Player and Parent Education

Transcription

1 Player and Parent Education Functional Movement Screens Concussion Diagnosis and Care Presented by Dr. Jon Englund December 9, 2012

2 Functional Movement Screens (FMS)

3 What is FMS? 7 item screen evaluating balance, strength, and flexibility The screen: Identifies functional limitations and asymmetries; and Provides corrective exercises specific to each identified deficiency

4 Why use FMS? Evidence based - multiple studies showing that score of <15 associated with increased risk of injury Fast and simple screen Standardized Able to track progress

5 What does evidence show? The FMS is reliable A score <15 associated with 2-10 fold increased risk of injury(sprain/strain) 6-8 week training programs result in average increase score of 2-3 points One study showed additionally that asymmetry also denotes increased injury risk

6 How does FC Wisconsin Eclipse plan to use FMS? Identify those at risk of increased injury Obtain trends seen across specific ages in female soccer players to help tailor group strength and conditioning sessions Provide individual corrective exercises to improve score Retest to make sure identified functional limitations are corrected

7 Concussions in Soccer

8 What is a concussion? Blow to the head or violent twisting of the head resulting in a temporary alteration of brain function

9 Why so many concussions??? Bigger, faster, harder More athlete exposure hours Societal desire for kill shot More conservative diagnostic criteria/better definition Better societal understanding

10 Incidence of concussion.35 per 1000 hours of practice/competition in girls soccer between =1/3000 However rate of diagnosed concussion increased 4 fold between 1998 and 2008 Therefore actual current incidence likely 2-3 fold higher?1/1000 hours 2-3/team/season Girls soccer is girls high school sport with highest concussion incidence Girls soccer players have 2 fold higher concussion incidence than boys players Neck strength, more honest reporters, other?

11 Concussion Mechanism in Soccer Almost always head-to-head, head-to elbow, head-to ground, head to goalpost Far fewer when head struck unexpectedly by ball Purposeful heading extremely unlikely to cause concussion No good evidence at this time to demonstrate that repeated frequent heading of ball leads to decreased neurocognitive performance

12 Concussion symptoms Blurred Vision Dizziness Drowsiness Sleeping More than Usual Easily Distracted Fatigue Feeling In a Fog Feeling Slowed Down Headache Unusually Emotional Irritability Loss of Consciousness Loss of Orientation Memory Problems Nauseous Nervousness Personality Changes Poor Balance/Coordination Ringing in the Ears Sadness Seeing Stars Sensitivity to Light Sensitivity to Noise Sleep Disturbances Vacant Stares/Glassy Eyes Vomiting

13 What about isolated headache? Focal headache at site of trauma without any other symptoms very unlikely to represent concussion Diffuse or more severe headache even in absence of other symptoms should be held out of practice/competition and observed

14 Acute Treatment for Suspected Concussion Absolutely NO same day return Home to rest No NSAIDs or Aspirin Monitor closely first 12 hours If headache becomes severe, athlete becomes lethargic, or if focal neurologic deficits, to ER Lots of sleep No physical activity Minimize TV, video games, school work If activity provokes symptoms, Stop

15 Subacute Treatment of Concussion No physical exertion Nap/rest when tired If symptoms moderate/severe or not improving, recommend cognitive rest as well Minimize external stimuli(loud noises, activities which require intense focus/concentration)? Fish oils 1 gram per day Females and young athletes may take longer to recover from concussion*

16 What Grade is my Concussion? Most no longer employ grading systems Loss of consciousness, presence of amnesia no great predictors of clinical course Most still divide concussions into 2 basic categories: simplex and complex Complex concussions are concussions with symptoms lasting > 3 weeks or if history of red flags: multiple previous concussions, recent concussion

17 Return to Soccer Following Simple Concussion Fully asymptomatic for minimum 24 hours Normal physical exam Normal balance Normal neuropsychological test if available Graduated return to play over 5 day period with progressive increase in intensity demonstrating that athlete remains fully asymptomatic

18 Graduated Return Protocol Day 1: light aerobic activity(not enough to break a sweat) Day 2: Moderate aerobic activity Day 3: Intense aerobic activity/soccer specific movements and ball drills Day 4: non-contact practice( no heading drills, no scrimmage, no high-risk contact drills) Day 5: full return-to-play

19 Return to Soccer Following Complex Individualized Concussion Team-approach with physician, neuropsychologist, physical therapist, family If return, most recommend slower graduated return Some are not recommended to return to sports with high risk of concussion

20 What are the Risks of Return to Play Following Concussion? Prolongation of symptoms Decreased threshold for recurrent concussion Second impact syndrome Too many concussions leading to long-term neurocognitive dysfunction

21 Post-Concussion Syndrome Symptoms lasting beyond 3 weeks Headaches Memory loss Difficulties concentrating Balance issues Sleep disturbance Depressed mood

22 Post-concussion Syndrome Treatment Mental and physical rest Listen to body, respect symptoms Optimize school/work environment to minimize symptoms Avoid activities with risk of head trauma Physical and neurocognitive therapy? Sleep medications?depression medications?headache medications? amantadine

23 When to Disqualify After Concussions History of multiple concussions with progressively longer recovery History of multiple concussions requiring progressively less force History of multiple concussions occurring with progressively shorted intervals Concussion causing any chronic neurologic symptoms? Concussion with prolonged (> 3 month) recovery

24 Concussion Prevention in Soccer Proper heading No use of frozen or wet ball Padded goal posts? Neck strengthening?header bands

25 Questions Jon Englund Orthopaedic Associates of Wisconsin 1111 Delafield st., suite 120 Waukesha, Wi (Jill)