Prolonged symptoms after concussion are called post-concussion syndrome (PCS). PCS is a controversial disorder because it has a wide differential diagnosis. The success of treatment for patients
depends mostly on his/her doctor’s ability to differentiate among the varying symptoms and conditions associated with PCS.
While many patients will recover from their concussion, just as many will not. To make matters worse, as an athlete sustains repeat concussions, the chance of recovery becomes less likely.
The controversy over PCS is that most patients who suffer from post-concussion syndrome will have normal blood work, normal MRI examinations, and normal vital signs.1 Therefore they are “normal.”
Since many doctors cannot treat “normal” and they cannot “see” an apparent cause of their symptoms by these traditional tests, a conventional treatment for post-concussion syndrome does not exist.
If you have PCS, you will be told by some doctors to rest and possibly undergo physical and occupational therapy until symptoms resolve. Some patients have reported to us that waiting for the symptoms to go away is the hardest part because of the chronic pain, depression, memory loss, and headaches.
Post-concussion syndrome treatments
The order to rest among youth athletes has recently come into question. One study said recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care.2
Research on hyperbaric oxygen treatment for persistent postconcussion symptoms has found favorable results while equally sparking debate.3
USA TODAY ARTICLE JANUARY 16, 2009
Gagne returns to pre-concussion form
PHILADELPHIA — Simon Gagne hated the mornings he would wake up with that familiar pounding headache.
He couldn’t even blame a night of revelry.
The throbbing would surface, and no pain reliever would cure it. His neck ached, and there were days when he felt woozy or had blurred vision.
All Gagne wanted was to grab a stick and play hockey again for the Philadelphia Flyers. But even when he did skate, well, good luck keeping track of the whizzing puck.
Missing the playoffs, losing in the playoffs, none of it pained Gagne like the agony of living with a concussion.
“Last year,” Gagne said, “was a tough situation. Tough. I wouldn’t wish it on anyone.”
The head injuries limited Gagne to 25 games and he missed Philadelphia’s run to the Eastern Conference final. Gagne had nagging fears about his future, about what another traumatic hit to the head might mean for his career. He wondered if he could resume the high-scoring pace that made him an All-Star and an Olympian.
Those doubts all seem behind Gagne, for now at least. While Gagne has cooled a bit from one of the fastest starts of his career, the quick forward has 18 goals and 42 points in 41 games this season. And the Flyers are in the thick of a tight race in the Atlantic Division, one point behind the New York Rangers headed into Friday night’s game at the Florida Panthers.
For Gagne, the miserable side effects and cobwebs in his nerves have vanished.
“The way I feel now is back to where it used to be,” Gagne said.
Gagne, who turns 29 next month, considers himself lucky. He might not even be playing this season had he not caught a local TV report about a doctor who eschews traditional anti-inflammatory medications, cortisone injections, and surgery in favor of an approach that stimulates natural healing processes to strengthen joints, tendons and ligaments.
Gagne hoped the treatment would cure his chronic neck pain and headaches and, after checking with the Flyers trainer, met with Dr. Scott Greenberg last April. Greenberg, a Cherry Hill, N.J., physician, didn’t like what he saw.
“The damage that Gagne had was very significant,” he said.
The nerves running from Gagne’s neck and head, neck and shoulder blades and other joints, ligaments and tendons were all damaged. That was the cause of the dizzy spells, the loss of balance and blurred vision. Greenberg’s approach is to repair the joints and nerves with pinpoint injections into selected areas of the spine and the symptoms clear.
The treatment is called Prolotherapy. The shots, a concoction that sparks the body’s immune system, regenerate the damaged tissue and strengthen joints. Greenberg said Gagne’s neck is now as strong as it was before he was hurt. The player needed 20 to 30 injections in his neck his first few visits, but he hasn’t visited Greenberg since November. Gagne might go again around the All-Star break for a checkup.
His neck and spine stable, Gagne proclaimed himself “good to go” the rest of the season.
All he has to do is look at recent Flyers history to know his day-to-day life could be much worse. Former Flyers captains Eric Lindros and Keith Primeau both had their promising careers curtailed because of concussions and still suffer from post-concussion trauma.
Gagne has had two minor setbacks this season – a bout with the flu and dehydration in December, and he was the victim of a blindside hit against Vancouver that caused a shoulder injury and kept him out of two games.
A scary moment came in November when Montreal’s Alexei Kovalev plowed his shoulder into Gagne’s head. Gagne was able to shake off the hit, but any shot near his neck or head is an immediate cause for concern.
Gagne believed Kovalev deliberately targeted his head and shared his view with NHL disciplinarian Colin Campbell.
If Gagne had his way, shoulder-to-head hits would be banned from the game.
“If you get hit shoulder-to-head, you’re going to have a concussion no matter what,” Gagne said. “You see it too much. Almost every night you look at highlights on TV and you see someone get knocked out.”
He also talked with Glenn Healy, the player affairs director for the NHL players’ association, about what could be done to better protect the players. Hockey will never become a non-violent sport, but Gagne and others feel it could be a safer one.
Healy said the NHLPA is working on adding soft caps, which are already on elbow pads, to shoulder pads to reduce the impact of hits. Last season, of the 65 diagnosed concussions, Healy said 39 were from a shoulder-to-head blow.
On the NHLPA’s fall tour of all the teams, videos were shown of players deciding not to finish their body checks in a situation where an opposing player was vulnerable or the outcome had already been decided. Healy also does not want to see players launching themselves at someone’s head.
“That’s going to take a lot longer to change that cultural view of how we play the game,” Healy said.
The NHLPA hopes to sit down with the league this summer and discuss possible solutions or punishments.
Gagne was diagnosed with three concussions (two in juniors, one early in his career with the Flyers) before last season. He suffered a fourth concussion after his jaw crashed into the shoulder of Panthers defenceman Jay Bouwmeester early last season. Gagne returned after only four games, then was hurt again and missed the next 26 games. He was reinjured in February and didn’t play again.
Gagne eventually learned that he didn’t suffer three more concussions, but that the first one in October never healed and was aggravated with each additional blow.
Gagne says he might have returned too quickly from the initial hit and wonders whether last season would have been different had he been more patient.
“Until you go through a tough time like that, you know nothing about concussions,” Gagne said. “Now I know the brain takes a lot of time to heal.”
But this pre-season, Flyers coach John Stevens was so encouraged by Gagne’s play that he had no reservations about playing him his regular minutes.
“We didn’t expect him to get back to where he was so quickly,” Stevens said.
Gagne totalled 31 points in his first 22 games and was on pace to at least match his career high of 47 goals set in 2005-06. Gagne’s numbers have tailed off lately and the winger has gone eight straight games without a goal entering Friday’s game.
Some of the scoreless slump can be blamed on the shoulder injury. Another factor is just simple fatigue. Gagne, the Flyers’ first-round pick in the 1998 draft, is still working his way back to his physical peak after a seven-month layoff.
“People forgot, I didn’t play for a while last year,” he said. “For me to play at that level again, it takes time to get back.”
When he’s playing, Gagne can’t think about absorbing a hard hit, he just has to attack the net and play as hard as he did in an Olympic or playoff game.
He does admit to a different approach this season. Gagne comes to the rink to have fun, be able to play all his shifts and feel good when the game is over. He’s not concerned with goals, points and other personal achievements. So far, that style has worked out fine.
“It’s just fun being back to normal and being able to play the game that I love to play,” Gagne said.
Dr. Greenberg is located at the Magaziner Center Prolotherapy New Jersey
1. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012 Mar;4(2):147-54.
2. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015 Feb;135(2):213-23. doi: 10.1542/peds.2014-0966. Epub 2015 Jan 5.
3. Sigal T et al. Hyperbaric oxygen may induce angiogenesis in patients suffering from prolonged post-concussion syndrome due to traumatic brain injury. Restor Neurol Neurosci. 2015 Oct 7. [Epub ahead of print]