In fact, it is imperative to see a Sports Medicine Physician as soon as possible after the injury for optimum results. That is the reason why Dr. Geraci, a Board Certified Sports Medicine Specialist, has always made it a point to see patients with athletic injuries within the first 24-48 hours.
Obtaining an accurate diagnosis and determining the proper treatment are essential to getting you quickly and safely back to your sport and keep you playing. Another important step to recovery is finding any other contributing factors that may have led to the injury. Among the more common causes can be over training, under training or no training at all. During your first visit, Dr. Geraci will take the time to review with you not only your training routine, but equally as important, he will consult with you on a plan for future injury prevention.
Some of the ways to diagnose and treat your sports related injury and accomplish these goals include but are not limited to:
Over the past several years there has been a dramatic increase in awareness of concussions, both nationally and internationally. Whether we are talking about little leagues, high school, college or at the professional level, everyone involved (parents, coaches, athletic trainers, physical therapists and physicians) is well aware of the risks of concussions and more importantly the danger of prematurely returning an athlete to play again.
In New York State, at the high school level, we have instituted laws to protect athletes with concussions from returning to play too soon. An athlete with a concussion, once asymptomatic, will have to complete a 6 day return-to-play protocol, guided, in all likelihood, by the athletic trainer.
The long term risks and consequences of repeated head injuries and the guidelines established by the state of New York, have caused the district to re-address our return-to-play protocol following concussions. Where previously, we would accept the private physician’s medical clearance for an immediate return to practice and competition, the physician’s clearance is now one part of several measures we use for a student’s readiness to return. These protocols were developed in conjunction with our school athletic trainer, physician assistant, district physician and the NYSPHSAA (New York State Public High School Athletic Association’s) return to play protocol and are based upon the newest international recommendations for management of head injuries and have been approved by the district administration and adopted as best practice by the New York State Public High School Athletic Association and locally by Section V Athletics.
We have initiated the ImPACT Testing (Immediate Post-Concussion Assessment and Cognitive Testing) for an athlete which establishes a baseline to aid in managing suspected head injuries. If an athlete receives a head injury, they will be required to take a post-injury test. Both the baseline test and the post-injury test data can be given to either a family doctor or the district physician to help evaluate the injury.
If a student receives any type of head injury during an athletic practice or contest, they will not be allowed to resume the activity that day. Accordingly, when a student sustains a head injury diagnosed as a concussion, they must be medically cleared by a private physician and remain completely symptom-free for at least 24 hours before a return-to-play is allowed. Even then, there is a mandatory six day graduated return-to-play schedule that must be followed. If symptoms return at any point during this re-training period, the process is suspended, and the student must be symptom-free again for 24 hours, at which time, the graduated re-entry plan starts over.
This protocol applies to the first mild concussions that an athlete experiences. More serious concussions, for example, if there is any loss of consciousness, and subsequent concussions, carry more risk and require a longer process. In these cases, the protocol will be individualized and determined by the athletic trainer, private physician and school physician working together. All final decisions about clearance for participation in school athletics will be determined by the school physician.
No day may be skipped to speed up the process of full return-to-play. Due to the extreme risk factor, no exceptions will be made to this re-entry process for any reason. Medical literature has demonstrated a repeat of even a minor blow to the head of a previously injured child who is not fully recovered can lead to permanent brain damage and even death. Because there is no way to know whether a headache, nausea, confusion, memory issues, and similar symptoms that persist are related to either post-concussion symptoms or to an intercurrent illness, such as sinusitis, the “flu”, or other conditions, we have made the deliberate decision to err on the side of caution. Our ultimate goal is the health and well being of the student-athlete.
It is important to understand that we have developed this protocol in order to ensure the health and safety of the student-athlete. As a sports medicine physician, I feel it is crucial to educate the student-athlete in the importance of following a graduated re-entry to play after experiencing a head injury.
In addition, I recommend the following during recovery from a concussion:
Sports Medicine, like Spine Medicine, has a vocabulary that is unique, and few health care workers outside of the field speak this language fluently. Below are sports medicine terms that often are confused by clinicians and patients alike.
Functional term referring to joint laxity that is not controlled by stabilizing muscles—may be unidirectional or multidirectional and is symptomatic.
Maximum stress that a structure can sustain before failure.
Tendon sheath inflammation.
Tendon degeneration (usually focal).
Diseased tendon.
Inflammation of a tendon.
Partial dislocation of a joint.
Injury to a muscle or tendon owing to excessive stress. Strain classification is as follows:
Injury to a ligament owing to excessive stress. Sprain classification is as follows:
Degree of looseness, usually referring to a ligament. Occurs in persons with generalized ligamentous laxity (so-called “double jointed”).
Joint inflammation.
Complete loss of apposition of articulating bones that normally comprise a joint.
Chondral (cartilage) degeneration.
Softening or damage to the articular cartilage of the patella—diagnosis made under direct visualization at the time of surgery. This term is often used to describe similar lesions in other bones.
Inflammation of a bursa.
Microfractures seen on MRI.
Injury to tendinous insertion site where a small piece of bone is fractured in continuity with the tendon, rather than rupture at the tendon-bone interface.
Muscle wasting, loss of muscle mass.
Joint degeneration.
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