Concussions: Second Impact Syndrome

Athletes are notorious for pushing through pain and playing through injury. This inherently puts the athlete at more risk of further damaging the injured body part or suffering an injury elsewhere as a result of compensations or other factors. This should always be presented to the athlete and their family so they can make an informed decision whether playing through the injury is worth the risk. There are many factors at play here such as time of season (preseason, league play, or playoffs), player’s level of performance, team needs, player’s future in the sport, etc. 

So, it’s no surprise that an athlete will try to return from a head injury as quickly as they can. However, the implications here are more serious than playing through a sprained ankle or knee. Returning too soon or without going through the proper testing following a concussion can have long-term severe consequences. As stated in previous blogs (see Concussion: What You Need to Know After Head Injury), the brain actually goes through a metabolic depression phase after concussion that can last up to 4 weeks!!! This is where the metabolism (energy production) of the brain slows way down. This can actually be one of the sources contributing to prolonged symptoms known as Post-Concussion Syndrome

Second Impact Syndrome is the condition that can occur from taking another concussive blow or jolt to the head and/or neck while the brain is still in the depression phase. Suffering another impact in this phase causes another dip in brain metabolism causing the metabolic levels to drop into dangerous levels! This second dip can lead to permanent brain damage aka cell death! You see, normal mTBI’s (mild traumatic brain injury aka concussion) don’t cause permanent brain damage and full recovery usually happens over a short period of time (2-4 weeks). Additionally, when an athlete returns to sport too soon following concussions, they can become more susceptible and the force required to cause a mTBI is less. This can be the reason an athlete is suffering from recurrent concussions and seeing longer recovery times. 

The way the medical profession used to treat concussion (and some still do) was to rest until symptoms dissipated and they were then cleared to return to normal activity and sports. However, there has been a great advancement in our understanding of concussions and the proper way to recover and return to sport. Active recovery is now the recommended course of action. This can be confusing and challenging to handle on your own, so seeing a trained healthcare professional familiar with treating concussion and getting athletes back on the field is so important! It takes the guess work out of this process and ensures the safest and quickest return possible! 

It is recommended to see a concussion management specialist as early as same day as injury to develop a treatment plan. After 5 days post-concussion, we will conduct the proper tests to identify what you need to work on to get back in the game! Here we will provide the plan to re-integrate you back to school, work, and sports! Finally, getting a thorough physical exertion test before returning to unrestricted practice allows us the confidence in our decision in returning the athlete to full practice and games!

If you have more questions, please book an appointment with Dr. Kirk Ramirez, PT, DPT for more information and to develop a plan!

– Dr. Kirk Ramirez, PT, DPT

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