Sports & Military Concussions

Sports & Military Concussions Mar18th 2021

by Sasha Kolbeck, MPT, DPT, OCS, COMT

How many concussions are due to sports vs. military?

If you have ever had a concussion, you know that it is a serious matter. Many people think concussions only come from sports and activity, however, military personnel experience an astounding number of concussions as well. There are an estimated 3.8 million concussions or mild traumatic brain injuries (mTBI) in the USA per year. The media has extensively reported on sports concussions, primarily within the National Football League. There is less public information on concussions that occur in the military. Sports account for 300,000 concussions annually, and those with the highest incidence are rugby, ice hockey, American football, lacrosse, soccer, and wrestling. American military personnel experience a 15 to 22% rate of concussion. Spooner and colleagues researched data from Camp Leatherneck, a military medical facility in Afghanistan, over a nearly three-year period and reported that medical providers treated 1,241 personnel for a concussion during that period.

Camp Leatherneck uses a sports medicine model to treat both concussion and musculoskeletal injuries. During the study period, 88% of concussions were due to blast injury, 4.8% were vehicle accidents, and 5.2% were other work-related. Treatment was multidisciplinary and continued as appropriate until the service member was asymptomatic at rest and during physical activity. The subjects missed approximately ten days of work, with 97.9% returning to duty, showing excellent success.

Concerning sports, a 2019 article in The Journal of Pediatrics by Chrisman and colleagues reported that for athletes five to 14 years of age, 50% returned to school in three days, 50% returned to their sport in 13 days, and 50% returned to baseline in three weeks. Research in 2007 by Gessel et al. in the Journal of Athletic Training stated that more than 50% of high school and collegiate athletes returned to their sport in nine days or less.

Research shows 80-90% of concussion symptoms resolve within seven to 10 days; however, cerebral blood flow regulation during blood pressure changes may take 14 days to recover, and brain energy deprivation typically takes 22-30 days to restore. Risk factors for delayed recovery include the severity of initial symptoms, delayed treatment, youth, female, prior concussion, depression, anxiety, and ADHD.  Surprisingly, loss of consciousness has no bearing on recovery.

Whether sports or military, the concussed individual must be evaluated, educated, and treated appropriately to decrease the risk of Post Concussion Syndrome (PCS), which is ongoing chronic concussion-based symptoms. The criteria for PCS are continued symptoms 10-14 days after the injury.

How do you treat concussions?

Treatment recommendations and education after experiencing a concussion have changed over the years. Experts advise that treatment should begin within five days of onset. They include initial rest as needed for 24-48 hours, a progression of early graded physical activity, education on sleep hygiene, focusing on anti-inflammatory and antioxidant-based nutrition, and pacing oneself. Additionally, educating the patient on signs and symptoms to look out for that would require them to follow-up with their healthcare practitioner and testing for timing about when to return to work, sports, or school are part of the concussed individual’s management.

A thorough evaluation by an experienced practitioner in concussion management reveals what treatment is needed and by what practitioners. Red flags indicate the need to refer to a physician specialist, including worsening headaches, repeated vomiting, and cervical spine ligamentous instability. The cervical spine is often overlooked, untreated, and can be the cause of Post Concussive Syndrome. Cervical (Whiplash-Associated Disorder) symptoms overlap with concussion symptoms, so even after the brain has healed, it may be assumed the complaints stem from the concussion when in actuality, they can be from the cervical spine. Rebeck and colleagues in a 2019 Journal of Orthopedic and Sports Physical Therapy article report that the shared symptoms of neck pain, headache, dizziness, fatigue, and cognitive impairment may persist for five years. Imaging is not able to differentiate between whiplash-associated disorder (WAD) and concussion. One distinguishing feature for PCS is the loss of consciousness or post-traumatic amnesia. Treatment beyond the cervical spine may include visual, vestibular, balance and motor, aerobic, cognitive, and psychological care, and referral as needed for specialists for nutrition, vision, vestibular, and cognitive.

When can I return to my sport or work?

Return to sport and work requires graduated phases and comprehensive and multimodal assessment. Research shows the importance of waiting to return to work or sports during the brain’s healing period to avoid Second-Impact Syndrome, a rare but possible complication when a person sustains a second concussion during the healing phase. The Second-Impact can result in death.  

The brain is only 2% of our body weight but uses 20% of the blood supply, which requires time to heal. Basing return to sport or work on symptom resolution does not factor in the brain’s healing time. Brain changes with neuroimaging persist beyond the resolution of symptoms. The decision needs to be comprehensive with testing that considers the various symptoms the patient may be experiencing.

Specialists advise an athlete to retire from the sport for repeated low-force concussions, protracted recovery from a concussion, or when they have experienced intracranial hemorrhage. Also, retirement is advised for the athlete that has experienced three or more concussions, which have taken more than 30 days to recover, structural injury on MRI or CT scan, and development of chronic traumatic encephalopathy (CTE) symptoms.

Can I reduce my risk of a concussion?

Streifer, Brown, and colleagues in the Journal of Orthopedic and Sports Physical Therapy in 2019 reported about reducing the risk of sports-related concussions. Increasing neck strength and girth are modifiable factors. For every one pound increase in neck strength, concussion risk decreases by 5%. Neck strength is vital in reducing head acceleration. The aim is to have equal 1:1 strength between the muscles that flex and extend the neck. The sternocleidomastoid muscle is essential. Poor posture can also deactivate the deep neck stabilizers and decrease the strength ratio.

Rose City Physical Therapy is a Complete Concussion Management certified clinic. If you or someone you know has sustained a concussion and are interested in information, please contact our clinic at 503.228.1306.

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