Thrive by IU Health

August 09, 2021

Concussion. A diagnosis no athlete ever wants to hear.

IU Health Arnett Hospital

Concussion. A diagnosis no athlete ever wants to hear.

As fellowship trained primary care sports medicine physicians, Jonathan Mongold DO, and Jeff Wang MD are concussion specialists. Research continues at a high rate in the field of concussion which helps the specialists diagnose concussion accurately and achieve a more exact return to play to get high school athletes back to sport as quickly and most importantly safely as possible.

Jonathon Mongold

“This is very important, because concussion brain injury is unlike many musculoskeletal injuries such as an ankle sprain or a broken bone,” explains Mongold. “Ankle sprains and broken bones usually heal without any concern for long term or lifelong problems. An injured brain (concussion) that is not treated appropriately can cause a lifetime of problems including but not limited to, slowed thinking, mood changes, chronic headaches or dizziness.”

A subtle concussion can often be very challenging to recognize for the athlete themselves, parents, coaches or even a physician or provider that is not accustomed to treating concussions on a regular basis or without specialty concussion management.

Jeffrey Wang

“As fellowship trained primary care sports medicine physicians, we have this specialized concussion training for you,” stated Wang. “There are no blood tests or imaging that detect concussion. We rely on the report of what occurred from the athlete and family at the time of the head trauma and how they felt after the trauma. We also use objective data such as a physical exam including neurological and vestibular ocular motor (VOMS) exam which is key to detecting subtle concussions. Objective data also in a neurocognitive test such as an IMPACT computer exam can be a helpful tool to assist in diagnosis and management but a combination of how patient is feeling, and good physical exam including a careful testing of eyes, VOMS and balance, is imperative to make sure we are not missing a mild subtle concussion.”

The most severe concussions with lasting consequences later in life tend to occur after an athlete sustains a second concussion after having not recognizing a previous subtle concussion that was not treated appropriately. For the long-term brain health of student-athletes, it is essential that all concussions are treated appropriately.

“This also goes both ways, because of our highly trained diagnosis and management of concussion, we can often get student-athletes returned to play sooner because of our ability to recognize the presence of concussion as well as when an athlete is recovered,” explained Mongold. “Many mild concussions that recover quickly are often back to full play in 7 days after finishing the concussion protocol, if assessed by us as recovered from concussion before starting full contact practice.”

Concussion exam 2

For instance, in a patient with a subtle and mild concussion, if only having symptoms for 1-2 days and vestibular and neurological exam returns to normal, they can start the 7 day minimum return to play protocol with non-contact light cardiovascular training, which has been shown in recent literature to speed the recovery of concussion.

“We help protect our student athletes, if the athlete feels ‘fine’ but our physical exam shows evidence of poor balance or slight difficulty tracking of eyes, we can be sure that the concussion is not completely resolved, and will wait until concussion is truly resolved, by seeing these findings resolve. This protects the athlete from potential long-term problems with the brain by not going back to play contact sport too soon and sustaining another concussion before the brain is healed,” elaborated Mongold.

“We want to absolutely avoid any head trauma (being hit in the head) until completely recovered from concussion, and once the athlete’s symptoms, physical exam and neurocognitive testing all show we can progress back to contact practice and competition.”

Even with a mild concussion, the specialist follow the 7 day return to play protocol which is backed by research and the law, so as to make sure that there is not a subtle concussion that does not show it’s symptoms again as exercise is slowly ramped up. It is important to point out, a mild and subtle concussion if missed can be very dangerous in the long term. If a concussion is missed and the athlete sustains another hit to the head and a subsequent concussion in the setting where the first concussion was not treated appropriately, this is when it is much more likely to see term brain health problems.

“Although concussions can be ‘silent’ or easily missed in diagnosis, I would argue that in comparison to some obviously painful musculoskeletal injuries that the accurate diagnosis and management of concussion is more important for our student-athlete’s long term health and life,” stated Wang.

“Dr. Wang and I are passionately committed to helping student-athletes be the very best versions of themselves now and in the future. We want our amazing athletes and teams to have great success in High School and beyond and continue to be better as individuals and teams under our care! As always we will help our student-athletes get back to playing the sport they love as quickly and safely as possible under accurate diagnostic and therapeutic skill,” added Mongold.

concussion exam

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