The occurrence of concussions in isolation or in combination with other injury such as a ski accident can be overlooked and neglected. A concussion is the result of the brain impacting, twisting, stretching and or bouncing off the skull from impact. This impact and stress distorts the brain cells and disrupts normal functioning in multiple ways. There is cellular chemical imbalance that results leading to disruption of oxygenation and nutrition in both baseline function as well as increased demand from the injury and need to heal. This imbalance leads to signs and symptoms of a concussion that must be evaluated and closely followed. Loss of consciousness (LOC) occurs in about 10% concussions however the occurrence of LOC of any length indicates a positive concussion. Immediately after insult the person can be disoriented, confused, forgetful of events previous, during or after the event, and be repeating themselves. Poor balance, headache, nausea, irritability, mental fogginess, dizziness, vomiting and light sensitivity are commonly seen at the accident sight as well. Tearfulness, sadness, malaise, sleep disruption, decreased appetite, mood changes and neck pain can be seen as well. Symptoms can last for days, weeks and even months.
Recognition and treatment of these symptoms should not be taken for granted. Evaluation immediately by a trained provider is important, however follow up and close monitoring of the patient with oversight of a brain rehabilitation program is just as important. Worsening of symptoms, lethargy, vomiting, numbness, weakness, increasing balance problems, slurred speech and confusion needs immediate medical care even after the initial evaluation. NSAIDs (Ibuprofen, Naproxyn) as well as aspirin should not be taken. Tylenol is ok to take for the headache and pain.
Baseline evaluation prior to activity has proven to be important for return to baseline, return to play and specific injury recovery. The basic recommendation I make for patients is not to return to sport until signs and symptoms are gone and then close oversight into gradual return with limited duration and intensity reintroduction based on testing and response by the athlete. Any return of symptoms results in immediate rest and more recovery. Continued focus on proper nutrition, hydration and supplementation for months after resolution of symptoms are indicated.
Stay safe out there.
Griggs Orthopedics (gO) is located in Crested Butte and Gunnison. Dr. Griggs is the Orthopedic Director of the GVH Mountain Clinic and the Medical Director of United States Ski Mountaineering Association. For more about gO and what gO can do for you, contact griggsortho.com or 970-349-5103.