Concussion awareness outside of contact sports

As concussion awareness continues to grow, more and more preseason education on the signs and symptoms of concussion are discussed with both parents and athletes. Majority of athletes involved in contact sports, such as soccer, football, and hockey receive preseason education on concussion, typically during baseline testing or preseason meetings. The popularity of baseline testing, even among athletes involved in non-contact sports, such as volleyball or basketball continues to develop. However, for those athletes involved in individualized sports (e.g., swimming, golf) or activities outside of school athletics (e.g., horseback riding, figure skating), concussion awareness training is limited. Often times these individuals are left to learn about sports related concussions through the media, peers, or internet search. Unfortunately, this type of information seeking can lead to misconceptions about the injury and treatment approach – particularly with such a highly individualized injury.

This was the case for 20-year-old, college student and horseback rider, Claire Jensen. Jensen began horseback riding around the age of eight and throughout her entire horseback riding career, she admittedly never had a formal conversation about the possibility of sustaining a concussion while riding.

“I didn’t think it was something that could happen to me or something that I even thought that much about. I knew to always wear a helmet though,” Jensen said.

During a routine cross country trail ride this past spring, Jensen’s horse lost her footing as she traversed downhill, falling to the side taking Claire with her. Jensen explained that she “went down hard” with the horse almost rolling on top of her. “I remember hitting the ground and sliding on my shoulder. I didn’t think I had a concussion, since I didn’t black out,” Jensen explains. Without recalling an impact to her helmeted head, Jensen did not consider concussion as a possible injury in the incident. She knew to call her mother, but admittedly did not seek treatment for several weeks when her headaches were not subsiding. When speaking to her mother during her initial visit at the TRIA Sports Concussion Program, it was evident that Jensen experienced post-traumatic amnesia as she had limited recollection of details following the injury, including the phone call to her mother.

During the first week after her fall, Jensen continued to participate in college courses but quickly realized difficulties with tolerance of social settings and a worsening of symptoms with her regular exercise routine. Her symptoms were not improving with rest and constant headaches remained and worsened with daily tasks such as driving or watching television. Her world was suddenly shrinking as she decreased participation in activities she enjoyed doing because they made her feel sick.

Approximately, one month post-injury, Jensen was evaluated by Dr. Aimee Custer, Clinical Sport Neuropsychologist at the TRIA Sports Concussion Program. “Claire was being an excellent patient,” Custer said, “she was following the recommendation of rest, but what she didn’t know was that the type of concussion she sustained required active treatment to get better.”

Dr. Custer identified difficulties with Jensen’s vestibular system, the part of the brain involved in interpreting movement and motion. Jensen began participating in vestibular therapy, a form of physical therapy that focuses on reintegrating the vestibular and ocular motor systems.

“I did a lot of eye work, like holding a Popsicle stick and shaking my head. I worked on balance and movement, walking with head turns and slowly returning to physical activity,” Jensen explains.

“The difficulties Claire was experiencing with stabilizing her vision during movement or head turns is what was causing an increase in her symptoms (e.g., headaches, dizziness, nausea) while driving or exercising,” explained Custer. Surprisingly, Claire was prescribed activities that actually caused symptoms, in a very safe, gradual way, to actively treat symptoms; rest was not the solution in her case.

Two weeks ago, Claire returned to horseback riding for the first time since her fall in May. “I felt pretty good, but I was a bit nervous at first. After I rode her for a while, I got back into the grove of things,” Jensen reported with a smile. Jensen reported that she does not have a fear of returning to her beloved sport, understanding that accidents can happen, especially when working with horses. Jensen is excited with her progress.

“She continues to impress me each time I see her,” Custer said. “She has worked very hard throughout her treatment and has a good understanding of concussion.” Custer explained that delayed initiation of treatment can sometimes lead to prolonged recovery. “Educating all athletes on the signs and symptoms of concussion, regardless of sport, is very important. Despite increased efforts by health care professionals, coaches, etc., misconceptions about this injury remain. This can be a very scary injury and not having the correct information can make things much worse,” Custer emphasized.

The top five misconceptions Dr. Custer says she hears most frequently:

1. If I don’t lose consciousness then I didn’t sustain a concussion
2. If my brain imaging (CT/MRI) is normal, than I didn’t have a concussion
3. Rest is the only form of treatment for concussion
4. If I didn’t hit my head, then I didn’t have a concussion
5. My friend had a concussion, therefore, my recovery will the same