Guest blogger and retired skater Speedin’ Hawking discusses her history of concussions and provides resources on diagnoses, rehabilitation, and how to ease yourself back into play.
My 5-year derby-versary was approaching in only a few months. I was extremely excited to re-join our B travel team after a spot opened up, and brought that enthusiasm to my first practice back that night. Towards the end of practice we scrimmaged our A-team, as we often would. At one point when I was blocking, I got caught in a pick and took a clean hit in the chest. It caught me off guard and took me off my feet. My head flung backwards, and as I was falling, I am told that the back of my head made contact with another skater in motion who was behind me, thrusting it forward. My immediate reaction was a panic attack. I started hyperventilating and crying and was ultimately confused and really distraught. I quietly moved off the track to gain control of what I thought was just a weird emotional outburst, withdrew myself from the group and hid behind a pillar so as not to bring attention to my embarrassing reaction. I sat out for the few remaining minutes of the practice while our first responders and my loving derby wife checked me out and tried to put me at ease.
I didn’t lose consciousness or forget my name, but I didn’t know exactly what had happened or how. I was really confused, and that is unusual for me as a fairly aware skater. I felt like I got my bell rung and immediately felt ‘out of it’. I drove myself home alone, which was a challenge in itself, as the road looked like that drunk driving commercial from the 80s. Bad idea.
If this was a concussion, it would have been my fourth in a year and a half. Given that I am a shorter skater at 5’2″, it’s not a surprise that half of these were due to being hit in the chin or jaw and made worse with the whiplash that came with it. The other half are because I am a bit of a spaz in my day-to-day life. I wish I could tell you it’s from being bad-ass.
Needless to say I took some time to stay off skates, and since have had to pack it in for roller derby. As sad as this is, I have found that since I have become a vet at this concussion thing lately, and more and more leaguemates of mine have been asking about it: What does it feel like? What can you do about it? Who do you go see? Should I get a hockey helmet? Face shield? You too??!! And so on. Or sharing quietly that they think they have one and ask what they should do.
I am not sure if you have noticed in your leagues, but I have never seen so many people off skates at the same time due to this injury. We have become fitter, better, more agile, faster and more aggressive skaters. We are weapons on wheels. We are making fancier moves on our skates. Our style of play has evolved to be more scrum-like. Our rules have recently changed to allow some clockwise movement. I am not sure if all these things are linked, but they can’t be ignored either. If this is the way things are going, then let’s look after our brains cause we only get one (at least for now: c’mon science, where are you on this one?).
I also sucked up precious screen time searching the Internet for answers as to how I was feeling, what’s normal, and what I should do as a coping mechanism to counter the fear and anxiety I was experiencing. Now that I am mostly symptom-free 5 months later (hurray!) I thought I would compile some resources as well as share my learning from a derby perspective. This way, they are on-hand for others with symptoms who might be new to this or for teammates, captains and coaches to refer to in case of future injuries. Thanks to others who have gone through this too who shared their tips and resources with me.
I am not a doctor, or a professional healthcare provider, just a gal who has been searching for more and more answers on the Internet every time she bonks her face in roller derby.
If you think you or your buddy might have suffered a concussion, please visit a physician (sports or specialist if you can rather than a walk-in clinic or even your family doctor. Get checked out as soon as you can. Even if you think it’s no big deal and you feel mostly fine. Even if you only feel “just a bit off”. It’s very easy to talk yourself out of your injury, especially if you have a game coming up, or are super busy in life, so you really need others close to you to call you on your bullshit.
Following is a summary of things you might be wondering about concussions along with some handy references.
WHAT IS A CONCUSSION?
Your skull is your body’s built-in helmet. Your brain sits in your skull suspended in fluid. When you get rocked by a hit, your brain bounces around inside your skull, which can result in “bruising.” This could be because you fell and hit your head, but can also occur by being jostled or shaken.
Watch this! Science!
“What Happens to the Brain During a Concussion” from Scientific American
WHIPLASH AND CONCUSSION-LIKE SYMPTOMS
Found to be highly related to concussions, whiplash can produce similar symptoms. Sometimes the tension or alignment in the neck that results can cause a pinching in your spine, which can have the same weird neurological effects as a concussion.
“Whiplash: 5 Things You Should Know” from spineuniverse.com
POSSIBLE CAUSES OF CONCUSSION
I am sure you are creative and can find more ways but here are some common ones:
– impact to the head from a hit or a fall
– impact to the face or jaw causing the head and neck to jostle and may include whiplash
– impact to the body causing the head and neck to jostle and may include whiplash
Read the Mayo Clinic’s list of basic causes here.
DIAGNOSIS AND TESTING
Ensure that your first-responders or coaches and managers in your league have been trained to screen and assess if a concussion may have occurred or can help with triaging the injury. Review WFTDA Safety Protocol Section 6 carefully as well as Appendix C-D for concussion info.
The SCAT (Sport Concussion Assessment Tool) is quite commonly used. The current version is SCAT3: Sport Concussion Assessment Tool
Here’s an offline sheet that you can keep a few copies of near the track or in your bags: Sport Concussion Assessment Tool PDF
The CDC also offers this palm card that walks through the assessment: Palm card assessment
And, of course there’s an app for that! Here’s a great breakdown of the popular concussion apps.
You might end up getting a CT Scan or in bad cases an MRI to be sure there’s no head trauma or blood clotting, but because it’s really hard to “see” bruising on your brain, there is really no conclusive way at this time to see how bad your concussion is. You break a bone, you get an x-ray and can see it. We don’t have that kind of thing yet for concussions.
So the best you can do is monitor your symptoms which is why it’s super important to see a doctor and talk this out with them. Bonus points if they have a specialty or are a sports physician who deals with this a lot.
There are tests that rely on testing your neurological responses, cognition and balance, but their accuracy is debated and there aren’t any broadly accepted tools at this time for diagnosis. A couple of them are:
As for finding a physician, many in our league here in Toronto have visited the David L. MacIntosh Sport Medicine Clinic at the University of Toronto for help
Also check out:
- UHN Krembil Neuroscience Centre, Toronto Western Hospital
- Sport Concussion Centre at York University
- Canadian Sports Concussion Project
The clinic you visit already for physio for your myriad of other derby injuries might also have someone there with a specialty in treating sports concussions.
SIGNS AND SYMPTOMS
Here is a list of common symptoms. This is your best way to track your progress, so really try to monitor how you feel. Write it down every day even. You might start seeing patterns emerge after certain stimulus. For example, during a regular work day post-concussion, it was normal for me to get a pressure headache between 3 and 4 pm due to computer usage and thinking so darn hard. I knew I was getting better when that would start to go away.
Think of it as a “buffet” of options, or a “portfolio”. You might not feel all of them at any given time, but even feeling one of them counts. Don’t tell yourself that you don’t have a concussion if you feel a bunch of these but then don’t feel nauseous, for example. A good sign is thinking that something is out of the ordinary for you. Also, you aren’t better until your symptoms go away completely.
If you decide to take anything to treat these symptoms (like ibuprofen or anti-nauseants), just be aware that you could be masking your symptoms which is your only reliable way to measure progress in your rehab.
- Pressure in head
- Neck Pain
- Nausea or Vomiting
- Blurred vision
- Balance problems
- Light sensitivity
- Noise Sensitivity
- Feeling slowed down
- Feeling “in a fog”
- “Don’t feel right”
- Difficulty concentrating
- Difficulty remembering
- Fatigue or low energy
- Trouble falling asleep
- More emotional
- Nervousness or anxiousness
“Concussion Signs and Symptoms” from momsteam.com
“Concussion Signs and Symptoms” from the Centers for Disease Control and Prevention
This is actually a thing! You are not on crazy pills! You may have rolled away from a practice or game feeling alright after a hit, but then start feeling the effects later or a month later. Post-concussive disorder symptoms skew more on the psycho-behavioural side of things rather than physiological. So if you are seeing behavioural or emotional changes in yourself, this could be why. Like feeling extra “hulk-smash-y” or like you are PMS’ing, or like your old anxiety challenges have been triggered again. Try not to get too paranoid about it and go see a doctor to put you at ease and work on next steps to rehab.
Rest. That’s it. Cognitive and physical rest. Nothing fancy. Unfortunately this often means laying down and doing nothing, no brain stimulation. This includes abstaining from watching videos, listening to music, reading, writing, audiobooks. Stay off your smart phone! It’s like your body is now grounded as punishment for doing something dumb to your brain. You might be sensitive to light and certain frequencies of sound, so hang out in a dim and / or quiet room. Earplugs and sunglasses become your best friends.
ETY Plugs by Etymotics have been the best ever, I take them everywhere with me.
Work with your physician to determine a plan for what’s best for you as far as timing, rest and return to activities and exercise. Determine if you have to take a leave from work or school, and if there is any disability support in place to assist you with keeping up. If you are typically a busy-body, then you might need someone to explicitly tell you how to rest.
Stay away from practice. Watching your teammates skate fast around and around while whistles go off can be overstimulating. As much as you might want to participate off-skates and be with your team, this environment does not help with your rehab. Hopefully your coaches and teammates understand.
Supplements: Unlike taking something to treat your symptoms, your doctor might prescribe supplements that promote brain healing and cognitive improvement. This might include:
- Vitamin B2 (Riboflavin) – promotes the production of energy in the brain’s blood vessels (1)
- Magnesium – improves synaptic plasticity, aids memory and learning (2)
- Vinpocetine – enhances cerebral blood flow and neuroprotective effects (3)
- DHA Omega-3 or Fish oil – brain development (4)
- Vitamin B22 (From howstuffworks.com)
- “Magnesium Boosts Brain Function” from wellnessresources.com
- Vinpocetine (Wikipedia)
- Docosahexaenoic Acid (Wikipedia)
Physio / massage: Your treatment plan from your doctor might also include cranial massage or acupuncture to help with the pressure release and stimulate circulation to the brain to aid the healing process. I have had cranial massages, skull pecking, acupuncture in my head and even a deep neck flexor massage for whiplash. I have also been prescribed neck strengthening exercises as part of my physio.
Your treatment plan might even include some low-impact exercise to help increase blood flow to your brain. I found it also helps get those feel-good endorphins going to counter those downer feelings you might be experiencing.
RETURN TO PLAY
This is going to take time, and like all injuries, rushing back will only harm you in the long run. You want to be sure that you are fully recovered before trying to skate again in order to avoid aggravation or re-injury. Since multiple concussions have a cumulative effect, you don’t want to experience another, and especially not right away. It will set you back exponentially and can leave you with lingering or long-term effects.
Most concussion guidelines for sports have a pretty explicit return to play outline, however, ensure that your doctor clears you to skate initially (your sport is skating around and around for hours!) and then again to resume contact.
Here are a few good ones:
- “A Heads Up on Managing Return to Play” from Centers for Disease Control and Prevention
- “Return to Play” from Parachute Canada
- “Sport-Related Concussion Evaluation and Management” from the Canadian Pediatric Society
Captains and managers should also treat this injury as they would any other player injury. Depending on your league policies, a doctors note would be ideal. Know the steps:
- No activity, complete rest
- Light aerobic exercise
- Sport-specific activities – like skating
- Drills, no contact
- Drills with contact
- Game play
Take it step by step.
Start with light, low impact activity, like biking, walking or swimming, and move through the levels only if you are completely symptom-free. Not even a little headache. If you do feel your symptoms as a result, you need to continue your rest and rehab. Then try again at that level. This can sometimes be a slow, frustrating process.
There are also newer studies that suggest some exercise might also accelerate your progress. Best to just monitor how you are feeling. Try and see what might work for you and how you feel.
If you have suffered from multiples or even a single major event, know when it’s time to pack it in. Look at your risks vs rewards if you are considering returning, and consider how to avoid long-term damage (Decrease competitiveness? Try low contact? Take a couple of years off?)
As much as we are in love with our sport and the derby community, you only get one brain.
Like my catholic upbringing taught me, the surefire way to avoid accidents is abstinence from engagement in risky activities. But really, we can’t skate around in a safety bubble like in bubble sports, can we? No really, can we??!!!
We play a contact sport that celebrates our athletes’ differences in size and shape, and we would hate to see that change. We have complete understanding that sometimes accidents just happen in contact sports.
Here are some ideas, however, that could help avoid first or future concussions in roller derby, or at least reduce the frequency we are seeing. It would also be wonderful if the ruleset was evaluated for safety by medical professionals and revised accordingly in addition to considering changes related to improvement of game play and spectator experience.
- Helmets and face shields: Helmets can be great for helping absorb impact when hit, and protect your skull, but can’t help as much when you get a shot in the face or whiplash. At least, start with a legit multi-impact helmet for real! With the hard foam. Take that rubberized helmet you bought and throw it in the garbage. Don’t let your fresh meat buy them when they are investing in gear at the beginning. Check out section 9.1.3 of the rules to find out what equipment variations pass. Just like all of your other gear try options on, or borrow from your pals till you find the proper fit. Acknowledge that your head shape just might not fit properly with certain models. Look for a balance of protection and functionality (lightweight, not too hot, etc.) Some might find that hockey-style helmets stabilize the jarring and head and neck a bit more. Some find that face shields help prevent face hits. There are many options, just don’t cheap out on this body part when it comes to protection.
- Practice backwards blocking as a skill: This is a newer blocking style that is becoming more prominent in game play, however not one commonly taught as a foundation in fresh meat programs. Practice greater control when transitioning quickly. Practice more upper body blocking techniques, giving and receiving, with the aim of avoiding flailing limbs or head/face hits. Especially try safely backwards blocking and side blocking or “picking” with a variety of different-sized opponents.
- Strengthen your neck and upper body: Roller derby is definitely a total body sport, so don’t forget these body parts in your dry land training. Now that there is much more backwards blocking and shoulder blocking, strengthen this part of your body so that you can safely absorb and deliver these upper body hits. For blockers, this may also help dealing with that transfer of momentum from jammers coming in hot to a slow or stopped pack.
- Call out head and face hits: For coaches and managers, try to pay attention to these hits as much as you would cutting and back blocking if refs aren’t at practice to call the high blocks. I feel like we let this one slide a lot because “it just happens”, meanwhile, we might be enforcing sloppy play and letting repeated hits to the face or head happen, which over time could increase susceptibility if a bigger hit is received. Remember that this injury is cumulative. Pull or bench any players for egregious play for sure.
TALK ABOUT IT
Finally, talk this out with others in your league or reach out to our amazingly supportive sports community. As horrible as it was that a number of us got injured at the same time in our league, we’ve become a great little support group for each other. It has also helped raise awareness about the injury in our league. There’s a great deal of comfort in knowing that you have leaguemates concerned for your well-being that have experienced the same symptoms and are going through rehab with you, especially in dealing with the psycho behavioural effects. We have also shared a great deal of knowledge and referred others to the right doctors, as well as have some ideas for future projects in this area, so stay tuned!
We play an adrenaline-driven sport that on top of it all, we put our hearts into organizing, building, running and progressing. This can make it extra challenging to pull back when the time comes, whether it’s taking a short break or a long one.
There’s a great documentary called The Crash Reel that helps puts things into perspective and does a great job illustrating how passion for our sport can take over. Thanks Kamikaze Kitten for the recommendation and for being just a random Facebook message away!
Watch Trailer: The Crash Reel
Save your brain, you may need it later.
And if you are currently rehabbing a concussion, thanks for using up some of your screen time here.
Feel free to keep the conversation going here in the comments section, or by sharing your resources and experiences too!
Guest Blogger Speedin’ Hawking skated with Toronto Roller Derby from 2009 to 2014 as a member of the Death Track Dolls (2013 co-captain) and the Bay Street Bruisers B-level travel team (2012-2013).
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