Canada's Paul Rosen makes a save against Japan during second period semi-final ice sledge hockey action at the 2010 Winter Paralympics in Vancouver, B.C., on Thursday March 18 2010. Photo Credit: (THE CANADIAN PRESS/Darryl Dyck)
Paul Rosen has had a headache for days, the after-effect of his latest concussion, at least the eighth he's sustained in decades of playing hockey and other sports.
He now knows the drill: shut everything down, body and brain. Rest -- and then rest some more.
Not that Rosen's having trouble giving into the urge to sleep. His fatigue has been so pronounced since getting beaned in the temple by a foul ball while umpiring a baseball game a week earlier, he's lucky to accomplish more than having a shower each day.
"For me, it's the fatigue factor that's making everything else so difficult," says Rosen, who's also been experiencing dizziness, confusion and a fuzzy memory, all trademark symptoms of concussion.
"I don't do anything that makes it worse for me. Anything that makes me concentrate too much tends to tire me out or give me this headache back again."
Rosen took his share of brain-rattling head thumpings as a big, fight-prone right-winger on amateur teams during his teens and 20s.
But after losing most of one leg in 1999 because of a rampant infection following knee-replacement surgery, Rosen turned to sledge hockey, becoming goalie for Canada's national team from 2000 until he retired a year ago at age 50.
He figures he suffered five concussions during his sledge hockey career, which included three Paralympics --the team took gold at the 2006 Games in Torino -- and five world championships.
"The first real bad one was in Salt Lake, where I took a sled to the head making a diving save," he recalls. "The game in sled hockey as a goalie, especially if you're an aggressive goalie like I was, you get hit a lot in the head, because an able-bodied goalie's stomach is where my head is."
Throughout his career, like a lot of athletes, he just sucked up the symptoms as much as could and went back on the ice.
It's only with the recent, growing attention on concussion -- think side-lined Sidney Crosby, the possible concussion-related suicides of three NHL enforcers this summer and reports of neuron wasting in the brains of deceased pro athletes -- that Rosen realized how dangerous these brain injuries can be.
Now he's following the prescribed protocols to let the brain rest -- and hopefully heal.
...It's critical that anybody who has suffered a significant blow to the head should see a doctor, whether a neurology specialist, a sports medicine physician, an emergency room doctor or a family doctor to determine whether a concussion has occurred, says University of Toronto neurosurgeon Dr. Karen Johnston.
"Our treatment, no matter what type of practitioner you are, really has to start with the same structured approach," says Johnston, who also heads the concussion management program at Athletic Edge Sports Medicine.
"It starts with identifying the injury, which is key. And then we have cognitive and physical rest."
For both children and adults, that usually means unplugging from anything that stimulates the brain -- working on computers, texting or watching TV and movies.
"You want to shut down anybody whose brain is sort of working on overdrive," she says. "From the point of view of an adult, it may be their work situation. It can certainly be any other stressors, so it can be financial stressors. It can be personal things, relationships, all sorts of stress.
"You just want to put it all on the back burner while the brain is in recovery mode."
As symptoms start to subside, the concussed patient can begin resuming some activities, but gradually to avoid a set-back, says Johnston, adding that the effects from the brain-rattling can last longer in some people than others, especially if there's been multiple concussions.
"Honestly, all concussions I think in a sense are the same injury, so we treat a professional athlete in the same way that we treat a child.
"The brain sees the injury in the same way, so there shouldn't be a different way to handle each one, although we have to acknowledge that each one is individually managed because it may reveal itself in slightly different ways."
Besides the cognitive effects from a skull-jarring, there can be physical repercussions such as head, neck and back pain. That may call for one or more therapists, each using a different technique to try to alleviate muscle tension...
One of those therapies is osteopathy, a system of hands-on manipulation of the bones and tissues aimed at restoring the body to health...
"A lot of doctors say, "I don't really know what you do, but the athletes seem to get better,'"
Some people will see a cognitive-behavioural therapist or go to group therapy. There are even Internet sites for concussion-related depression that help a person cope, he says. Doctors may also prescribe antidepressants or other medications.
"The main thing is safety first," ...stressing the need for both physical and psychological healing, and avoiding repeat concussions that can lead to severe cognitive impairment, including progressive forms of dementia.
"All of these things can turn the clock one way and you can't turn it back. You end up in a situation where you may not retrieve your full cognitive function, you may not return back to the way you were."