The Waiting Game: Concussion Needs Time to Heal
Kristin Wheeler, 17, president of her junior class and a varsity cheerleader for Swampscott High School, would seem to be an unlikely candidate for a concussion, but she’s already suffered two—the last of which required six weeks for recovery.
Today’s cheerleaders do more than stand on the sidelines and cheer. They tumble, flip, dance and perform stunts requiring them to be thrown into the air to execute a twist or split. This increased athleticism and showmanship also puts them into surprising company. With football, hockey and soccer players, they are among the athletes more likely to suffer a concussion. Five of the 20 cheerleaders on Wheeler’s team were diagnosed with concussions during the Fall 2010 season.
Hear Kristin tell her story in this video
Concern about concussions has received increasing media and public attention over the past few years as new research has shown the long-term effects that multiple concussions have on the brain. These include changes in personality or mood, anxiety, depression, cognitive and memory problems, and even dementia from chronic traumatic encephalopathy.
In a 2009 study, 18 percent of Massachusetts students reported a head injury in the previous year. In response, Massachusetts enacted new rules in June 2011, that require middle and high school athletes suspected of having a head injury or concussion to be removed immediately from practice or competition and be barred from returning to play the same day. They must be cleared by a certified medical professional and have a “graduated reentry plan” before returning to the classroom or field. In addition, coaches, parents and students are required to receive training to recognize the symptoms of a concussion.
For Wheeler, pre-season testing and concussion awareness helped her recognize the signs of her concussion. This past September, while practicing stunts with her team, Wheeler was hit repeatedly in the head while catching another cheerleader. “After the last hit, I stepped out and started crying because I couldn’t take it anymore. Instantly, I had a bad headache, felt nauseous, foggy, and was just out of it,” said Wheeler. She took some ibuprofen, but the headache continued. “As soon as I heard about her symptoms,” said Wheeler’s mother, Joanne, “we went to the pediatric emergency room at MassGeneral for Children at North Shore Medical Center.”
Wheeler was diagnosed with a concussion and referred to NSMC pediatrician Donald McAuliffe, M.D., who is experienced in concussion management.
Says Wheeler, “I initially laughed when Dr. McAuliffe told me to just lie down and rest in a quiet place. I’m usually always on the go and I didn’t think a concussion could shut me down.”
But Dr. McAuliffe was right. “I just couldn’t stand the noise and the constant pounding in my head and I had to rest in my room with the lights off. I couldn’t even read a paragraph without feeling enormous strain,” she says.
“The most important part of treating a concussion is giving the brain time to heal without risk of further physical trauma or even the cognitive strain of learning or concentrating too hard,” said Dr. McAuliffe. “If an athlete broke a leg, she wouldn’t put pressure on the injury for a couple of weeks. It’s the same with the brain; it doesn’t heal overnight. Why risk further damage by rushing back before it’s fully healed?”
Navid Mahooti, M.D., an NSMC family medicine and sports medicine physician adds, “If an athlete returns to activity before his brain has healed, it may increase his risk of developing post-concussive syndrome or other more serious brain injuries.”
To help physicians and coaches determine when the brain has healed and athletes can return to play, Swampscott instituted ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) testing in 2010. Students take a pre-season computerized test to measure verbal and visual memory, processing speed and reaction time. This baseline assessment helps to objectively evaluate the athlete’s post-injury condition and track recovery for safe return to play, preventing the cumulative effects of concussion.
Wheeler was allowed to return to school after a week, but her headache and other symptoms persisted. “Just the noise of pushing in chairs would cause an awful headache. Because I didn’t have any outward signs or bruises, I had to remind my teachers that I had a concussion, so they could give me extra time to complete an assignment or test,” said Wheeler. “It was frustrating because I wanted to get back to normal and to cheering. I couldn’t even go to the games because it was too loud.”
After repeating the ImPACT test for six weeks, Dr. McAuliffe determined that her brain had finally healed and cleared her to return to cheering.
Wheeler’s mother is perhaps most relieved. “If we hadn’t had the ImPACT test, I’m sure Kristin would have gone back to cheering too soon. I don’t like to think about what could have happened if she were hurt again,” she says.
“Concussions are the one sports injury that can change an athlete’s life forever if not properly managed,” said Dr. McAuliffe. If athletes have any type of brain injury, they should always see a medical expert for evaluation before returning to sports.