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Ask The Expert - db Orthopedic Physical Therapy, PC
David Bertone, PT, DPT, OCS
db Orthopedic Physical Therapy, PC
732 Newman Springs Road, Suite 300
Lincroft, NJ 07738
db Orthopedic Physical Therapy, PC is the solo private practice of Dr. David Bertone, PT, DPT,OCS. Dr. Bertone has 24 years of experience specializing in orthopedic rehabilitation and resolution of musculoskeletal problems. He is Board Certified in Orthopedic Physical Therapy, and is a Diplomate of the American Board of Physical Therapy Specialties. Dr. Bertone is a Sports Medicine consultant for Brookdale Community College Athletic Department and currently performs baseline concussion screening for the college and several youth sports organizations.
Many of our Living In readers have children in youth sports, either recreation, travel or playing for their respective high schools. Concussions have become more prevalent in soccer and other sports that you would not typically associate with concussions. Can you comment on what you see on the local level?
It is important to understand that concussions can occur with participation in any sport or recreational activity. Concussion is a complex process affecting the brain, induced by traumatic forces that occur by a direct or indirect blow to the head. According to the Centers for Disease Control, the top five activities for concussion-type injury for people under age 19 are bicycling, football, playground activities, basketball and soccer. Most of the injuries that I have seen in my practice for post-concussion rehab were from youth soccer and ice hockey.
Can you talk a bit about signs - are they easily spotted?
This is really the most critical component of any concussion prevention program. Parents and coaches must be able to easily recognize the most common signs of a concussion to ensure the athlete is not put in further danger with return to play. The clinical symptoms may or may not involve a loss of consciousness, and the player should be evaluated using standard emergency procedures with special attention to exclude a neck injury. The typical symptoms are headache, feeling of being in a fog, dizziness, nausea, memory loss, irritability, slowed reaction times and drowsiness. The most important point is always when in doubt, sit them out! Returning to play too early and sustaining another head injury can increase the risk of Second Impact Syndrome, a devastating condition caused by repeated trauma to an injured brain.
What are your thoughts on the best course of action for respective levels of concussions?
The majority of concussions (80-90%) should resolve within 7-10 days after injury but can be slightly longer in children and adolescents, according to the 2004 International Conference on Concussion in Sport. For those concussions that donít resolve, it is important to ensure the brain gets rest without over-stimulation from school activities, video games, loud noises, television or any physical exertion. Once the symptoms resolve, a supervised graduated return to play protocol under a physical therapist or athletic trainer is recommended, to monitor symptoms during physical exertion and sport specific activities.
When is the right time for a young athlete to return to their sport after a concussion?
This is why pre-concussion baseline testing is so critical, in order to know the athleteís prior level of function. Cognitive testing will measure factors like memory, speed of processing and color recognition. Balance testing measures the bodyís ability to maintain stability under several conditions. Both are objective tests that document brain function and are repeated after injury until the numbers return to preinjury baseline.
Some sports have no protection (i.e. basketball, soccer, etc...). What are your thoughts here?
Education is the most important factor in prevention and protecting players. Coaches and parents must be aware of symptom recognition since they are usually the ones on the sideline in youth sports. Teaching proper technique in sports and ensuring that safety rules are followed can go a long way in preventing concussions. The future may involve sensors and other devices to monitor force absorbed by the head and brain during impact in sports.
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