Podcast: Concussion Q&A
Dr. Jason Weller discusses non-sports related concussions in adults.
Jason Weller, MD
Originally from Chicago, Dr. Jason Weller finished medical school at St. Louis University after attaining a Master’s degree in Neuroanatomy at the same institution. He completed his fellowship in Sports Neurology and is now a Sports Medicine physician at Boston Medical Center. Dr. Weller is board certified in neurology and his special interests include Concussion, Post-Concussion Syndrome, and Chronic Traumatic Encephalopathy.
Melanie Cole (Host): You may think concussions only happen to football players, but that’s not necessarily the case. Concussions can happen for all sorts of reasons including a crash or a fall or yes, even while playing sports. My guest today is Dr. Jason Weller. He’s a Sports Medicine physician in the department of Neurology at Boston Medical Center. Dr. Weller, what a pleasure to have you here and this is such a great topic. Tell us a little bit about the prevalence of concussions and the most common causes that you see.
Jason Weller, MD (Guest): Concussion is actually very prevalent across the United States. It’s estimated that there’s between one and a half and three million concussions that happen every year. And that’s just in the pediatric population. We don’t really have a good marker for concussion for adults and the vast majority of them go undiagnosed because people don’t feel like they should go to the emergency department or report these things to their doctors.
In my experience, the vast majority of concussions that I have seen have been from your everyday activities whether it was driving your car and you get rear-ended or you take a fall down the stairs or something as simple as hitting your head on a door or coming up too fast under a cabinet. These are all things that I’ve seen and all things that can cause concussion and mild traumatic brain injury.
Host: Dr. Weller, as we grow older, and I’m 55, are we more at risk? I mean are our skulls thinner or anything? Because we talk about children as you said all the time, and helmets and safety and recognition and awareness; but as adults, are we now more susceptible if we bump our heads to a concussion or not necessarily?
Dr. Weller: I wouldn’t say necessarily concussion per se. As we get older, our brains tend to reach their maximum volume around 20 years of age and then they stay relatively stable until we reach that age of 50 and then there’s a little bit of shrinkage or atrophy over the next 25 to 30 years or so. So, I would say that your risk of concussion doesn’t go up when you get older, but your risk of something more severe like a hemorrhage in the brain or subdural hematoma does definitely go up.
Host: So, as we talk about with kids, the buddy system and recognition of the symptoms; tell us what you want us to know about adults and the symptoms to recognize. If we are getting a pan out of the thing and the cabinet above us is open and we stand up and hit our head on that thing and that hurts like crazy, but our thoughts don’t always go to concussion. What do you want us to be aware of symptom wise and is this an emergent condition in adults? Is it something we toddle off to the emergency room or even call 9-1-1?
Dr. Weller: So, the first thing you are going to notice when you get an acute concussion is the proverbial seeing stars. And literally, it is just that. You smack your head; you head butt someone accidentally or you run into another car and everything goes black for a few seconds and you actually see that flashing lights. Afterwards you may notice you will feel either nothing, so most people or a lot of people feel relatively normal in the first hours or even a few days after the injury. Or some people will notice things like headaches which are more centered towards the front, neck pain and neck stiffness which is associated with the whiplash type of injury from the movement of the head or things like dizziness and eye strain which are all tied into the injury process.
And so, in thinking about going to the emergency room or calling 9-1-1; if you notice that these symptoms last more than a few seconds, if there are any what we call focal or localizing signs like weakness on one side or loss of vision or certainly change in your mental status; then that is definitely a time to call 9-1-1.
Host: Then what’s the standard of care for concussion treatment? Is there a treatment and do you do imaging to find out? Tell us a little bit about what happens if we do go to see a specialist?
Dr. Weller: The mainstay of therapy has been debated for a long, long time and really, rest is the first prescription. It’s been questioned as to how much rest is necessary, how much rest is too much and what we actually have found that there is definitely such a thing as too much rest. When a person is diagnosed with a concussion, usually in the first few days or first couple of weeks; we do prescribe them an amount of strict rest and that includes everything from no television, no screens. I know people love to look at their phones but those are actually symptomatic for a lot of people and especially no exercise and no activity at least for a few days until the symptoms start to recover.
And then, we recommend a good physical therapy regimen which includes all of these things like balance testing, vestibular therapy, oculomotor retraining to get your eyes back into focus as well as working on your neck range of motion to help decrease the symptoms and get the pain under control. There has been a blood test that’s recently been developed, and it really doesn’t necessarily look for concussion per se; it looks for markers of more severe traumatic brain injury and it looks for spillage of contents of the brain into the bloodstream and that would be an indicator to get more advanced imaging like a CAT scan or an MRI.
Most people don’t need those because the symptoms are mild enough and the exam is normal enough that we can feel relatively reassured that the brain is intact but if things tend to persist longer than a few weeks; then we start rethinking our diagnosis and then go onto the further imaging.
Host: I find it interesting you mentioned physical therapy and other types of therapy. So, how does this management of the injury; does this shorten recovery time or reduce the risk of long-term symptoms and complications? What would you like patients to know about the importance of following up, if their doctor recommends those types of after concussion therapies?
Dr. Weller: Absolutely. It has been shown and there is good evidence that shows that physical therapy and a good concussion-based regimen does shorten the recovery period by a good three to six weeks. Most concussions will recover within a period of one to six weeks but with the therapy that helps give you a graded increase in your activity regimen in a certified professional who is able to monitor your symptoms and sort of cut your off whenever you get too much or push you a little harder whenever you don’t do enough; that actually helps increase and shorten the recovery process that you get back to your normal life a lot faster.
Host: Dr. Weller, as we talk about this with kids all the time and the big question is return to play, return to school; but with adults, what about return to work? And if you are somebody who works at a desk in front of a computer or you work a very physical job; what do you want patients to know about when it’s okay to start staring at that screen again or driving or any of those things?
Dr. Weller: Well there is no consensus out there, but in my experience, what I have seen is you take the same approach as you would to returning an athlete to the field or returning a kid to school. It’s very much the same activity as it is going to school and trying to learn material or do your job the way that you have always known how to do it. It’s really about exposure. So, in my line of work, what we recommend is we have patients that start to feel better and they may still have some symptoms, but they at least feel better and we engage them into activities that’s more specific to their work environment or their learning environment.
Some of the physical therapy locations can help with these by giving them more exposure to screens and more exposure to reading but what we recommend is when you get back to work; you literally take it easy. We go in half-time, half days a week so that you have time to recover, so your symptoms will get better and then whenever you go on to the next day, you wont feel so bad and you actually will feel much better and more confident in you ability to get back to that level where you are used to working.
Host: What great advice. Wrap it up for us Dr. Weller, best advice about concussion in adults and for those weekend warriors even when they are riding a bike or running or playing weekend sports. What do you want us to know about hopefully preventing these in the first place?
Dr. Weller: So, your best bet, like you said, is prevention. So, if you are riding a bike, wear a helmet. If you are playing contact sports like backyard football or recreational hockey, remember to protect yourself. Remember you only get one brain and it’s better to not have the symptoms at all than to try to deal with the symptoms later on down the road.
Host: Perfectly said. Thank you so much Dr. Weller. Really, really great advice. And that wraps up this episode of Boston MedTalks with Boston Medical Center. Head on over to our website at www.bmc.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did; please share on your social media. Share with your friends and family because as adults, we don’t think about concussions. We think that’s only something that happens to our youth athletes. But that’s really not the case. So, share with your fiends and family so we can all learn from the experts at Boston Medical Center together and don’t miss all the other fascinating podcasts in the Boston Medical Center library. Until next time, I’m Melanie Cole.