Due to the extensive media coverage of Sidney Crosby’s four diagnosed concussions while playing in the NHL and the devastating brain injuries sustained by NFL players, awareness of the seriousness of concussions has skyrocketed.
But in the early 2000s, the attitude toward concussions was more laissez-faire. At the time, Stewart Munroe, a certified athletic therapist and owner of Ken-Val Rehab and Sports Injury Centre in Rothesay, New Brunswick, was working with an AHL team who were in the Calder Cup finals. During a game, after assessing a player who had received numerous hits in the first period, Munroe alerted the team doctor, who ended up pulling the athlete.
The player wasn’t pleased. “He was about 6 foot 3, and 240 pounds,” recalls Munroe. “He called me every name in the book and said he would deal with me later.”
Since that incident, Munroe has gone on to treat numerous concussions. In addition to Ken-Val, where he treats a variety of orthopedic injuries and post-surgical repairs, Munroe also works with Dr. Jennifer Fletcher at the Saint John Concussion Clinic.
Aside from sports concussions, Monroe has treated people who have sustained concussions from assaults, slips and falls, car accidents and work-related incidents.
A concussion is a form of mild traumatic brain injury caused by either a direct blow to the head or an indirect mechanism, such as whiplash, which can still cause the brain to shake violently inside the skull.
While the signs and symptoms are usually temporary, lasting between 1-2 weeks in adults, in some patients these symptoms may persist months after the injury, resulting in a condition called post-concussion syndrome (PCS).
Generally, in sports, Munroe says one of his roles is to determine if an athlete is “hurt” or “injured.” For most parts of the body, an athlete who is “hurt” can continue to play without risking further damage. By contrast, an athlete with an “injury,” means additional play can have dire consequences.
While the signs and symptoms of a concussion can resolve rapidly, sometimes even within 24 hours, the long-term effects of concussion are still not well understood. It is important to remember that a concussion is still a brain injury, even if mild, and so it is imperative that we take the proper steps in making sure it is safe to return to sport. Says Munroe, “Why would we risk damaging the most important structure of the body, the brain?”
After conducting a thorough assessment, if an athletic therapist suspects a concussion, the patient is removed from contact sports and vigorous physical activities and is referred to a medical physician for further evaluation and diagnosis.
Overall, Munroe would like to stress the urgency of seeking immediate help. “Getting athletes in right away to assess their injury and provide the most up-to-date, medically supported information is crucial for them to heal properly. And to prevent further injury from continuing to play with symptoms.”
Current research indicates that after a few days of physical and mental rest, the patient should slowly start sub-threshold activities (Sub-threshold activities are defined as activities of daily life which do not increase symptoms). An athletic therapist can help a patient determine what is safe sub-threshold exercise. Athletic therapists also help guide concussed athletes through a well-established protocol to help determine if it’s safe to return to sport. And they also advise teachers on return-to-learn strategies for students with lingering symptoms
If symptoms do persist beyond the typical recovery period, an athletic therapist can help to determine rehabilitation strategies that are based on the specific types of signs and symptoms a patient is experiencing. This could include soft tissue work and neck strengthening for cervicogenic factors such as neck pain and headaches, therapeutic strategies for oculomotor and balance issues, and referring patients for further evaluation for cognitive and emotional components. Symptoms can be present due to a number of different overlapping factors; therefore, it is essential to seek medical care immediately following injury in order to ensure safe and effective rehabilitation from injury for a safe return to activity and sport.
As for the hockey player pulled from those playoffs long-ago. He recovered in time to return to the lineup for the end of the season and was instrumental in helping his team win the Calder Cup. After that season, the player asked to speak with Munroe.
“I thought this is it, he’s going to kill me. But he put his arm over my shoulder and thanked me. He said that my job as a team therapist was to look out for the safety of players, no matter the circumstance. I’ve never forgotten this story.”
A graduate from Acadia University in 1995 Sheridan College, Stewart has been working in private practice for the past 18 years. He and his wife own Ken Val Rehab and Sports Injury Centre in Rothesay NB. He is also the Rehab Consultant for Saint John SeaDogs of the QMJHL