While waiting to see the doctor

The first 48 hours after a blow are critical. The watchword? Rest, both physically and mentally.

If you do the right things during this period, you’ll recover considerably faster.

During the 48 hours following a blow to the head:

    • Cease all physical activity.
    • Limit all auditory and visual stimulation,
      wear earplugs and sunglasses if necessary, and try to avoid noisy environments.
    • Limit your exposure to screens (TV, computer, phone).
      If you have to contact someone, call instead of texting.
    • Avoid concentrating for a long time. 
      This means no reading, no homework and no watching TV.
    • Relax.
      Close your eyes and meditate. Focus on your breathing to relax you and keep your mind at ease.
  • Stay hydrated by drinking plenty of water.
  • Make sure that someone keeps you company

Tuesday morning, 10 AM, I get a text from an amateur boxer:

“Ariane, I think I’ll call your doctor, but I just wanted to know if it was worth it. I don’t want to bother him for nothing …After my fight, I don’t know if I felt weird because I wasn’t satisfied with my performance or because I was rattled … I have received much stronger punches in the past than those I got on Friday! This weekend, the headaches started again and I had bursts of anger for absolutely no reason.

[…]

How am I feeling? It would be hard to describe lol. The best adjective word would be « weird » lol. Small headache, a little dizzy, emotions are up and down. Today, I feel sad for a minute, then a bit later I’m ok and in a good mood.”

 

It’s possible to have a long career in boxing, to compete at a high level while maintaining a healthy brain. But, in order to do so, you have to be able to recognize the symptoms that might indicate a concussion so you can rest as soon as you feel them – not 3 days later or after the next competition. In short, you must rest your brain the same way that you rest your muscles after a demanding workout.

Do you know all the symptoms?

The symptoms obviously vary from one person to another and even from one concussion to next for the same person. Unless you are (really!) unlucky, you will not get them all.

Headaches, vomiting and vision problems are easy to identify, but other symptoms are more subtle: feeling slow or foggy, nervousness, mood swings, feeling a pressure in the head or having very low energy. If you don’t pay attention, you can easily miss these symptoms and think they are due to something else (#finaltermexams #worktrainsleepworktrainsleep #canadianchampionshipmode).

Testimonial from a provincial champion

“I don’t really have a headache; it’s more like a pressure that’s always there and it’s been more than a week. Besides, I don’t understand why, but I’m really emotional for no reason. I’m in mid-session and, with the competition that’s coming, I train a lot, so for sure I’m tired … so I don’t really know if that’s it.”

 

Yes, that’s it.

When in doubt, rest for 48 hours, then come back to training gradually. If the symptoms reappear during training, it means that you need more rest. And, if you need several rest periods, start with a low intensity exercise every time you go back to training.

Examples:

  • I do shadow and I get dizzy: I stop, I rest for another 48 hours.
  • I go for a light jog (rather than sprints) and I feel good: next time I can increase the intensity.

Don’t be fooled by your « little voice » or someone who says that « it’s normal to have headaches. » It may be common in boxing, yes, but it’s not normal.

symptômes à l'entraînement

In the long run, it will always be better to « waste » 48 hours of training than to compromise your health for life. If you don’t take the necessary measures to rest your brain when it needs it, your body may end up forcing you to stop for much more than 48 hours.

Testimonial from a Canadian Champion forced to retire, 27 years old

“For me, it was always the same when I had my concussions. It was always the same stages: I’d finish my fight and often I felt pretty ok, maybe like my head with in the clouds a bit. At this point, I don’t know if it’s fatigue or if it’s from a shot, but I feel tired.

The first symptoms always started 20 minutes later. First, it was my vision … like flashes, with white spots. In the end, I had had so many [concussions] that I knew when it was starting. Between 5 to 20 minutes after the flashes, the headache and nausea started. My eyes were straining, but I just couldn’t keep them open. I couldn’t do anything … just staying up was draining all my energy. I would go to my hotel room to close my eyes and try to sleep. I would spent part of the night awake, because it took me forever to fall asleep.

The next day, my head would feel super sensitive, almost like an eggshell. If I moved it just a little bit too fast or hard, it would hurt. I wasn’t dizzy, but the headache kept getting stronger. It’s as if I were balancing a glass of water on my head: I had to move really slowly so that it didn’t spill, because every sudden movement really hurt. I still had vision problems, but no nausea.

It always happened to me in bouts, never in sparring. For me, it was like normal [to have concussions when fighting]. Towards the end, the National Team doctor was monitoring me over the phone, but if I had a competition 1 month later, I would still go.

Each time you have a concussion, you get more fragile. After a while, it doesn’t take much. At my last competition, I did 2 bouts. I watched them, and I’m still trying to find the punch that caused it. My legs never got weak and I didn’t even get hit hard.

Towards the end, I realized that I took less and less to get the same symptoms.

 

Is it good to sleep after a blow to the head?

No, not in the first 2 hours after impact. It’s also necessary to monitor the athlete closely during these 2 hours. « If a person is extremely sleepy in the hours following a trauma to the head and cannot be woken up, call 911 and go to the ER immediately,” says Dr. Hugo Hébert, who works with National Team athletes, including the Boxing Canada team. « The occurrence of intracranial bleeding after a boxing bout is rare, but it happens, even among amateur boxers. There were 2 deaths last year in the UK, » he adds.

The athlete should not be left alone and must go to a hospital at once if they:

  • Have a headache that gets worse
  • Are very drowsy or can’t be awakened
  • Can’t recognize people or places
  • Have repeated vomiting
  • Behave unusually or seem confused; are very irritable
  • Have seizures (arms and legs jerk uncontrollably)
  • Have weak or numb arms or legs
  • Are unsteady on their feet; have slurred speech

Contrary to what was once believed, athletes can sleep after 2 hours if none of these unusual symptoms are present. It’s even good to do so, because sleep contributes to recovery.

If you are unsure of the athlete’s condition, you can let them sleep (after the 2-hour period), but wake them up after 1 hour. Then ask them a few questions to check their state of consciousness and reactions.

Advil, ibuprofen and other non-prescription drugs that cause drowsiness should be avoided. Tylenol can be taken for headaches.

The headache should not last more than 3 days. If it does, see a doctor immediately.

symptômes à l'entraînement corde à danser

Get your baseline: it matters!

Basically, a baseline test is a series of assessments and examinations that indicate how your body and brain respond, and how you feel in your “normal state”. All athletes should consult their physiotherapist or doctor at the beginning of the year to complete this test.

What’s the point?

« »Let’s an athlete who thinks he’s had a concussion comes to see me without a baseline and tells me that he has no more symptoms. If he asks « am I cured? « , I can never be sure that his concussion is resolved, since I don’t have anything to compare with, » says Dr. Hébert.

With a baseline, however, your doctor will be better equipped to diagnose the concussion, because he will have before and after information on your condition. And, most important of all – and this is the part that matters – he will be able to tell you exactly what to do to recover effectively and return to the competition when you are perfectly healthy.

Many sports therapists, physiotherapists and of course doctors are qualified to do these tests. SCAT3 is the world’s most popular one, because it’s free.

Testimonial from an active professional boxer

“When I had my concussion, it was from a punch to the back of the head. I knelt down on one knee, got another shot, and the referee stopped the fight. It wasn’t a big knockout.

Before this competition, there were 2 sparrings where I had a flash and I took a step aside … you know when you get hit by a big shot and it’s like you miss a step going down stairs. It was 2 months and a half before, and the other one, about 1 month. For 2 days after these sparrings, I had tension in my neck and my jaw was tight. I couldn’t even check my blind spots while driving.

Even after the tournament, I wasn’t really aware that I had symptoms of a concussion. I thought I was in pain because of an old neck injury and because I had been punched to the back of the head. I took a week off, as I usually do after each tournament, and it was only when I started training again that my coach suspected I might have a concussion. I wasn’t able to push myself. When it was hard, for example when I was doing cardio or major strength training workouts, I would get a little dizzy. Then, my coach contacted a specialist to see if everything was ok.

At the beginning of the year with the National Team, we had done a baseline. When I redid them [the tests], I was slightly less stable when doing two of the movements. So my doctor referred me to a neurologist.

I waited almost 2 months before sparring again. We took the time to see how I reacted to training. When we were training and I had no symptoms, we pushed a little more. Afterwards, we started sparring again gradually. My coach did a great job in helping me recover. He asked me a lot of questions about how I was feeling and he followed all the doctor’s instructions.

It’s been 2 years now. Today I feel ok and it’s getting better and better. The only thing is that at first whenever I would get hit in the back of the head in sparring, I would worry a little. But this passed in time. It’s going better but I still have to be careful too … I don’t drink alcohol at all. My excesses are with Vachon cakes! 😉 On the other hand, before I used to dehydrate a lot to make weight, it’s perhaps what harmed me.”

 

symptômes à l'entraînement bandages

Dehydration + punches + alcohol = brain damage

Dehydration makes the brain more fragile. Dehydrating to make weight, taking punches, then drinking alcohol (i.e. getting dehydrated even more!) is far from a desirable scenario for your brain! Yet this is what many athletes do when they celebrate a victory or get over a loss. As much as possible, stay hydrated before, during and after exercise, whether in training or at a tournament. Celebrate with fries, cake and a tasty Gatorade! 😉

Testimonial from a Canadian champion

“I’ve had 2 concussions diagnosed by a doctor. The first time was in sparring. I was mentally tired and I had worked all day. I was having trouble focussing. I got hit with a hook. I had pain, but I continued and, coming out of the ring, my ear was all purple. That evening, I started to have a headache and felt a little dizzy. I had the feeling that I was in another dimension, it was weird.

The mistake I made was that, the next day, I put the gloves on again, because I was afraid of telling my coach that I had a headache. The day after the second sparring, that’s when it hit me the most. I was walking with a friend outside. She was walking fast, and my body wanted to walk fast too, but my brain couldn’t keep up. I started to cry. I had like a panic attack. The only thing I wanted was to go lie in my bed; walking was too demanding.

When I had my second concussion, it was the same thing: I was in a state of mental fatigue. I had put on the gloves with girls at the gym. What was different that time was that the symptoms arrived just 2 days later. And then, I started to get the same migraines that started in the neck and went up to the top of my head. I had some nausea. It was like a hangover, but without drinking.

The difference with this concussion is that I went outside and the reflection of the sun on the snow gave me a terrible migraine. I had another panic attack because I couldn’t control the migraine. In the days that followed, I had wear on sunglasses because the light outside was so intense; the white of the snow was too bright. Not long after, I went shopping. I had another panic attack because it gave me a migraine just to see the mix of colours with the neon signs in the store. I made me dizzy.

The recovery was faster the second time than the first [7 months rather than 2 months], but the second time I had more permanent side effects. The first time, the sensitivity to light and colours went away. Now, I still have symptoms, and it’s been 3 years.

Now I don’t never spar 2 days in a row. And when I put on the gloves with a guy, if I get hit by a dangerous punch, I tell him [my coach] that I want to stop. I don’t mind doing it anymore.

I often say to people in the gym: when you’re tired, do drills instead, don’t spar. Even if you’re scared of looking lazy or whiny. When it comes down to it, it’s your health that’s at stake.

 

Concussion Resources

In Montreal, for athletes identified as ExcellenceÉliteRelève et Espoir :Clinique médico-sportive de l’INS (at the stadium).

In Montreal, for everyone: The Université de Montréal medical clinic (CEPSUM). Make an appointment once you have a note from your family doctor or physiotherapist advising you to see a sports doctor for concussion symptoms. The consultation is free with your health insurance card.

In the Québec City region, for athletes identified ExcellenceÉliteRelève et Espoir : contact Pascale DélisleExcellence sportive Québec-Lévis : pdelisle@esql.ca or +14186562316.

In the Québec City region, for everyone: Cortex is a private clinic specializing in the prevention, management and treatment of concussions.

In Sherbrooke, for athletes identified as ExcellenceÉliteRelève et Espoir :contact Émilie RoyExcellence sportive Sherbrooke : emilie.roy@excellencesportive.com or +18198212002 poste 323.

Info-Santé 811 (24 hours a day, 7 days a week)

Dialing 811 promptly puts you in contact with a nurse in case of a non-urgenthealth issue. However, in the event of a serious problem or emergency, it is important to dial 9-1-1 or go to the emergency room.

Advantages and disadvantages of different resources

UER doctor (at the hospital) or at a walk-in clinic: « immediate » access but generally no follow-up.

Family doctor: Family doctor: The access times are variable, and the knowledge of concussion is also variable from one doctor to another. Some will be comfortable treating concussions, others less so. Fortunately there has been a lot of awareness raising in the medical communication on this subject in recent years. The average level of knowledge on concussions has definitely increased.

Sports doctor: Access is variable. Allow about 1 to 6 weeks before getting an appointment.

Neuropsychologist: Unless you are a National Team athlete, it will cost between $650 and $800 for an evaluation. Access is fast, however, since it’s private!

Kinesiologist with concussion subspecialty: Unless you are a National Team athlete, it will cost between $100 and $200 for an evaluation. Quick access, however, since it’s private!

See: the documentary After the Last Round

 

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