For Daysha Shuya, team physiotherapist for the University of Regina Rams, the threat of a concussion is always looming.
With more and more athletes ending up “out indefinitely” due to concussions, the eyes of the sporting world have increasingly turned toward the physical trauma endured by players. Behind the benches at the U of R, things are no different. Although Shuya and the rest of the Rams medical team do everything they can to prevent a concussion from occurring, the inevitable fate is that they will happen; it’s just a matter of how to handle them properly.
“Our protocol with football is if we suspect a concussion, the first thing that we do is generate a referral to the team physician,” Shuya explained. “The physician does the assessment and if the physician is concerned that it may be a concussion we send the player to our team neuropsychologist and the neuropsychologist does cognitive testing.”
Requiring the players to complete cognitive testing was implemented into the Rams program over 10 years ago as a way to prevent and treat head trauma.
“We were one of the first teams to start this in Saskatchewan,” Shuya said. “We have a baseline test of how every player performs before they start football for the season – what their normal value would be – and that way if we suspect a concussion and we retest and they don’t test as well it is often an indication as to how severe the concussion may be.”
The first question on everyone’s mind almost immediately after a player gets injured is, ‘How long will it be before he or she returns to game action?’ As Shuya explained, this can often be quite difficult to determine.
“One of the difficult aspects is that the neuropsychological testing only goes after the cognitive functioning of the brain, so it doesn’t tell us things with other parts of the brain,” she said. “That is where our team doctor becomes an invaluable resource to determine how long or how severe the concussion is.
“If we are trying to determine their return to play, we use what’s called the SCAT [Sport Concussion Assessment Tool] 2. What it does is, we go through a series of tests and measures that we perform on the athlete and then the athlete also has a responsibility to go through some tests on their own.
“Once they go through all the tests and there [are] no significant findings or we don’t find any signs and symptoms that they initially had when they were injured, we start them on [the next step].”
The next step on the road to recovery for an injured player is the graduated return to play protocol. Although this method is designed to ease players into activity, it can also be quite time consuming for a player eager to return to the game.
“The graduated return to play protocol is going to take approximately one week if everything goes smoothly, but if at any time we push them too hard or they push themselves too hard, we have to go back to square one and the first stage,” Shuya said.
“They have to go through the whole protocol again, so another week. As long as they show any symptoms they cannot start the protocol.”
In many of the highly publicized concussion stories, the question arises of whether the player made his or her return to action to soon – something that has Shuya worried.
“There are lots of different things that can happen that are quite scary,” she said.
“Probably the worst thing is that if the brain hasn’t restored itself to baseline functioning or back to its normal state, there is the risk of something called second-impact syndrome. Second-impact syndrome is a second or repeated trauma to a brain that is still trying to recover from the first trauma – basically in simple words the brain freaks out and swells.
“When the brain starts to swell it gets pushed through a little hole in the base of the skull. That part of the brain that gets pushed through the hole is the brainstem and that is where the vital life functions are. That is that part of the brain that tells the body to breath, tells the body to pump blood, tells the body the things that it needs to do to stay alive. As it gets pushed through the base of the skull the person will actually die on the field instantaneously.
“That is in my mind the most scary thing, but the thing that I am probably afraid of even more than that is that if we put someone back to play when they still have signs of a concussion, we can make it so those signs don’t resolve quickly or they can take up to months or years to resolve. We can take a happy, healthy athlete and we can give them signs or symptoms of a concussion that may not go away for a long time.”
Hockey fans have been following the concussion stories surrounding two of the National Hockey League’s most well known players, Sidney Crosby and Chris Pronger. Fans will remember hearing the term “post-concussion syndrome” surrounding any Pronger discussion.
“Post-concussion syndrome means that the concussion and the brain haven’t healed themselves or resolved in a timely fashion,” Shuya explained. “The symptoms then progress from what they might have immediately felt when they hit their head to prolonged depression, mood changes
“Some people get headaches that just won’t go away; there is a whole list of different symptoms that can be part of post-concussion syndrome and what makes concussions very, very tricky to deal with [because] no two concussions will be exactly the same.”
When it comes to Crosby’s concussion, even Shuya, who admitted to following the story, is not sure about his return to the ice.
“That is so hard to tell,” she said. “Sidney Crosby has had the best of the best looking at his case and following it and I don’t know to be honest what will happen.
“I think only Sidney and probably the first couple of doctors that saw him really know what’s going on because we only know the details that have been released to the general public, which isn’t really a lot to form a good opinion on him.”
While questions have swirled in the professional leagues about possible equipment and rule changes in order to reduce the number of concussions, Shuya also insisted the Rams are constantly looking for the next best in equipment to reduce the probability of injuries. However, having top of the line equipment can ironically cause the athlete to receive a more severe injury.
“I know that with the Rams our equipment manager Dan Stark is really on top of the new equipment that comes out and we do have the players in the best equipment that we can get. What we are noticing though is that each year injuries are getting worse in severity.” Shuya said. “We are questioning if that is because the players are bigger and stronger [or] because we have them so protected they are not getting the small little injuries they used to get.
“When they get hurt they get hurt really bad.”
Minimizing concussions, Shuya believes, will take a combined effort from numerous personnel on any team.
“I think it needs [to be accepted] from everyone on the team; it can’t just be the trainers or the medical staff. The coaches have to be a part of it, but even more so the players have to be a part of it,” Shuya said.
“It’s also proper technique: using the best equipment you have available, educating the players, the team, and the staff on what a concussion is and how to try to minimize the event.
“It’s an all-encompassing focus. I think that if there was a quicker, easier fix, someone would have come up with it by now.”