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Concussions in High School Sports: Expert Says They're Serious but Recoverable

Tim Rylander discusses his concussion management program at Accelerated Physical Therapy, including the recovery process, how to prevent them and when to call it quits.

By Michael Sewall

When Tim Rylander played football, first at Bloom Trail in Chicago Heights and then at Eureka College, concussions were a bit of a joke.

"When I was growing up, concussions were totally blown off," said Rylander, who now runs the concussion management program for the entire Accelerated Physical Therapy network. "I remember coaching staff and players laughing when players walked to the opposite sideline or they were in a complete daze. We just shrugged it off. Over time we recognized these were very serious injuries."

Now the culture is changing. As high school sports return, there's perhaps no issue at the forefront of our minds more than player safety, particularly in regard to concussions. 

Former NFL great Kurt Warner has shown reservations about his kids playing football, and even President Barack Obama said that if he had a son he would have concerns about him participating in the sport. 

Rylander said that while concussions must be taken seriously, it's important to understand that "they are very recoverable injuries." Accelerated Physical Therapy's concussion management program takes a customized approach to helping athletes return to play. 

In 2011, Illinois enacted legislation requiring student athletes be medically cleared before returning to practice or games after they've left with concussion-like symptoms. 

So more people than ever are coming into Accelerated Physical Therapy for concussion treatment and rehabilitation, and this year at least 1 million youths are expected to sustain concussions, according to an Accelerated news release. Meanwhile, another study showed that one-third of concussed athletes are released to play before they're ready

Accelerated's program focuses on two types of concussed athletes: Those who are asymptomatic and seeking a return-to-play protocol under the guidance of a physician and those that still have symptoms after three weeks and are seeking more advanced therapy. The program includes musculoskeletal, sensory and oculomotor evaluations to test the symptoms in an athlete as well as a variety of therapies to help them recover. Learn more about Accelerated's concussion management program

But it goes beyond that; Rylander said education is important so that athletes, parents, coaches and trainers all understand the symptoms of concussions, how to recover from them properly and how, if at all possible, to prevent them. 

Patch: Concussions in sports are being talked about more than ever. Have you seen more people coming in for treatment?  

Rylander: More people coming with concussions in general. and the reason for that is more awareness and more recognition. But those are just the ones reported. There’s a false badge of honor a lot of athletes want to wear that does nothing but perpetuate their symptoms. It’s OK to admit to these symptoms. The sooner someone is treated the sooner they can play again.

Patch: How does the program at Accelerated help athletes recover quickly and responsibly? 

Rylander: We use what we've seen from the international medical community getting together and saying this is the best way to do it. We don't just test physical exertion, but also cognitive. That’s where a lot of programs fall short. 

We suggest athletes get a baseline neurocognitive test for concussions every two years. It gives us something to go off for when they have an injury, we can know what their baseline is. It’s the same test a lot of the pros use, it’s the test used at a lot of universities.

If someone has been concussed, typically what happens is they’re evaluated by a sports medical professional on the sideline. We suggest rest immediately, physical and cognitive rest. It doesn’t mean stick them in a dark closet, just let them rest. Reduce stimuli, TV time, computer time. If you have an injury to the brain, it’s hard to put our brain in a sling. the easiest way to do that is help shut them down.

We follow up with them 25 to 48 hours after injury. We monitor them until their symptoms resolve. If they pass everything there in a controlled manner, then sent back to a medical physician for clearance.

Patch: Why do some people still fear admitting they have concussions and going through the treatment? 

Rylander: They feel they’re going to be taken out of competition and never return. The reality of it is, as much publicity and press concussions get, for the most part research shows that 80 percent of individuals will be better in three weeks. And 90 percent of individuals better in four weeks. 

Patch: Is there a cutoff point, though, where someone has had enough concussions that they wouldn't return? 

Rylander: There’s nothing that solidly puts a stamp on when to cut someone off. Some doctors have said three concussions in one year. But no two concussions are alike. 

My personal suggestion is if someone’s doing a high-risk activity and they’ve consistently received a concussion -- multiple seasons in a row -- is this really your calling? If every single year you’re dealing with some kind of trauma to your brain, maybe it’s time to evaluate and see if there’s another sport for you.

Patch: When you're out educating people, what are some common misconceptions you hear about concussions? 

Rylander: One thing I'm asked about a lot is equipment. There’s no such thing as a concussion-proof helmet. The main design of the football helmet was the prevent skull and jaw fractures. The head gets knocked around, the brain shakes around in the skull. It’s really hard to have an external structure that cushions or supports the brain. And the cost becomes astronomical for products that haven't been proven to work. If anything, the athletes gain a false sense of security.

Patch: The NFL has changed some rules to try cutting down on hits to the head, but those hits still happen. Is there a way to prevent concussions, or is it all about the treatment and rehab after the injury? 

Rylander: If you’re in a high-risk sport, you’re already at risk for having a concussion. But technique can go a long way. It starts at the fundamental level, when you’re in Pop Warner or the community park district league. At this level and beyond, you need to be teaching sportsmanship, fundamentals and safety before pushing wins and losses.

Another big component for prevention is not specializing in a sport and playing whatever the season is. If they’re a soccer player, they play soccer all year round. They do the same movement patterns and have the same muscle memory and can lose focus after a while. Being a multi-sport athlete can go a long way in properly strengthening the body and keeping the mind focused. 

Patch: Where are we at in regard to understanding the impact of concussions and taking them seriously? 

Rylander: We’re starting to find that center point. Years ago, it was laughed off. But lately I’ve seen a lot of paranoia and extreme concern about concussions. So we're at the middle point we know that while they’re very serious, these are very recoverable injuries. We have strategies and tools available to get people back into competition in a very safe, responsible manner. 

For more information about Accelerated’s concussion management program, go to acceleratedrehab.com or call 877-97-REHAB.

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