I finally found some time to post.
It used to be thought that concussions were bruises to the brain. While you can still have a bruise to the brain, and which is what we look for with a CT, the cause of concussion is much more cellular. Decreased blood flow to the brain, plus a flow of calcium into the brain cells are the main causes of concussion symptoms. There are about 50 more changes as the injury plus the 2 things above create a cascade of problems we are still trying to completely piece thru. The worst symptoms to have at the time of injury are loss of consciousness, amnesia and vomiting and sometimes lead to the decision to go to hospital or get a CT. These, however, give us very little hints into how long the concussion will last. Most experts agree that dizziness at the time of injury is the most ominous sign that the athlete will be out for a while. How long? In grade school, 80% are out for a month; high school 60%; College 40%; pros 20%. These are gross generalizations, but gives you an idea as to how long the brain takes to lose its plasticity and become a mature brain. Without dizziness, chances are likely that he will recover in 5 days. (more on that later) Imagine if we had put him back in, he got hit again, got dizziness and was out for a month. Taking him out was, without a doubt, the best thing.
10 years ago there were 38+ protocols on return-to-play for concussion. Some were strict, and some not so strict. You could choose whichever one, based on your desire to get a kid back in -or not. Then a neurosurgeon in Toronto named Karen Johnston came up with a great protocol. A "concussion in sport group" was formed and have met about every 4 years in some exotic place in Europe. This included some important people who had their own protocols, so that the decision would be more universally accepted. Since then, everyone uses the same protocol. Day 1 - brain rest, do nothing, no TV, no studying, nothing. Day 2 - if no headaches from day1, begin light, non-sport specific activity, light film study. If at any time there is headaches, you drop back to the day in which you had no headaches. Day3 - if no headaches from day 2, begin light sport-specific activities, more film study. Day 4 - If no headaches from day 3, resume practice with no contact or very light contact. Day 5 - if no headaches from day4, resume full activity. If no headaches, be evaluated by a physician and hopefully cleared. The impact studies, or computer testing, is the real bug-a-boo here. Part of being released is getting back close to where you were when they pretested you before the season. Great! But, 20-25% of the time you can be back to where you were and the test will suggest you are not. Why? Because great outcome studies have not been done on these tests. I love them and use them, but they are not the end all be all, and are usually much worse than a great physical exam. In both cases, you are trying to take physical symptoms and see if they can predict cellular changes/improvement. I have seen kids held out for a long time based not on symptoms, but because of a computer test.
In any case, Klein is going to have reduced practice, and more importantly, reduced film study. Forget Sunday and Monday, he begins to climb back Tuesday (hopefully). Not too bad if you really think about it.
Hope this helps.
