In this weeks Ask Dr Jessica, Dr Hochman talks to sports medicine physician, Dr Tracy Zaslow. This is part 2 of our conversation, and discuss common sports injuries that show up at the pediatrician office---specifically sprained ankles and head injuries. Dr Zaslow explains what a sprained ankles is (@ 0:54 sec), how to treat a sprained ankle and when it is advisable to see your doctor.
Also, have you ever wondered what a concussion is exactly? (@8:20) Dr Zaslow explains common signs of concussions and in general, how to treat them. For any parent with an athletic child, this will be an informative listen!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Hello, Happy Fourth of July and welcome to this week's
(00:03):
episode of Ask Dr. Jessica thepodcast where I interview
experts to talk about commonchildhood concerns. today's
podcast will be the second partof my interview with my
favourite sports medicine doctorTracy's as low. We talked today
about two really common sportsinjuries that I get a lot of
questions about my practicesprained ankles, and
concussions. So thank you somuch for listening. And if you
(00:25):
can remember to subscribe andleave a review, just know that I
would be so appreciative. Nowonto the podcast. Okay, so now I
know there's a lot of specificswithin your field of sports
medicine, but I thought I wouldask you about in general, some
of the most common injuries thatI see in my office so that
parents can know, you know, whenthey can treat it at home when
(00:47):
they might need to see a doctorwhen they might consider getting
the injury imaged. So I thoughtI'd first start with sprained
ankles. That's something that Isee probably weekly in my
office. In general terms, canyou let parents know how to how
to manage a sprained ankle fromhome and when they might need to
talk to a doctor about it?
(01:09):
Yes, so you know, sprained anklehappens all the time, you know,
running, just twist the ankle.
And then a sprain specificallyrefers to the idea that a
ligament was pulled. But if yourkid is running, twist, their
ankle comes in crying, and ankleswells up, then the thing is a
swollen ankle isn't the end ofthe world. Um, you can
definitely start with ice 20minutes on 20 minutes off,
(01:32):
depending if they're old enoughto tolerate that usually under
five or six, they will not letyou put ice on it. But as they
get older, they can toleratethose short term icing. And then
so I keeping it elevated,meaning laying down and putting
the ankle above the level of theheart so the gravity can kind of
pull that down. And then you canwrap it not too tight. And some
(01:53):
patients get a little overvigorous with their wrapping,
but wrapping it with like acompression wrap to give a
little bit more of that.
Compression and helpless whilelike those are kind of your
basic at home. Treatments. Andyou can do Tylenol or Motrin, so
acetaminophen or the the nonsteroidal anti inflammatory, so
(02:15):
Motrin, ibuprofen, Advil, any ofthose are fine, I'd lean towards
the non steroidal antiinflammatory. So I do pro fun in
that family. Because that mighthelp with inflammation as well.
But you would just want to becautious that you don't give
ibuprofen and then they say, Oh,I feel great. And now they're
running around on those soreankles. So if you did give
medication, they should justkind of lay low for a little bit
(02:37):
till we make sure that they'retruly feeling better. And so
then the question comes, so whendo you need to go get it checked
out. So the big thing would be,are they able to walk normally,
if they can walk normally, then,then they're probably fine to
watch at home. If they arewalking with a limp, or they
(02:58):
won't put weight on that ankle,then they should probably be
evaluated by a medical provider.
That's one of our criteria thatwe look for to determine whether
or not to do an x ray. So ifyou're if you're limping or
can't bear weight on that on theon the foot, then then we
probably want to check it out.
And likely we'll look at an xray to make sure there's not a
(03:20):
break. The one thing with kidsis that even though sprained
ankles are really, really,really common. Kids are still
more likely to break to hurt thebone than they are to hurt the
ligament and versus adults thatare more likely to hurt a
ligament. So we have a lowerthreshold to look at an x ray
and make sure that we're notmissing something there.
(03:41):
So a couple of questions, justto touch upon. One is, you know,
right after sprained ankle, mostkids will limp. So does it? Is
it more of the length of timeafter they sprained their ankle
that you would get an x ray orwant to be evaluated?
Yes, that's a good question. Imean, you know, the criteria is
that you don't think at the timeof injury or once they come into
(04:01):
your office, so into our office.
But you know, I think Sure, ifthey twist their ankle, they
they live for a few minutes, andthen they're up and running
without any medications or othersignificant intervention. So I
think you're, you're fine,you're good to go. But if it's
going on, you know, hours intodays, then that's when you'd
want to check it out. If it'sstopping them from doing their
(04:22):
regular activity. That would betime to check it out as well.
Okay. And, and just to alsotouch upon, you mentioned ice. I
think that's such a great pointabout under five, it might not
it might not work out. So well.
I remember I used to always tellparents, you know, advise them
to ice injuries. And then when Ihad my own kids, and they were
(04:42):
little, and I tried putting iceon an injury and they wouldn't
let me. I thought yeah, that'san example of where the advice
that's really easy to give butharder to follow. So
yeah, yeah, I think yeah, thoseyounger kids are just not gonna
they're gonna be toouncomfortable with it. And even
even some of the older kidswon't tell already, but it's
worth a try is that you know,we're offering it and see what
(05:03):
they'll tolerate. Soand specifically, you said to
put it on every Did you sayevery 20 minutes? Yes.
Um, so usually we you want atleast 20 minute break between
icing sessions, and then andthen not to have it on more than
20 minutes. And then when you dohave it on nothing, something
between the ice and the skin, solike a thin towel, or, you know,
(05:25):
washcloth or something just sothat you're not, you know, I've
seen some cases of frostbite, oryou know, skin injury, because
the ice was on either too longor just too cold against the
skin. So we want the cold, butwe got to get to that happy
medium of having the coldwithout injuring the skin.
Okay. And out of curiosity, doyou think it really makes a
(05:48):
difference? Does ice more workto improve symptoms? Or does it
work to help the ankle feelbetter to like to know?
So for For ankle injuries, Ithink it is a combination, I
think the ice does bring downthe pain level, but it also
constricts those blood vesselsand decreases the swelling that
can occur. So I think itdefinitely plays a role there.
(06:10):
In other injuries, that may notswell so much, then it probably
is less of a role and maybe morepain. But for ankles, it can be
really helpful. It's great.
And and how long should parentsexpect to ice the injury for a
day or two?
Yeah, it really depends on theseverity of the injury of how
long the ice is needed. And sohow much swelling is there. But
(06:33):
if there's swelling, then theice can be helpful. So as long
as there's swelling, then it'sworth trying some ice to bring
that swelling down.
And then while we're on thesubject of ice, something that
comes up a lot, parents don'tknow whether to use ice after
injuries and when to when toswitch to heating pads and
warmth. Do you have any generaladvice on that principle?
(06:54):
Yeah, I mean, the number one ismedical data, it doesn't you
know, isn't isn't super strongin either direction, except for
acute injuries is is morehelpful. So again, I used to
prevent the swelling or bringdown the swelling and an acute
injury. So meaning they theyran, they twisted their ankle,
and now it's sore or they felland you know, landed on their
(07:16):
knee, it was put some ice on itthat will prevent it from
getting too swollen or bruise,hopefully. So those are
definitely cases for ice thingswhere it's more chronic, like,
well, I've had a sore back for aweek or so that's where it's
much more mixed ice versus heatversus a combination of the two.
And as where I recommend justdoing what feels better for you
(07:37):
so. So sometimes in those cases,like a sore back would be, you
can do ice after activity orafter injury. And then before if
you're trying to kind of warm itup and feel better than actually
doing some heat can help behelpful. Sometimes people just
like to alternate ice and heat,or ice bugs them a lot and he
feels good or vice versa. And sofor those situations, it's
(08:01):
really what feels best. But forthe acute injury of fall, a
twisting of an ankle, thingslike that ice is the best.
Okay, so right after an injury,ice, maybe for the first day or
two. And then aside from that,it's more about what feels good.
Exactly. Okay. Now, this is acomplicated subject. I know
there's a lot of details and alot of specifics to get into.
(08:23):
But I wanted to briefly touchupon concussions. A lot of kids
are now back in sports. And I'veseen an up an uptick in head
injuries. And I just wanted tolet parents have a general
understanding about concussions.
My first question to you is Howcan parents distinguish between
if their child gets hit on thehead? How can they distinguish
(08:45):
between a head injury, you know,feeling a headache after just
being hit on the head versus anactual concussion?
It's tough. So in the sense thatour question Yes, exactly. I
mean, concussion is defined asany, you know, trauma to the
head that is associated withheadache, dizziness, nausea, and
(09:08):
a whole constellation ofsymptoms. So by definition, if
someone comes in and says to me,or tells me as like, over the
phone conversation, that yes,there got hit in the head, and
they have a diffuse headache,meaning like it's the whole head
if they have, oh, I bumped myforehead and it hurts right here
in that one spot, then thensure, that probably is just a
(09:31):
bump to the head. But if they'reif they have a headache, if they
have nausea, if they're kind offeeling tired or a little out of
it, dizziness, any any of theother symptoms, then it gets
called a concussion. And so it'spretty low threshold to call it
a concussion. And we don't havea tonne of test to define it
(09:52):
better. It's not like it can belike okay, well it sounds like a
concussion. Let me do an x ray.
And then we can we can confirmwhether it's a concussion or
not. It really, once we hearthat history, if there's a
trauma, and then any of thesymptoms that go with
concussion, then we call it aconcussion. And the part with
that Vegas that's challengingis, you know, then it does
change what you're going to dofor the next, you know, week or
(10:14):
so in the sense that if it is aconcussion, then we don't want
the new head injury during therecovery period. And so that,
you know, so going back to that,so, recap here, so, so what do
you do if your kid gets hit inthe head, and you're not sure if
they have a concussion or not? Ithink that's the time to call
(10:36):
your primary care physician,have the conversation and then
work through whether whether weneed to take further precautions
for a concussion, or whether youknow what, maybe this is just a
bump on the head. But I thinkit's a hard decision as a parent
to make. But if they're symptomsother than just paying at the
spot where they were hit, thenwe're probably going to lean
(10:57):
towards calling it a concussion.
I think this is a great, youknow, this is a great overview,
because I think what's so trickyis that there really is no
specific test to diagnose aconcussion, there's no MRI,
there's no x ray, no CT scanwhere you can visually see or
identify a concussion, it reallyhas to do with a constellation
of symptoms, as you described.
(11:19):
Yeah, exactly. And I always liketo tell families, too, that
sometimes though, there'll be ahead injury, and they will go to
an emergency department. Andsometimes a CT scan will be
done. And sometimes it won't.
It's not done unless the medicalstaff is really concerned that
there's a bleed in the brain orskull fracture or something more
(11:39):
serious. And that's because ifwe can avoid a CT scan, that's
great, because it's a bunch of Xrays to the head. With that
said, if there is concern thatthere's something more going on
than that CT scan is worth everybit of exposure. And, and then
sometimes it comes back normal.
(12:00):
So when when the CT scan isnormal, families sometimes come
out thinking, Oh, it's okay,there was no concussion. But the
definition of concussion is anysort of head injury with those
symptoms. And by definition, theCT scan would be normal, because
it's more of a functionalproblem than a structural
problem. So meaning the CT scanlooks normal, but it's still,
(12:23):
you know, things are still notquite working quite right.
I also find what's interestingwith concussions is that kids
will have emotionaldisturbances, they're more
sensitive, or their personalitymight seem different. They're
slower to respond to parents. Sothose are also symptoms to be on
the lookout for.
Yes, absolutely. And I thinksometimes even it's a little
(12:46):
delayed in the sense of whateveryone picks up as for the
concussion, meaning that maybethey played in a soccer
tournament on Sunday was a hotday. And so they there were lots
of bumps during the game, therewasn't any one specific one. But
you know, end of the game,they've got a headache, they're
tired. And everyone's like, Oh,it was a hot day, they're
dehydrated, it was long day,they're tired. And so no one
(13:08):
quite puts it all together justyet. And then they go to school
Monday. Now they're having somedifficulty concentrating, or
they take a test that theyperform much more poorly than
usual. And so in then inhindsight, we go, oh, wait, was
there something more thathappened? Maybe they're more
sensitive at home, they'recrying out of out of character.
And, and those can all be signsthat concussion had occurred?
(13:31):
And in general, I know this is avery complicated topic, and
there's a lot to discuss. Butwhat would the recovery in
general look like for families?
What could they expect? Is achild going to stay home? Until
the symptoms completely,completely resolve? Or will they
anticipate going back to schoolshortly after?
Yeah, good question. And thishas changed a lot over the past
(13:53):
really five to 10 years. So itused to be if you were diagnosed
with a concussion, you were toldgo in a dark room and don't come
out until your bed that'sabsolutely fallen by the
wayside. Research has shown usthat the sitting in that dark
room makes you more anxious andworried about your symptoms and
feel more symptoms and makes thesymptoms lasts longer. So what
(14:15):
we want to do is veryindividualised, because we need
to support the symptoms thatthey're experiencing and try not
to aggravate them, but reallyencourage them to engage in as
you know, as much of life that'snot too stimulating. So some of
the the example I put it wouldbe with school. So again, they
looked at staying home fromschool for five days versus
(14:36):
going to school when you feellike you could and the kids who
started to go when they feltlike they could actually recover
faster. So gradually gettingback into school, you know,
maybe you don't go a full dayright after your concussion but
for a couple hours if that feelsgood, slowly increasing that.
And still engaging in socialinteraction with friends is
(14:58):
important doing calm on thingslike listening to music,
listening to podcasts, watchingtelevision is okay, but avoiding
things like video games, lots ofcomputer time, big events, like
concerts with lots ofstimulating components. So it's
finding the balance between allof that, and it is a longer
(15:20):
discussion, but those are someof the key points of
it. So it sounds like ingeneral, it's more about
monitoring their symptoms andand gradually increasing what
they do based on their based onwhat they can tolerate.
Exactly. Yes, that's perfectsummary. And that happens
anywhere from a few days to afew weeks time. So when parents
(15:40):
are wondering, Well, how long isit going to take to, to see this
recovery 70% of kids are 100% bythree weeks, many are better
faster than that. And you know,then there's still that little
component that takes longer, andwe just need to treat each child
individually, depending on theirsymptoms and supporting them.
Now,I know we talked about going
back to school, but what aboutparticipating in sports again,
(16:02):
do they have to be fullyrecovered from symptoms.
So um, so to return to sports,there's also a gradual return.
And this is actually a veryspecific day by day advancement
that you will go through, andyou need to complete each step
before you go to the next. Butwe encourage early activity. So
(16:23):
starting with walking, somestretching, some things to get
the heart rate up, you know, assoon as they can tolerate and so
that's like 10 to 15 minutes onthe first day, if that feels
good, meaning their symptoms arenot worse, they can do 20 or 30
minutes on the second day, 30 to45 minutes on the third day, and
then move up to noncontacttraining. So noncontact training
(16:43):
can look like, yeah, you knowwhat, they still have some
symptoms. But when they play,they go kick the ball around or
go for a run, they they feelgood. So they're allowed to be
out there, but not doing drillswhere they're playing defence,
or someone playing defence onthem or having anything coming
at them. So for baseball, forexample, that they can go out
and hit off a tee, they canthrow they can run, but they
(17:05):
shouldn't be fielding or hittinga pitch ball. And then they sit
at this level of kind of noncontact until they are symptom
free. So once their symptomshave completely resolved, the
criteria to go back to full playis symptoms have completely
resolved. They're back to fullschool and academic normal
academic performance. Andthey've done this non contact
(17:27):
level of training and have feltgood without symptoms, then
they'll usually see theirmedical provider who can then
say, alright, now you'recleared, but they still need to
complete a contact practicebefore they go to a game. So as
I always tell patients when theycome in for their visit, don't
come to me on game day for yourfollow up, please come so that
(17:48):
we can make sure to get thatcontact practice in before the
game.
So it really sounds likerecovery from cash from
concussions and returning tosports is a very individualised
approach100% That's that's the key word
at this point is individualisedreturn to play and and so like I
said, some kids do thatprogression over a seven day
(18:10):
period and they're good to go.
And they're back to their fullsport and, and other kids, they
might, you know, kind of sit atone of those levels for a few
days, two weeks, or maybe thatyou know, two or three days at
each level and they get backthere by definition concussions
resolve you get back to yourfull activity, but but it just
(18:31):
takes different people differentamount of time.
No, thank you for explainingthis. I know, I know that this
could be a long conversation andan in and of itself concussions.
But it is an area that I as asyou mentioned has really changed
and how we manage them over thelast 510 years. Thank you for
that overview.
Yes Now chronic concussionbecause it's a very lengthy
topic I could talk to youprobably all day about it but
(18:54):
but yes, I think those are thethe key concepts Yeah, better
and it just takes the takes theamount of time that you need as
an individualthank you so much so so now just
to conclude our conversation, isthere any advice that you give
to parents you know, after allthe work and children you've
treated in the field of sportsmedicine? Any have any advice
for families should they thinkabout sports? Should they avoid
(19:16):
sports?
Yeah, I think sports are great.
I think they just play such agreat role in in children's
lives and families lives I thinkthey're a great way for kids to
to be active use social buildconfidence, build strength, stay
out of trouble, you know, keepgood motivation and direction.
So I could go on and on with mylist of you know, I think the
(19:40):
role of sports and I think it'sjust engaging with sports and
physical activity in a reallyhealthy way. Making the fun
finding your passion within inthe sense of there's so many
different sports that are outthere from from you know, kind
of your your more common soccer,football, volleyball to do all
sorts of new sports that havepopped up over the years from
(20:01):
parkour and rock climbing andyou know, you indoor outdoor,
there's something for everyone.
And so I think it's reallyimportant to help kids to
discover what they love and howthey can stay healthy and
active.
Thank you so much. That's suchgood advice.
Thank you. Thanks so much forhaving me. It's such a great
conversation.
(20:22):
Thank you so much for tuninginto this week's episode of Ask
Dr. Jessica. I would be sograteful if you would take a
moment to leave a five starreview. Your support is what
helps this podcast grow. See younext Monday.
Hello, Happy Fourth of July and welcome to this week's
(00:03):
episode of Ask Dr. Jessica thepodcast where I interview
experts to talk about commonchildhood concerns. today's
podcast will be the second partof my interview with my
favourite sports medicine doctorTracy's as low. We talked today
about two really common sportsinjuries that I get a lot of
questions about my practicesprained ankles, and
concussions. So thank you somuch for listening. And if you
(00:25):
can remember to subscribe andleave a review, just know that I
would be so appreciative. Nowonto the podcast. Okay, so now I
know there's a lot of specificswithin your field of sports
medicine, but I thought I wouldask you about in general, some
of the most common injuries thatI see in my office so that
parents can know, you know, whenthey can treat it at home when
(00:47):
they might need to see a doctorwhen they might consider getting
the injury imaged. So I thoughtI'd first start with sprained
ankles. That's something that Isee probably weekly in my
office. In general terms, canyou let parents know how to how
to manage a sprained ankle fromhome and when they might need to
talk to a doctor about it?
(01:09):
Yes, so you know, sprained anklehappens all the time, you know,
running, just twist the ankle.
And then a sprain specificallyrefers to the idea that a
ligament was pulled. But if yourkid is running, twist, their
ankle comes in crying, and ankleswells up, then the thing is a
swollen ankle isn't the end ofthe world. Um, you can
definitely start with ice 20minutes on 20 minutes off,
(01:32):
depending if they're old enoughto tolerate that usually under
five or six, they will not letyou put ice on it. But as they
get older, they can toleratethose short term icing. And then
so I keeping it elevated,meaning laying down and putting
the ankle above the level of theheart so the gravity can kind of
pull that down. And then you canwrap it not too tight. And some
(01:53):
patients get a little overvigorous with their wrapping,
but wrapping it with like acompression wrap to give a
little bit more of that.
Compression and helpless whilelike those are kind of your
basic at home. Treatments. Andyou can do Tylenol or Motrin, so
acetaminophen or the the nonsteroidal anti inflammatory, so
(02:15):
Motrin, ibuprofen, Advil, any ofthose are fine, I'd lean towards
the non steroidal antiinflammatory. So I do pro fun in
that family. Because that mighthelp with inflammation as well.
But you would just want to becautious that you don't give
ibuprofen and then they say, Oh,I feel great. And now they're
running around on those soreankles. So if you did give
medication, they should justkind of lay low for a little bit
(02:37):
till we make sure that they'retruly feeling better. And so
then the question comes, so whendo you need to go get it checked
out. So the big thing would be,are they able to walk normally,
if they can walk normally, then,then they're probably fine to
watch at home. If they arewalking with a limp, or they
(02:58):
won't put weight on that ankle,then they should probably be
evaluated by a medical provider.
That's one of our criteria thatwe look for to determine whether
or not to do an x ray. So ifyou're if you're limping or
can't bear weight on that on theon the foot, then then we
probably want to check it out.
And likely we'll look at an xray to make sure there's not a
(03:20):
break. The one thing with kidsis that even though sprained
ankles are really, really,really common. Kids are still
more likely to break to hurt thebone than they are to hurt the
ligament and versus adults thatare more likely to hurt a
ligament. So we have a lowerthreshold to look at an x ray
and make sure that we're notmissing something there.
(03:41):
So a couple of questions, justto touch upon. One is, you know,
right after sprained ankle, mostkids will limp. So does it? Is
it more of the length of timeafter they sprained their ankle
that you would get an x ray orwant to be evaluated?
Yes, that's a good question. Imean, you know, the criteria is
that you don't think at the timeof injury or once they come into
(04:01):
your office, so into our office.
But you know, I think Sure, ifthey twist their ankle, they
they live for a few minutes, andthen they're up and running
without any medications or othersignificant intervention. So I
think you're, you're fine,you're good to go. But if it's
going on, you know, hours intodays, then that's when you'd
want to check it out. If it'sstopping them from doing their
(04:22):
regular activity. That would betime to check it out as well.
Okay. And, and just to alsotouch upon, you mentioned ice. I
think that's such a great pointabout under five, it might not
it might not work out. So well.
I remember I used to always tellparents, you know, advise them
to ice injuries. And then when Ihad my own kids, and they were
(04:42):
little, and I tried putting iceon an injury and they wouldn't
let me. I thought yeah, that'san example of where the advice
that's really easy to give butharder to follow. So
yeah, yeah, I think yeah, thoseyounger kids are just not gonna
they're gonna be toouncomfortable with it. And even
even some of the older kidswon't tell already, but it's
worth a try is that you know,we're offering it and see what
(05:03):
they'll tolerate. Soand specifically, you said to
put it on every Did you sayevery 20 minutes? Yes.
Um, so usually we you want atleast 20 minute break between
icing sessions, and then andthen not to have it on more than
20 minutes. And then when you dohave it on nothing, something
between the ice and the skin, solike a thin towel, or, you know,
(05:25):
washcloth or something just sothat you're not, you know, I've
seen some cases of frostbite, oryou know, skin injury, because
the ice was on either too longor just too cold against the
skin. So we want the cold, butwe got to get to that happy
medium of having the coldwithout injuring the skin.
Okay. And out of curiosity, doyou think it really makes a
(05:48):
difference? Does ice more workto improve symptoms? Or does it
work to help the ankle feelbetter to like to know?
So for For ankle injuries, Ithink it is a combination, I
think the ice does bring downthe pain level, but it also
constricts those blood vesselsand decreases the swelling that
can occur. So I think itdefinitely plays a role there.
(06:10):
In other injuries, that may notswell so much, then it probably
is less of a role and maybe morepain. But for ankles, it can be
really helpful. It's great.
And and how long should parentsexpect to ice the injury for a
day or two?
Yeah, it really depends on theseverity of the injury of how
long the ice is needed. And sohow much swelling is there. But
(06:33):
if there's swelling, then theice can be helpful. So as long
as there's swelling, then it'sworth trying some ice to bring
that swelling down.
And then while we're on thesubject of ice, something that
comes up a lot, parents don'tknow whether to use ice after
injuries and when to when toswitch to heating pads and
warmth. Do you have any generaladvice on that principle?
(06:54):
Yeah, I mean, the number one ismedical data, it doesn't you
know, isn't isn't super strongin either direction, except for
acute injuries is is morehelpful. So again, I used to
prevent the swelling or bringdown the swelling and an acute
injury. So meaning they theyran, they twisted their ankle,
and now it's sore or they felland you know, landed on their
(07:16):
knee, it was put some ice on itthat will prevent it from
getting too swollen or bruise,hopefully. So those are
definitely cases for ice thingswhere it's more chronic, like,
well, I've had a sore back for aweek or so that's where it's
much more mixed ice versus heatversus a combination of the two.
And as where I recommend justdoing what feels better for you
(07:37):
so. So sometimes in those cases,like a sore back would be, you
can do ice after activity orafter injury. And then before if
you're trying to kind of warm itup and feel better than actually
doing some heat can help behelpful. Sometimes people just
like to alternate ice and heat,or ice bugs them a lot and he
feels good or vice versa. And sofor those situations, it's
(08:01):
really what feels best. But forthe acute injury of fall, a
twisting of an ankle, thingslike that ice is the best.
Okay, so right after an injury,ice, maybe for the first day or
two. And then aside from that,it's more about what feels good.
Exactly. Okay. Now, this is acomplicated subject. I know
there's a lot of details and alot of specifics to get into.
(08:23):
But I wanted to briefly touchupon concussions. A lot of kids
are now back in sports. And I'veseen an up an uptick in head
injuries. And I just wanted tolet parents have a general
understanding about concussions.
My first question to you is Howcan parents distinguish between
if their child gets hit on thehead? How can they distinguish
(08:45):
between a head injury, you know,feeling a headache after just
being hit on the head versus anactual concussion?
It's tough. So in the sense thatour question Yes, exactly. I
mean, concussion is defined asany, you know, trauma to the
head that is associated withheadache, dizziness, nausea, and
(09:08):
a whole constellation ofsymptoms. So by definition, if
someone comes in and says to me,or tells me as like, over the
phone conversation, that yes,there got hit in the head, and
they have a diffuse headache,meaning like it's the whole head
if they have, oh, I bumped myforehead and it hurts right here
in that one spot, then thensure, that probably is just a
(09:31):
bump to the head. But if they'reif they have a headache, if they
have nausea, if they're kind offeeling tired or a little out of
it, dizziness, any any of theother symptoms, then it gets
called a concussion. And so it'spretty low threshold to call it
a concussion. And we don't havea tonne of test to define it
(09:52):
better. It's not like it can belike okay, well it sounds like a
concussion. Let me do an x ray.
And then we can we can confirmwhether it's a concussion or
not. It really, once we hearthat history, if there's a
trauma, and then any of thesymptoms that go with
concussion, then we call it aconcussion. And the part with
that Vegas that's challengingis, you know, then it does
change what you're going to dofor the next, you know, week or
(10:14):
so in the sense that if it is aconcussion, then we don't want
the new head injury during therecovery period. And so that,
you know, so going back to that,so, recap here, so, so what do
you do if your kid gets hit inthe head, and you're not sure if
they have a concussion or not? Ithink that's the time to call
(10:36):
your primary care physician,have the conversation and then
work through whether whether weneed to take further precautions
for a concussion, or whether youknow what, maybe this is just a
bump on the head. But I thinkit's a hard decision as a parent
to make. But if they're symptomsother than just paying at the
spot where they were hit, thenwe're probably going to lean
(10:57):
towards calling it a concussion.
I think this is a great, youknow, this is a great overview,
because I think what's so trickyis that there really is no
specific test to diagnose aconcussion, there's no MRI,
there's no x ray, no CT scanwhere you can visually see or
identify a concussion, it reallyhas to do with a constellation
of symptoms, as you described.
(11:19):
Yeah, exactly. And I always liketo tell families, too, that
sometimes though, there'll be ahead injury, and they will go to
an emergency department. Andsometimes a CT scan will be
done. And sometimes it won't.
It's not done unless the medicalstaff is really concerned that
there's a bleed in the brain orskull fracture or something more
(11:39):
serious. And that's because ifwe can avoid a CT scan, that's
great, because it's a bunch of Xrays to the head. With that
said, if there is concern thatthere's something more going on
than that CT scan is worth everybit of exposure. And, and then
sometimes it comes back normal.
(12:00):
So when when the CT scan isnormal, families sometimes come
out thinking, Oh, it's okay,there was no concussion. But the
definition of concussion is anysort of head injury with those
symptoms. And by definition, theCT scan would be normal, because
it's more of a functionalproblem than a structural
problem. So meaning the CT scanlooks normal, but it's still,
(12:23):
you know, things are still notquite working quite right.
I also find what's interestingwith concussions is that kids
will have emotionaldisturbances, they're more
sensitive, or their personalitymight seem different. They're
slower to respond to parents. Sothose are also symptoms to be on
the lookout for.
Yes, absolutely. And I thinksometimes even it's a little
(12:46):
delayed in the sense of whateveryone picks up as for the
concussion, meaning that maybethey played in a soccer
tournament on Sunday was a hotday. And so they there were lots
of bumps during the game, therewasn't any one specific one. But
you know, end of the game,they've got a headache, they're
tired. And everyone's like, Oh,it was a hot day, they're
dehydrated, it was long day,they're tired. And so no one
(13:08):
quite puts it all together justyet. And then they go to school
Monday. Now they're having somedifficulty concentrating, or
they take a test that theyperform much more poorly than
usual. And so in then inhindsight, we go, oh, wait, was
there something more thathappened? Maybe they're more
sensitive at home, they'recrying out of out of character.
And, and those can all be signsthat concussion had occurred?
(13:31):
And in general, I know this is avery complicated topic, and
there's a lot to discuss. Butwhat would the recovery in
general look like for families?
What could they expect? Is achild going to stay home? Until
the symptoms completely,completely resolve? Or will they
anticipate going back to schoolshortly after?
Yeah, good question. And thishas changed a lot over the past
(13:53):
really five to 10 years. So itused to be if you were diagnosed
with a concussion, you were toldgo in a dark room and don't come
out until your bed that'sabsolutely fallen by the
wayside. Research has shown usthat the sitting in that dark
room makes you more anxious andworried about your symptoms and
feel more symptoms and makes thesymptoms lasts longer. So what
(14:15):
we want to do is veryindividualised, because we need
to support the symptoms thatthey're experiencing and try not
to aggravate them, but reallyencourage them to engage in as
you know, as much of life that'snot too stimulating. So some of
the the example I put it wouldbe with school. So again, they
looked at staying home fromschool for five days versus
(14:36):
going to school when you feellike you could and the kids who
started to go when they feltlike they could actually recover
faster. So gradually gettingback into school, you know,
maybe you don't go a full dayright after your concussion but
for a couple hours if that feelsgood, slowly increasing that.
And still engaging in socialinteraction with friends is
(14:58):
important doing calm on thingslike listening to music,
listening to podcasts, watchingtelevision is okay, but avoiding
things like video games, lots ofcomputer time, big events, like
concerts with lots ofstimulating components. So it's
finding the balance between allof that, and it is a longer
(15:20):
discussion, but those are someof the key points of
it. So it sounds like ingeneral, it's more about
monitoring their symptoms andand gradually increasing what
they do based on their based onwhat they can tolerate.
Exactly. Yes, that's perfectsummary. And that happens
anywhere from a few days to afew weeks time. So when parents
(15:40):
are wondering, Well, how long isit going to take to, to see this
recovery 70% of kids are 100% bythree weeks, many are better
faster than that. And you know,then there's still that little
component that takes longer, andwe just need to treat each child
individually, depending on theirsymptoms and supporting them.
Now,I know we talked about going
back to school, but what aboutparticipating in sports again,
(16:02):
do they have to be fullyrecovered from symptoms.
So um, so to return to sports,there's also a gradual return.
And this is actually a veryspecific day by day advancement
that you will go through, andyou need to complete each step
before you go to the next. Butwe encourage early activity. So
(16:23):
starting with walking, somestretching, some things to get
the heart rate up, you know, assoon as they can tolerate and so
that's like 10 to 15 minutes onthe first day, if that feels
good, meaning their symptoms arenot worse, they can do 20 or 30
minutes on the second day, 30 to45 minutes on the third day, and
then move up to noncontacttraining. So noncontact training
(16:43):
can look like, yeah, you knowwhat, they still have some
symptoms. But when they play,they go kick the ball around or
go for a run, they they feelgood. So they're allowed to be
out there, but not doing drillswhere they're playing defence,
or someone playing defence onthem or having anything coming
at them. So for baseball, forexample, that they can go out
and hit off a tee, they canthrow they can run, but they
(17:05):
shouldn't be fielding or hittinga pitch ball. And then they sit
at this level of kind of noncontact until they are symptom
free. So once their symptomshave completely resolved, the
criteria to go back to full playis symptoms have completely
resolved. They're back to fullschool and academic normal
academic performance. Andthey've done this non contact
(17:27):
level of training and have feltgood without symptoms, then
they'll usually see theirmedical provider who can then
say, alright, now you'recleared, but they still need to
complete a contact practicebefore they go to a game. So as
I always tell patients when theycome in for their visit, don't
come to me on game day for yourfollow up, please come so that
(17:48):
we can make sure to get thatcontact practice in before the
game.
So it really sounds likerecovery from cash from
concussions and returning tosports is a very individualised
approach100% That's that's the key word
at this point is individualisedreturn to play and and so like I
said, some kids do thatprogression over a seven day
(18:10):
period and they're good to go.
And they're back to their fullsport and, and other kids, they
might, you know, kind of sit atone of those levels for a few
days, two weeks, or maybe thatyou know, two or three days at
each level and they get backthere by definition concussions
resolve you get back to yourfull activity, but but it just
(18:31):
takes different people differentamount of time.
No, thank you for explainingthis. I know, I know that this
could be a long conversation andan in and of itself concussions.
But it is an area that I as asyou mentioned has really changed
and how we manage them over thelast 510 years. Thank you for
that overview.
Yes Now chronic concussionbecause it's a very lengthy
topic I could talk to youprobably all day about it but
(18:54):
but yes, I think those are thethe key concepts Yeah, better
and it just takes the takes theamount of time that you need as
an individualthank you so much so so now just
to conclude our conversation, isthere any advice that you give
to parents you know, after allthe work and children you've
treated in the field of sportsmedicine? Any have any advice
for families should they thinkabout sports? Should they avoid
(19:16):
sports?
Yeah, I think sports are great.
I think they just play such agreat role in in children's
lives and families lives I thinkthey're a great way for kids to
to be active use social buildconfidence, build strength, stay
out of trouble, you know, keepgood motivation and direction.
So I could go on and on with mylist of you know, I think the
(19:40):
role of sports and I think it'sjust engaging with sports and
physical activity in a reallyhealthy way. Making the fun
finding your passion within inthe sense of there's so many
different sports that are outthere from from you know, kind
of your your more common soccer,football, volleyball to do all
sorts of new sports that havepopped up over the years from
(20:01):
parkour and rock climbing andyou know, you indoor outdoor,
there's something for everyone.
And so I think it's reallyimportant to help kids to
discover what they love and howthey can stay healthy and
active.
Thank you so much. That's suchgood advice.
Thank you. Thanks so much forhaving me. It's such a great
conversation.
(20:22):
Thank you so much for tuninginto this week's episode of Ask
Dr. Jessica. I would be sograteful if you would take a
moment to leave a five starreview. Your support is what
helps this podcast grow. See younext Monday.
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