last longer than a week. The following is a list I provide to patients and their coaches when I suspect upon evaluation the athlete has had a concussion. Keep in mind that no concussion should be considered minor. • Avoid strenuous activity for 24 hours after the injury • Do not take medications without consulting your physician • Eat a light diet such as soup, toast or crackers for 24 hours after the injury • Avoid alcohol • Do not take aspirin, sleeping pills or ibuprofen. • Call your doctor or return to the ER if any of the following occurs: • You become sleepy or are difficult to awaken • Vomiting • Trouble with balance • Your eyes move oddly, difficulty with focusing or unequal pupil size • Persisting or increasing headaches • Restlessness or irritability, personality changes • Convulsions or seizures • New swelling at the area of the head injured • Increased neck stiffness • Numbness • Ringing in the ears • Confusion Some chiropractors specialize in a form of treatment called “chiropractic neurology.” This technique came into the concussion spotlight through hockey star Sid-ney Crosby, who has been treated, many say, success-fully for concussion symptoms by Canadian chiroprac-tor Dr. Ted Carrick. Treatment methods are brain-based, non-invasive, drug-free physical rehabilitation. It in-cludes chiropractic adjustments, movement, nutritional therapies and exercise rehabilitation. Collectively, these approaches work to re-establish balance as well as max-imal brain and nervous system functionality. Post-concussive syndrome has not been listed as an absolute contraindication for cervical manipulation. However, I would strongly urge the chiropractor to al-ways think of it as a relative contraindication to cervical spine diversified manipulation. A full cervical spine exam, neurological and cognitive tests should be given prior to any cervical manipulation. Currently, there are few large randomized controlled trials that suggest chiropractic care benefits those that suffered concus-sion, however there is a plethora of case studies that support its benefits. Mastery of concussion-specific knowledge and abili-ties to navigate the correct pathways of management are essential for successful care of the concussed individual. Return-to-play criteria are controversial. Similar to concussion classification guidelines, several different guidelines regarding return to play have been estab-lished. The big issue is that no scientific evidence exists to justify one criterion versus another. Return to sports and physical activity requires a progressive exercise program, a complete absence of symptoms, successful completion of a standardized neuropsycho-logical test, and continuing evaluation for any recur-ring signs or symptoms. Provocative tests are used to increase the athlete’s blood pressure and heart rate. These typically include jogging, sprinting, sit-ups or push-ups. The doctor should keep in mind that even relatively minor concussions might have more pro-longed neurologic deficits. The main criteria for an athlete’s return to play in-clude complete clearing of all symptoms, complete re-turn of all memory and concentration, and no symptoms after provocative testing. The most important aspect of all published guidelines is the concept of an athlete not being allowed to return to play until he or she is com-pletely asymptomatic. Consultation with a neurologist or primary care sports medicine physician is indicated for patients who have prolonged symptoms. Neuropsychologic consultation may also be considered to document any deficits that may interfere with the athlete’s return to sport, school or work. Sports-related concussion can be serious or even life threatening if not managed correctly. Protecting athletes from head injuries is one of the most important ways to www.canadianchiropractor.ca ChiRopRACTiC ConsideRATions ReTURn-To-plAy Kosim ideal for health Medical Innovation Equipment & Supplies Ultrasound & E-Stim Combo val! Arri New omboCare™ C ULTRA • 1 MHz & 3 MHz for Ultrasound Drug FREE Pain Relief • 2-channel of TENS, EMS, Russian, World’s most advanced 2-Pole & 4-Pole Interferential output Super Pulsed Laser Starting from $4,810 Now Special $1,095 pain relieving modality BUY 5 GET 1 FREE Micro-Sphere Cervical Pillow * 2-Sided * Sectional Divided Design Full line of portable TENS, EMS, IFC units Staring from $40.00 + Buy 6 Get 1 Free $699 135 SPARKS AVE (Victoria Park & Steeles East) Toronto, ON M2H 2S5 TOLL FREE: 1-877-50KOSIM T:416-502-3700 F:416-502-2808 Email: [email protected] $385 34 Canadian Chiropractor December 2014
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