Title: A Closer Look at Concussions: What You Should Know

1. Title: A Closer Look at Concussions: What You Should Know June 6, 2016 Brian L. Siddall, M.A., AT, ATC Supervisor of A.T. Services

2. INTRODUCTION • The past decade has seen a cultural shift in concussion awareness in sports. • High–profile sports injuries have brought concussions to the forefront of people’s minds. • Educating yourself about this serious brain injury and its potential dangers can lead to more prompt recognition if it happens to you or your child. • Knowing the signs will help you avoid potential delay in evaluation and recovery.

3. Q. So what exactly is a concussion? A. A concussion is typically a short-lived brain injury triggered by a hit or jolt to the head that causes mild, transient disturbance of brain function without loss of consciousness, and rarely causes brain swelling or permanent injury.

4. Q. What types of athletes typically tend to get concussions? A Although traditionally male athletes in contact sports like football, soccer, ice hockey and lacrosse get concussions, females who play similar sports like soccer and basketball can be at twice the risk of concussion when compared to their male counterpart. • When we consider the entire population, the most common causes for concussions are falls and motor vehicle accidents. • Young athletes may be more susceptible than adults to concussion and take longer to recover than adults, theoretically due to larger head-to-body-size ratio, weaker neck muscles or increase vulnerability of the young brain to concussion.

5. Q. What is the standard treatment plan? A. If someone is suspected of having a concussion, the most important thing is that they receive a thorough evaluation by a qualified healthcare provider experienced in the evaluation and management of head injuries and concussions. • We look for warning signs that raise the greatest concern, which can include severe headache, persistent vomiting, significant disorientation, lethargic, unusual behavior or waning consciousness.

6. Q. What is the standard treatment plan?(con’t) A. Typical concussion symptoms include headache, dizziness, nausea, neck discomfort, difficulty thinking clearly, trouble focusing on mental activities, disturbance of sleep patterns and mood changes. • Timely diagnosis and treatment can help prevent complications and prolonged recovery. • After diagnosis, athlete receives standard set of instructions on managing injury. Any activity that provokes symptoms should be limited or avoided so as not to make the symptoms worse or potentially prolong recovery.

7. Q. What about healing after concussion? • After the initial injury, the brain will initially require rest to recover appropriately. The key is to avoid or limiting symptom-provoking activities. These can include texting, watching TV, playing video games, or doing any physical activity. • Athletes should be relatively symptom-free at rest, before begin progressive steps of physical stress for return-to-play. They must also pass a series of assessments to ensure normal neurocognitive measures.

8. Q. What about returning to the classroom? A. School and homework can potentially worsen symptoms, so accommodations, such as increased time for assignments or test taking, might have to be negotiated with the school. Students may need to miss some school initially but are encouraged to attend school, even if for partial days, as long as their symptoms allow.

9. Q. How long does it take to recover from a concussion? A. About 85 percent of concussion athletes recover from symptoms within 7-10 days; and return to play within three weeks after their symptoms began.

10. Q. Why is concussion such a concern in sports? A Young athletes brains are still developing. • SIS, Second Impact Syndrome. Although rare, the athlete who sustains a concussion and does not recognize the symptoms and sustains another shot to the head is at risk for a potentially catastrophic injury. • Studies suggest that athletes with repetitive head trauma are at risk for chronic neurological symptoms.

11. What Does the Future Hold ?

12. Blood test shows promise in diagnosing concussions • University of Pennsylvania found a blood protein called SNTF surged and stayed elevated in professional hockey players with persistent concussion symptoms, but NOT in players who recovered with in days.

13. STNF – normally undetectable in the brain • After injury, the protein accumulates in brain nerve cells called axons. • Even when CT scan seems normal. • Finger prick test – take guess work out of diagnosising concussions.

14. PAUSE QUESTIONS ?

15. Muscle Cramps during Exercise-Is It Fatigue or Electrolyte Deficit? June 6, 2016 Brian L. Siddall, M.A., AT,ATC Supervisor of A.T. Services

16. INTRODUCTION • Electrolytes are some of the most complex and misunderstood nutrients, which can make answering coaches/athletes questions about replacement options a challenge for the A.T. • For example, athletes may ask why electrolytes are important, which specific electrolytes need to be replaced, as well as what options there are available for replacing electrolytes before, during and after exercise.

17. Q. – Why are electrolytes important to the athlete? • In the human body electrolytes must be present in proper concentrations to maintain fluid balance, muscle contraction and neural activity.

18. Q. – Do all electrolytes play an equally important role during exercise? • High Loss through sweat – sodium and chloride. • Low Loss through sweat – potassium, magnesium and calcium. GOAL Appropriate amount of ingested fluids is better retained and distributed to ALL fluid compartment = more complete rehydration

19. TWO PERSPECTIVES: FATIGUE VERSUS ELECTROLYTE DEFICIT Electrolyte Deficit • Can lead to widespread cramping (even when no overload/fatigue) • Predisposing Factors: • Excessive sweating • Significant sodium deficit • Insufficient dietary intake to offset sweat sodium losses Muscle Overload & Fatigue • Prompts muscle cramping locally. • Predisposing Factors: • Poor stretching • Insufficient conditioning • Excessive exercise intensity

20. DIAGNOSIS Electrolyte Deficit • Slight cramping that progress over longer period of time to more severe and widespread cramping. • Profuse sweating and salt residue on skin/clothing also present. Muscle Overload & Fatigue • Sudden onset exertion-related muscle cramping that is localized ( i.e. affecting solely the calf), responds to passive stretching.

21. RECOVERY AND PREVENTION Electrolyte Deficit • At first sign of mild cramping, give electrolyte drink with 3 g of sodium over 5-10 minutes. • (also apply ice/massage) • Prevent: • Increase sodium intake to match sweat sodium losses • Pay attention to athletes overdrinking low sodium fluids Muscle Overload & Fatigue • Resolve by passive stretching, massage, or by icing affected muscle. • Prevent: • Reduce training intensity • Improve conditioning • Better stretching routine

22. SWEAT RATE CALCULATION • Sweat Rate = (A +B) ÷ C A = Pre-exercise BW – Post-exercise BW, record in oz. B = Fluid consumed during exercise in oz. C = Exercise duration in hours _____________________________________________ A = 200LBS – 197LBS = 48 OZ. B = Drank 16 oz. C = 1.5 Hour Sweat Rate = (48 oz + 16 oz.) ÷ 1.5 = 42.6 oz/hr.

23. LET’S TALK ABOUT SODIUM REPLACEMENT • ACSM recommends 5-700 mg of sodium for every half pound you lose in a workout. (based on lose 9-1400 mg/liter of fluid loss) • 1 tsp. of salt = 2300 mg • Gatorade contains 110mg of sodium per 8 oz. serving, ( need 7 bottles of 32 oz. Gatorade ) Lost 3 pds.

24. Prevention – Are You Properly Hydrated? • AM Body Weight? • Urine Color? • Sweat Rate? • Workout exceed 1 hour? • ASK THEM: W. U. T.

25. Heat Index • Relative Humidity – amount of water vapor in the air. The higher the RH, the hotter we feel at same air temperature. -- WHY? • The wetter the air, the longer it takes for perspiration produced by our bodies to evaporate and cool our skin. • OSAA – Oregon Schools Activity Association Tab Coaches Section - Click On: Heat Index Calculator

26. FINDING HEAT INDEX FOR YOUR AREA: • On computer, Google OSAA Heat Index Calculator • Type in your zip code and click on Heat Index Calculator • Present Heat Index and Heat Index Forecast will be displayed with recommendations on length of practice, water breaks, equipment, etc.

28. REMEMBER THE GOAL • The key is to increase sodium intake to closely match the athletes sweat sodium loses – resulting in more complete rehydration. • Pay attention to athletes who are overdrinking low sodium fluids. • We want the appropriate amount of ingested fluids to be better retained and distributed to all fluid compartments = more complete rehydration