Concussions -
What Should Coaches Do?

By Terri Milner Tarquini

August 1, 2017
   In The Loop Extended Articles

When in doubt, sit it out.

That’s the medical mantra for dealing with an athlete who possibly is suffering from a concussion.

“We don’t have all of the information about what turns a mild traumatic brain injury into something more serious, but it has caused us to step back and be more cautious,” said Dr. Ellen Geminiani, primary sport doctor at Boston Children’s Hospital and chair of the sports science and medicine committee for U.S. Figure Skating.

Common symptoms of concussion that a coach should be looking for include: headache, haziness, heightened emotions, loss of consciousness, forgetfulness, neurological difficulties, balance impairment, behavioral changes, slowed reaction times, and sleep disturbances.

A coach should first get their skater to a medical professional if a concussion is suspected and then respect the graduated return to sport that is normally suggested.

“Of course the coaches want them back skating as soon as possible, but it’s a serious injury that can have serious symptoms and serious consequences,” Geminiani said. “It simply is not worth the risk. It takes to time to heal and to make sure the brain is functioning properly again. Until that is happening, the risk of another injury is just too high.”

The old concussion modus operandi, which generations of skaters who are now coaches operated under, was to keep a child awake with a concussion. No more.

“It’s a patho-physiological injury, which means cellular brain function is disrupted,” Geminiani said. “Even in the last 10 years, the idea has evolved. It takes tremendous energy to get back on track. Sleep helps the brain to repair and reset.”

The real difference lies in the graded return to physical activity.

“They need to rest so they can recover,” said Dr. Meeryo Choe, associate director of the UCLA Steve Tisch BrainSPORT Program and an assistant clinical professor of Pediatric Neurology at UCLA Mattel Children’s Hospital. “That’s not to say that they should be cocooned in a darkened room, but the first couple of days there should be symptom-limited physical activity, just relaxing and resting and taking it easy.”

The BrainSPORT program, which stands for sports safety, performance, outreach, research and treatment (SPORT), is a clinical practice for treating athletes with concussions, as well as a research center, specifically studying the effects of concussion in athletes.

“If there are only minimal symptoms present, I would then suggest some light off-ice aerobic activity that does not require significant balance or other sport-specific skills,” Choe said. “Assuming that seems to be on track, then the skater could get back on the ice and maybe do some basic skills, focusing on the athlete’s ability to balance and react. The athlete should be re-evaluated if there are any symptoms, but it would also be a good idea to have the athlete re-evaluated before returning to hardcore training.”

First step: Being aware and removing a skater a coach has any doubt about.

Second step: Advising the parents to get the skater to a medical professional.

Third step: Knowing the recommendations for a skater to return to training and continuing to be the lookout for any symptoms that could affect the skater’s training and wellness.

“It’s imperative for coaches to be extra cautious,” Geminiani said. “Even is the athlete is saying they’re ok, if there’s a little voice in the coach’s head that says something is off, then they should err on the side of caution. An athlete might not even develop symptoms right away, but if there’s even a hint of suspicion, the coach should remove them from the ice and get them medical attention to determine a treatment path. A coach should always be aware of what’s going on with their skater.”