A Team Approach to Concussion Care for Hockey Players

By Andrew Wyman, MS, ATC, ITAT and Kathryn Semlow, PT, DPT, FAAOMPT

It is no secret that the topic of concussions is at the forefront of athletics these days. With the Ice Hockey season already underway at the professional and youth levels, it is important to keep an eye on players following collisions, hits into the boards and impacts on the ice for possible concussions.

Caused by a direct blow to the head or a hit to the body that transmits a force to the head, a concussion occurs from injury to the brain from its movement within the skull. The resulting symptoms vary from person to person and case to case but can include the following:

• Headache
• “Pressure” in the Head
• Blurred Vision
• Nausea/Vomiting
• Dizziness
• Difficulty Concentrating
• Sensitivity to Light and/or Sound

There are several concussion signs that teammates, coaches, parents or medical professionals can look for in an athlete with a suspected concussion. These can include the following:

• Dazed Appearance
• Balance Problems
• Memory/Concentration Issues
• Confusion
• Personality Changes
• Irritability

Although concussions can be a scary and concerning injury, the medical professionals at Athletico Physical Therapy can provide all-encompassing care for these injuries.

Baseline Testing

Many parents and athletic organizations are looking for ways to ensure their athletes are properly cared for should a concussion occur. Gathering pre-injury information regarding an athlete’s brain function, known as a baseline test, can assist with concussion management. Select Athletico clinics utilize a baseline testing program known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). This FDA approved concussion management tool gathers information on an athlete’s visual and verbal memory, visual motor speed, impulse control and reaction time. Should a concussion occur, the physician overseeing care can order a post-injury test to be completed to compare to the baseline test. This assists with an athlete’s concussion management and determination when it is safe for them to return to athletic participation.

Click here to learn more about baseline testing for your athlete or athletic organization.

Immediate Concussion Care

An athlete with a suspected concussion should be immediately removed from athletic participation and evaluated by a medical professional trained in concussion management. Our certified athletic trainers who work with numerous professional, collegiate, high school and club sport athletes can evaluate an athlete for a suspected concussion and assist with next actions for their concussion management. Oftentimes, relative rest followed by a referral to a physician trained in concussion management will be the best course of care. However, there are a few instances where immediate referral to the Emergency Room (ER) is recommended.

Any of the following “red flags” warrant immediate evaluation at the nearest ER as they may indicate a more serious injury:

• Unequal pupil size
• Drowsiness, cannot be awakened
• Headache or pressure with increasing intensity
• Weakness or numbness
• Repeated vomiting
• Convulsions or seizures
• Loss of consciousness
• Suspected cervical spine injury

For most concussions, care instructions include allowing the athlete to sleep, regulating their eating and hydration, and avoiding tasks or activities that may provoke an athlete’s symptoms. This often means limiting visual and auditory stimuli (TV, computer, video game, cell phones, etc.) if an increase in symptoms occur with use. Physical activity should also be avoided until the medical professional overseeing the athlete’s care has determined it is safe to resume. Academic accommodations may also be put in place should an athlete have difficulty during school. Contacting the school nurse, principal or academic counselor at the school will allow them to assist with an athlete’s academic accommodations if needed.

Physical Therapy

Approximately 80-85 percent of patients with a concussion will recover to their neurological baseline within a month (10 days for adults and 4 weeks for children). The remaining 15-20 percent that do not return to their pre-injury neurological baseline after the expected timeframe are at risk for further co-morbidities, including chronic pain, anxiety disorder, depression, as well as poor academic performance.

Persistent symptoms can be the result of dysfunction of one or all of the following structures in the athlete’s body:

• The Vestibular and Oculomotor System: regulates gait, maintains balance and postural control and co-ordinates eye movements.
• The Cervical Spine: provides proprioceptive feedback (creating awareness of position and body motion) to the Central Nervous System
• The Autonomic Nervous System: regulates heart rate and blood flow to the brain

At Athletico, our concussion specialists are highly trained to evaluate each system as a possible factor contributing to the patient’s persistent symptoms. This allows the clinician to create individualized treatment plans for each athlete, allowing for a faster and more successful recovery and return to their sport.

While the athlete is attending physical therapy for treatment of their concussion symptoms, Athletico clinicians are in constant communication with the athlete’s athletic trainer (if applicable), parents, physicians, and coaches to provide for the best possible care and support.

Return to Participation (RTP)

Before returning to a school, club or recreational sport following a concussion, it is recommended that athletes successfully complete a Return to Participation (RTP) Protocol. This should be done under the direct supervision of a medical professional trained in concussion care. Oftentimes, this can be done with the certified athletic trainer should the athlete’s school or team have one. For those athletes who do not have access to regular medical coverage, our trained concussion clinicians can assist with an athlete’s RTP protocol in the clinic.

What is a Concussion RTP Protocol? This is a gradual, progressive exposure to cognitive, cardiovascular, vestibular, oculomotor and sport-specific activity allowing for a safe return to play for the athlete. By having RTP performed in an Athletico clinic, clinicians can provide one-on-one monitoring and sport-specific progressions throughout each phase of the protocol. This can help ensure the athlete does not prematurely return to participation, which has the potential to cause long-term problems such as cognitive impairments, depression or chronic pain.

During the Return to Participation (RTP) Protocol the athlete must complete the following six steps:

• Step 1– Symptom Limited Activity
• Step 2– Light Aerobic Activity
• Step 3– Sport or Hockey-Specific Exercises, such as: skating with helmet and gloves, body weight resistance training (squats, push-ups)
• Step 4– Non-Contact Practice Activities, such as: skating backwards, stick handling, passing, shooting, goal keeping position
• Step 5– Full Contact Practice: supervised by a certified athletic trainer (if applicable), parent, or coach
• Step 6– Return to Full Participation/Game Ready

In order to advance to the next step in the protocol, the athlete must have 24 hours between each step and be asymptomatic with activities in the current step, performing daily activities and participation in school.

A Team Approach

At Athletico, we take a team approach at every phase of the athlete’s road to recovery following a concussion. From the time of the concussive impact to an athlete’s return to participation, our certified athletic trainers and physical therapists are there to assist with every step of the process.

Please visit our concussion page to learn more about our services.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.