the symptoms get worse. They will don’t help either.
To be honest, it is frustrating to spend energy and money on finding the right and real treatment for a concussion.
Dear Sir or Madame, good afternoon, a most excellent article full of sound suggestions. Thank you, Ed
I suffered a concussion at work 9 months ago and am still dealing with headaches, light sensitivity, dizziness, etc. I have had physio and chiro and am looking for any and all treatments as the lingering effects are frustrating for sure.
My daughter has suffered from post concussion syndrome for almost 2 years. She has seen many medical personnel,and therapists including neurologists. No one seems to have an answer. She has had physio and acupuncture, vision therapy and speech therapy. These people have not been able to help her. We are now trying a Chinese medicine doctor with acupuncture and message. It should not take this long but it has. we need so hope that things will improve and that she will return to an active more 23 year old lifestyle.
Hi Maria, I am in the same situation as your daughter its been 17 months since my third concussion and I still have daily headaches. How is she doing now? anything else help her with her treatment?
I have a concussion. 5 months now. I am only beginning to look at screens for more than a few minutes at a time. Doing a little research on post-consussion issues, I found this site. I agree – rest, darkness and shutting down as much as possible is the key. In fact, it’s crucial from the beginning. However, as I regain a little strength and ability to think about the future, I know that I will attend all the alternative therapies that I think will help, because concussions are awful. And I need to repair as best I can. Alternative therapies will help reduce pain and stress, in the rest of my body that has had to lie still for months. Keep in mind – a brain injury will effect all parts of the body, mind and spirit. A nutrionist and hypnotherpist are also on the list, in due time. Recovery is a many layered journey, and it takes all sorts to get us there. As an adult, I can’t imagine how horrible it must be for a wee one to suffer the trauma. And parents, coaches, please mind the kids! Safety first. (Some time ago, we went to check out a zip-ling experience in Costa Rica – they didn’t offer head gear. Guess they don’t think much of tourists.) Rest, pull the drapes, no screen time, no music (killing me!) …quiet time! It works. Honour it carefully. Mind the kids.
I have found that Reiki Therapy and BodyTalk Therapy have had a profound effect on neutralizing the symptoms of a concussion. As a Concussion Therapist, I have successfully treated many people and I am building up a reputation for my work. I work with the innate body wisdom of my clients that is capable of rebalancing and healing itself (with a bit of help).
My information is found on my two websites:
the links to the 2013 study are not working – would appreciate the reference info.
Hi Pat – thanks very much for your comment and for letting us know that the study links were not working.
The study was published in an open access journal, so you should be able to download the full PDF using this link: http://link.springer.com/article/10.1007/s40141-013-0019-9
For your reference, here is the citation information:
Joshua B. Cantor, Shinakee Gumber. “Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury” Current Physical Medicine and Rehabilitation Reports. September 2013, Volume 1, Issue 3, pp 159-168
If you are still having difficulties accessing this study please email info[AT]healthydebate.ca and we will send you the PDF file.
I don’t think it is fair to blame our passion for hockey to all the concussions happening. For me concussions are a health issue and should be deal with health lens. Unfortunately, it happens in many sports (soccer, yes soccer! football, rugby, hockey, baseball etc) and also at works (one of my friend suffered multiple concussions at his work as electrician in a big plant). I’m not trying to avoid the problem but we need to remember that sport (physical activity) is a very important thing to promote and encourage as a healthy lifestyle starting point to prevent obesity and bad habits among our kids and youths. We need to better understand this health issue to help prevent it the most we can and be aware of the consequences if no action are taken to do so. But please don’t blame our national sport (whom I admit doesn’t deal enough well about the concussions issue but does better now than 5 years ago) only because we still need to enhance and stimulate the practice of any sport for our kids and youths. Go Canada Go!
Hockey, soccer and baseball dad!
Our national obsession with hocky is barbaric and selfish. To feel as if these young players, most of whom will never make a solid career out of the game, must put their brains at risk for our own entertainment reminds me that though we like to call ourselves civilized, we are merely animals who can tell stories; monkeys with a recorded history.
Perhaps a follow-up article on the growing fad among hockey leagues for using the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing).
From my brief review and comments from some key experts, there is no solid scientific evidence regarding the validity and utility of ImPACT.