August/September 2021 - 18

Concussions
THE PHYSICAL EXAM OF THE
ATHLETE WITH A CONCUSSION
By Eric A. Schwartz, M.Ed, LAT, ATC
S
..ports are second only to motor vehicle crashes as
..the leading cause of traumatic brain injury among
..people aged 15 to 24. Concussions in high school
athletics represent 8.9% of all injuries occurring from
sports. It has been reported that football and soccer have
the highest rates of concussion in high school athletics.
The athletic trainer's evaluation is a critical component to
the management of the post-concussion athlete from the
time the injury occurs to when the athlete returns to the
field of play.
Athletic trainers are excellent at recognizing when
an athlete potentially has a concussion on the sidelines
during a sporting event by performing the SCAT5 which
is the standard of care for helping diagnose an athlete
with a sports-related concussion. However, SCAT5 is not
enough. The athletic trainer, working in conjunction with
the team physician, needs a comprehensive plan for the
on-the-field examination and the follow-up examination
of the post-concussed athlete. This plan will, in turn, help
the athlete's medical team determine the appropriate
rehabilitation prior to starting the return to play process.
Athletic trainers are at the forefront with respect
to concussions and the management of concussed
athletes. However, even athletic trainers will benefit from
reviewing traditional approaches and new information on
the important elements of the multidimensional approach
to the clinical physical exam.
Athletes who have sustained a concussion can
experience any or all of approximately 21 different
symptoms, including a headache, dizziness, confusion, and
difficulty concentrating as well as cognitive, vestibular, and
ocular motor impairments. Most researchers and clinicians
can agree that on average sports-related concussion
symptoms resolve within about 7-10 days post-injury.
Researchers have identified several post-injury factors
that may negatively affect a patient's recovery. The
occurrence of post-traumatic migraine symptoms following
concussion (headache with nausea and photo- and/or
phonosensitivity), immediate dizziness, and sub-acute
(within 3-7 days) fogginess, difficulty concentrating,
vomiting, dizziness, nausea, headache, slowness,
imbalance, photo/phonosensitivity, and numbness predict
longer than normal (i.e. 14-21 days) recovery times.
Researchers have reported that vestibular impairments
are common following a sports-related concussion and
approximately 50% of athletes report dizziness within the
first few days post-concussion. Ocular-motor problems
18 | Training & Conditioning | August/September 2021
are experienced by approximately 1/3 of athletes in the
first week following a concussion. It is likely that vestibular
and ocular-motor symptoms may impair an adolescent
athlete's ability to learn and participate in athletics
because symptoms include dizziness, headache, vertigo,
fogginess, motion sensitivity, disequilibrium, postural or
gait imbalance, gaze instability, blurred vision, or diplopia.
Vision symptoms can include abnormal eye movements
and visual instability. Vestibular and ocular-motor
symptoms affect the learning of adolescents by making it
difficult for the student-athlete to read, copy notes, paying
attention to visual tasks, standing quickly, or walking in
a crowded environment of the school can be a challenge,
and the student-athlete might have problems with aspects
of a typical day of school (slide presentations, movies,
smartboards, computers, handheld computers (tablets and
cell phones), and artificial lighting). The vestibular ocularmotor
symptoms can affect the student-athletes ability to
run, balance, sports-specific movements, and the inability
to perform physical exertion. The detailed physical exam
of an athlete with a concussion can reveal which vestibular
ocular motor symptoms that the athlete is currently

August/September 2021

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