The steady increase of media attention to concussions has largely been a good thing – with increased awareness comes increased scrutiny and education. The downside, though, is that it also seems to bring with it a lot of inaccurate information that is frequently sensationalized to grab headlines. Sometimes it’s intentional, sometimes it’s not.
Along with the media hype, we also see an increase in personal testimonials, also with their pros and cons. Folks love a good story – especially a comeback story! – and it’s also very helpful for individuals who are struggling to realize that they’re not alone, and that there’s hope.
What’s most frustrating to me about these testimonials, though, is when they seem to inadvertently convey mistruths about injury and recovery. A recent release by the CDC – typically a source of balanced, trusted information – seemed to do this and left me feeling particularly compelled to respond because their concussion-related information is characteristically well-researched and accurate.
The most troubling thing to me about this article was how it described this athlete’s months-long recovery; the absence of any critical or editorial comments about that aspect of this athlete’s injury seemed to convey that this is typical, when it absolutely should not be. While we know that everyone recovers at their own rate, and that risk-factors such as one’s history of previous concussions, psychiatric issues, and medical factors can prolong recovery, it’s widely accepted that 80-85% of young adults will recover fully in 2-3 weeks, with 90% achieving complete recovery within a month, if properly managed.
Note the emphasis on proper management – this, too, will vary from person to person – there is no one-size-fits-all handout or formula that truly works – but will generally include such factors as:
- Adequate sleep (8½ – 9½ hours for most adolescents, which most don’t get), hydration (64 oz water/day, min) and nutrition
- Appropriate lifestyle adjustments – remaining engaged in school and social activities, but with sufficient adjustments and supports to remain sub-symptom threshold, with gradual withdrawal over recovery
- Headache management – by a good neurologist with particular expertise in concussion-related headaches; I refer if headaches are persisting past a week despite appropriate behavior changes, with consideration of cervicogenic causes, too
- Vestibular screening / therapy – if dizziness is persisting past 2 weeks, I will refer to trained PT’s with expertise in vestibular evaluation, orthopedics and strength/sports conditioning
- Consultation with cognitive-behavioral psychologist if stress and wound-too-tightness are interfering with treatment compliance
So, when I hear stories of recovery extending over many months, I not only wonder where things went wrong, I am also concerned that this will only serve to perpetuate the “suck-it-up-and-don’t-tell” culture out of fear that one’s likely to miss the season if symptoms are reported.
I much prefer the CDC’s mantra – “Better to miss one game than the whole season” – but we need to make sure the stories that are circulated behind it are consistent, and that they represent the current best standards of care. Or, if not, that there are at least some qualifiers for the lay public and related healthcare providers who would not know differently and otherwise presume that this is just the new normal.