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Thursday, 26 September 2013

Concussion - Recognizing the Symptoms

"Coach, I have a headache", those five words make every coach grimace, dreading the worse, hoping the athlete does not have a concussion.  A headache is the most common symptom of concussed athletes, but by no means the only one.  No one concussion sign or symptom is more important than the others and all must be taken seriously. To start we will define the difference between signs and symptoms.  A sign is something that you as the coach, parent, trainer or fellow athlete will notice.  They include poor balance, slow or slurred speech, poor concentration, vacant stare, delayed response to questions and a change in the level of performance.  Symptoms, how the athlete tells you they feel, fall under four categories.  Somatic (physical), emotional, sleep disturbances and cognitive.  Somatic symptoms include headaches, nausea, vomiting, balance problems, visual disturbances, dizzy spells, sensitivity to light and sensitivity to noise.  Emotionally an athlete may be sad, depressed, nervous and more irritable.  They may sleep more or less and may have trouble falling asleep.  Cognitively, they may have difficulties concentrating, trouble with remembering, feel mentally slowed down or that they are in a fog.

If an athlete presents with any of these signs or symptoms they need to be removed from activity immediately and evaluated further.  As a coach, parent or trainer, use the Sport Concussion Recognition Tool to determine what further care is needed and refer them to a trained health professional in the area of concussions.  It is very important to rule out a cervical spine injury as well with any athlete that is displaying concussion symptoms.  Typically concussion symptoms are quick in there onset and involve short lived impairment for the athlete.  It should be noted though that in some cases signs and symptoms are delayed in their onset.

Next to knowing what signs and symptoms to look for the greatest tool you need comes from knowing your athletes.  Being able to recognize the difference in your athletes is key.  An athlete may tell you that they do not feel right and if you ask many parents and coaches who have dealt with concussions will say the athlete was not themselves.  Even though they are symptoms take notice of them.  Coaches one of your biggest indicators to watch will be how well the athlete is performing.  If a skill typically always done well can is being done poorly, something is causing it.  Remove the athlete and evaluate, it may not be a concussion but no matter what it is always better to error on the side of caution.  Parents, pay attention to how your child is acting.  They may not tell you they are suffering but you will notice changes in their behavior.  Everything from how they are sleeping, eating and interacting with the family and friends will be an indicator of how they are feeling.

Many of the former athletes when asked about concussions will say they never knew that they had one and definitely did not know what to do when did occur.  Recognize that a concussion has occurred and remove the athlete from activity, do not let them return until evaluated by a trained health care professional. Next is proper management, following the proper return to play can be the difference from a quick return to activity or the unnecessary lengthening of symptoms.

Saturday, 21 September 2013

Concussion - Where to Start

Concussions, after staring at my computer screen for about an hour trying to come up with a new and inventive way to talk about concussions and why everyone in sport needs to be educated about them, I realized that their is nothing new to say.  The message is still the same, hopefully you will gain some new knowledge or understanding after spending some time reading this.  That is my hope, that by a coach, parent or athlete reading this, they will learn something about concussions.  We can't necessarily prevent concussions unfortunately it is one of the risks of sport, but we do need to increase the awareness of signs and symptoms and proper management when they do occur.

This may seem like a redundant thing to say but a concussion is a brain injury.  I state this because I have had a coach in the past say a kid could play because the emergency physician said he had a mild brain injury.  He must have been listening to me, he knew that he could not play a kid with a concussion, and obviously I had not educated him enough. As defined from the 4th Concussion Consensus Statement from Zurich November 2012, concussion is a brain injury caused by a direct blow to the head, face, neck or an impulsive force being transmitted to the head from a direct blow to somewhere else in the body that causes a set of physical, cognitive or somatic symptoms.  It is important to say that everyone person will respond differently to a concussion both in the symptoms they show and how they recover.

Every day it seems there is something new coming out about concussions.  For a coach or parent trying to keep up at times seems impossible.  I have found Twitter to be an excellent resource.  Follow health professionals who are known for concussion research to stay up to date and informed.   It is unfortunate that most general practitioners are not up able to stay up to date on the latest concussion research and proper return to play.  When dealing with any health professional ask them questions, if they have never heard of the consensus statements or are still following the earlier versions find someone new.  A great resource is a certified Athletic Therapist in Canada or Athletic Trainer in the States.  Proper concussion management is in their scope of practice and they deal with sport concussions on a regular if not daily basis.

So as a parent or coach what do you need to know.  We are going to break it down into three posts.  First we will focus on the importance of baseline testing, secondly recognizing a concussion, thirdly proper management.

Baseline concussion testing can involve a couple of different aspects.  Depending on your health practitioner they may choose to do a different test.  The most popular and common are the Sport Concussion Assessment Tool 3 (SCAT3), ImPACT and King-Devick.  The SCAT3 has a version designed specifically for athletes aged 5-13 as well as the standard for those 13 and over.  ImPACT should be used along with the SCAT3 or King-Devick.

The importance of having baseline testing done is not to compare to other athletes but to understand the athletes normal state as well as to determine their past concussion history.  Finding out if an athlete has suffered a concussion before and if they have any medical conditions that may effect their recovery from a concussion if one should occur.  Athletes, coaches and parents always ask if the baseline test was passed.  This is where the naming can be deceiving, baseline testing is not a pass or fail, it is to determine how the athlete normally feels to a set of symptoms and to evaluate their memory recall, balance and thinking skills.  It is an evaluation.  How many of us have a headache on a regular basis?  Since headache is the number one symptom of concussion, it is good to know if the athlete regularly has a headache when trying to determine if a concussion has occurred.  When doing baseline evaluations athletes typically tell me they have a hard time with numbers or remembering months.  If we had not done the baseline evaluation I would not have known that and it could effect my evaluation of them post injury.

Education about concussions is always important but that includes the health practitioners education about each individual athlete.  Doing baseline evaluations allows us to get to know the athletes better, which in turn gives us an advantage when an injury does occur.  Have your athletes do baseline evaluations prior to each season as their physical and mental growth and development will change their outcome.  Think of a baseline concussion evaluation as an insurance policy.  We never want to have to use our insurance but are sure glad we have it when it is needed.


Thursday, 12 September 2013

Balancing the Scales: Sport, School and Life

Being a student athlete is hard work.  The amount of time and dedication it takes to compete at any level can at times leave little room for anything else.  Finding time to schedule in school work, friends and family soon leaves many athletes overwhelmed and unsure of how to deal with all that is on their plate.  The majority of young athletes that excel in their sporting venue also excel in school because of their internal drive to succeed.  It is also what makes them say yes to student council, yearbook and many other school activities.   Creating an environment for the athletes to succeed is job held by many and each of them have specific roles.

As the parent you are the master conductor and scheduler.  You shuttle the kids from school to practices and games and back home again, watching them do homework in the back seat or in the stands while waiting for their siblings to be done.  You see them texting their friends or talking to them after school.  Part of your job as master scheduler is to put time in each day for your children to complete their school work.  Try to give them uninterrupted time and space to complete their homework for the day.  When planning for weekends away, have the children speak to their teachers in advance to get their assignments and reading for that period.  Schedule time each week for them to have friend time, family time and down time. It is very easy for everyone to get caught up in the rat race of classes and sport, even young athletes need time to spend with their friends.  It may be they end up playing street hockey, a pick up game of basketball or doing cartwheels in the basement but it needs to unstructured socialization time with their friends.  Family is important, as you will be who they fall back on when things get tough in life.  Spend at least one night a week together as a family to reconnect, turn off the phones and find out how everyone's week has been.  Each person needs some me time, so let them have it.  This time will be useful as your athletes will discover how they are feeling both physically and mentally when the world slows down around them.

Coaches need to remember that sport is not their athletes full time occupation, school is.  Schedule enough time for your athletes to rest, do school work and have fun.  Athletes who are both mentally and physically fatigued will not be able to focus on the skills expected of them.  You should encourage your athletes to excel at school, as the problem solving and critical thinking skills they gain there will help improve their on field performance.

As an athlete you may feel the pressure to say yes to every request you get.  Learn to say NO and to find a way to schedule time for yourself.  Using a day timer or calendar to organize and write down when assignments, tests and games are will allow you to manage your time wisely.  You don't want to have to worry about doing the ten page essay after family supper on Sunday night.  Talk to your friends, find time to hang out with them away from school or gym.  Your friends and family will help you out when you start feeling like everything is too much, keep them close so they are their for you when it happens.

Usually as a teacher you are probably doubling as teacher during the day and coach at night.  Be understanding of your student athletes when they let you know they will be away, let them know what work they will miss so they don't fall behind. Students who exercise typically do better in class, help them excel at both school and sport.

Everyone involved in student athletes lives needs to pay attention to how much pressure they are putting them under to complete everything asked up them.  We all need to be realistic in our expectations of them and to pay attention to the signs of burn out.  If they are getting burnt out, be there for them and help them adjust as need to so they can live that balanced lifestyle where they gain the full benefits of school, sport, family and friends.

Symptoms of Burn Out
low motivation, decreased energy, concentration problems, loss of desire to play, lack of caring, sleep disturbances, physical and mental exhaustion, lowered self-esteem, negative affect, mood changes, substance abuse, change in values and beliefs, increased anxiety, highs and lows.

Friday, 6 September 2013

Preseason Anxiety

It is the first day of tryouts, your hands are sweaty, you feel queasy and if the coach looks at you and then their clipboard one more time you are pretty sure you might burst into flames.  Everyone else seems to be understanding the drill perfectly, why does it feel like you have two left feet.

Tryouts and preseason can be a stressful time for everyone no matter their age or competitive level.  Some stress is normal, it is what helps drive us.  When stress becomes too much the body starts to react negativity. The body responds to anxiety mentally, physically and behaviorally.  Being aware of the symptoms both as an athlete and parent and coach is key to starting how to deal with anxiety.

Here are the symptoms of anxiety

Cognitive
Indecision, sense of confusion, feeling heavy, negative thoughts, poor concentration, irritability, fear, forgetfulness, loss of confidence, images of failure, defeatist self-talk, feeling rushed, feeling weak, constant dissatisfaction, unable to take instructions, and thoughts of avoidance.

Physical
Increased blood pressure, pounding heart, increased respiration rate, sweating, clammy hands and feet, butterflies in the stomach, adrenaline surge, dry mouth, need to urinate, muscular tension, tightness in neck and shoulders, trembling, blushing, distorted vision, twitching, yawning, voice distortion, nausea, vomiting, diarrhea, loss of appetite, sleeplessness, and loss of libido.

Behavioral
Biting fingernails, lethargic movements, inhibited posture, playing safe, going through the motions, introversion, uncharacteristic displays of extroversion, uncharacteristic displays of aggression, avoiding eye contact, covering face with hand, incessant talking, pacing up and down.

All of these can greatly effect performance.

There are some common ways to deal with anxiety to keep you performing at your best.

1. Progressive Muscular Relaxation is the process of moving from one area of the body to another creating and releasing tension.  It is important to start by keeping your breath shallow and steady.  Start with your hands and fingers and work your way up to the head and then down through the torso and into the legs ending with your feet and toes. This technique does take some time to master so practice it before using it during a sporting event.

2. Relaxing Place is a more advanced version of finding your happy place.  The good thing about this technique is that you do not need to be lying or sitting down.  The location you visualize can be real or imaginary but must convey strong sensations of relaxation.  Take a few deep breaths and let the noises of your immediate surroundings fade away.  Start to visualize your relaxing place and let your body relax as you place yourself there.

3. Five Breath Technique removes tension and clears your mind of what is causing your anxiety.  You can use it at any time or during any situation.  It involves taking five deep breaths and relaxing a part of your body during each as you exhale.  During breath one relax your face and neck, breath two relax your shoulders and arms.  When exhaling breath three let the tension release from your chest, abdomen and back.  Breath four relaxes your legs and feet and breath five is a final relaxation of the whole body.

Learning to deal with anxiety from sport is important in forging your path of success.  These techniques can be used throughout the season and off season to put yourself in a relaxed state for competition and training.  It is important to note that if using these skills during a competition not to get too relaxed as you need to keep some level of alertness to perform.