Return To Play Protocol After A Concussion with Dr. Brandon Eck, D.O. and PT, AT Michael Keenan [PART 2]
Season 3, Episode 8 | Podcast #44
Today, we will be discussing everything concussions with two of the best in the business: Vestibular certified Physical Therapist and Athletic Trainer - Mike Keenan, as well as Dr. Brandon Eck. Mike was on the podcast before to discuss concussions as was Dr. Eck in which we discussed his experience and roles in sports medicine specifically endurance athletes and the services he provides.
Dr. Brandon Eck
Let’s get into this Concussion Roundtable discussion. Dr. Brandon Eck is a sports medicine physician that earned his undergraduate degree at Villanova University where he ran track and field for the Wildcats. He then earned his medical degree at the Philadelphia College of Osteopathic Medicine. He completed his residency in family medicine. He also completed a sports medicine fellowship in Blacksburg, VA in which he served as a team physician to Virginia Tech and Radford University. Dr. Eck has extensive experience in treating athletes of many disciplines and is dedicated to the treatment of both athletes and non-athletes with orthopedic injuries, including sports injuries, overuse injuries, fracture care, and concussions. He is one of the Team physicians for U.S. Ski and Snowboard.
Check out our previous episode with Dr.Eck
Michael Keenan
Michael Keenan is a dual credentialed Physical Therapist and Athletic Trainer, Mike has been working in Sports Medicine and Rehabilitation since 2008. During this time, Mike has worked with patients of all ages and physical abilities from pediatrics to professional sports while with the Pittsburgh Pirates Baseball Organization. He specializes in vestibular and concussion-based treatment. I have had the pleasure of working with Mike Keenan over the past several years. I can say with the utmost confidence that he is the best I’ve seen at treating concussions – whether the patient was in an automobile accident, work-related accident, or as a result of an athletic trauma or injury.
Check out our previous episode with Mike Keenan
In this episode we cover:
1:18 What are the parameters for a student-athlete to return to play?
Once they have no symptoms, a baseline symptom score, and are able to go through a full school day without symptoms, student-athletes can then start the return to play protocol.
2:00 Return to play protocol is a graded 6-phase progression for return to exercise necessary before returning to competition
2:38 “Asymptomatic at school, they have to clear that before we can even talk anything field related.”
3:00 Athletes typically don’t usually start going to physical therapy with Mike Keenan until phases 2 and 3 of the Return to Play protocol.
The phases of the Return-to-Play protocol for concussions.
Asymptomatic at school
Asymptomatic with light aerobic activity
Asymptomatic with moderate aerobic activity
Asymptomatic with non-contact heavy field activity
Asymptomatic with practice & full contact
Asymptomatic at competition
3:46 There is always a conversation between the physical therapist and the sports medicine physician so that a student can be cleared to continue in the return to play progression.
5:00 How Dr.Eck approaches the Return-to-play protocol with the physical therapist, the athletic trainer, and the parents.
“What I want parents or athletes to do is, if they’re doing better before our second evaluation, call me. There’s no reason to delay it, just because of the schedule.
5:50 “I can’t emphasize enough how important it is for physical therapists to communicate with and offer our observations to the physician or sports medicine doctor, knowing we don’t call the shots”- Mike Quintans
7:45 The importance of the athletic trainer in later phases.
8:05 The role the athletic trainer plays as the student returns.
9:15 What a follow-up evaluation looks like with Dr. Eck.
No matter what he is going to do his own evaluation. He’ll get a new symptom score, physical and other exams.
9:50 Does the sport a student plays change Dr.Eck’s evaluation?
Not really, but age does matter in determining normal.
11:00 A student-athlete is done with PT when they are asymptomatic with heavy physical exertion.
12:40 If a student is prescribed medication, for physical or psychological symptoms, they are still allowed to play as long as they are asymptomatic otherwise.
13:00 Dr. Eck sites a study from March 2021, “Musculoskeletal Injuries And The Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players” that found that if a student had a concussion in the last twelve months, they are 87% more likely to have an acute noncontact lower extremity injury.
14:50 This leads Michael Keenan to think there may need to be better balance assessments in return-to-play testing.
16:00 Q urges better holistic testing to mitigate the overall risk of injury
“This comes down to a holistic approach to return to play. Are we clearing a concussion to return to play, or are we clearing a student-athlete to return to play?” - Q
Lighting Round
21:20 What are we doing right in regards to concussions?
23:00 What could we be doing better in sports medicine regarding concussions?
24:00 What is your biggest takeaway from recent research in concussion management?
25:00 How do we mitigate the risks and severity of concussions?
Eck says because of inherent risk but the more aware you are, the less likely you are to have an injury or have prolonged symptoms.
Keenan believes in neck strength awareness, risk assessments and risk factor mitigation.
29:45 What needs to happen for us to reduce the risk of concussions overall?
Dr.Eck says it’s hard to narrow it down to one thing but the biggest factor would be better communication.
Keenan states that while this may not prevent them, better community education could help reduce prolonged recovery rates.
31:50 Are we doing our due diligence?
32:35 Their take on the 70-30 breakdown.
70% of concussions take 7-10 days to improve
30% Have prolonged symptoms, usually due to delayed care.
Dr.Eck sees the split differently because of the current delay of appropriate treatment.
30% of the patients he sees are better in 7-10 days.
70% need additional treatment.
34:50 “It’s very rare that I see an individual and they’re not going to get some sort of referral”
36:50 Often times concussions will lead physicians to uncover underlying conditions that have gone unrecognized, especially in teenagers.
37:40 How many visits does a PT usually see the average concussion for?
38:40 “The faster you get in [to PT], the faster you get better.”
41:20 “Communication, education, early assessment”
Contact
Dr. Brandon Eck
Orthopedic Associates of Lancaster.
717-299-4871
Michael Keenan
484-498-8299
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