28 Mar Countering the Effects of Detraining Following a Concussion
For athletes of all levels, athletic performance is the result of years of training and practice. In spite of the time and
effort required to get to this impressive level of skill, the effects of a
process called detraining can be felt within two or three weeks of inactivity.
Detraining
Detraining is defined as a “complete or partial loss of the different physical adaptations (e.g., muscular strength, flexibility) and athletic skills, due to a period of inactivity. In cases of injury, detraining takes centre-stage because it causes an athlete to take an extended period of rest and thus, suspend their training regimen.
On top of having to complete injury-specific rehabilitation, the injured athlete has to counter, as much as possible, the loss of his physical abilities caused by this inactivity. The more this loss can be limited, the faster the athlete can safely return to play or competition. For healthcare professionals in the sports field, the planning of this crucial period becomes an important responsibility that can include different obstacles, varying for one injury to the next. With concussions, this challenge is even greater. Under normal circumstances, recovery from a concussion takes 2 to 3 weeks, meaning the possibility of detraining cannot be neglected!
Allying performance and security after a concussion
At The Concussion Institute, we believe an interdisciplinary approach addressing three aspects is the ideal method in order to counter detraining after a concussion: the mental aspect, the emotional aspect, and the physical aspect. This approach should be started as soon as the period of rest is completed.
- The emotional aspect
More than any other injury, the emotional state of an athlete will play a significant role in the recovery following a concussion. The fear of losing 
what was acquired, the deep uneasiness of being unable to be active or surpass oneself, as well as the fear of not coming back to the initial level are often recurring themes that can affect recovery. This highlights the importance of taking all the necessary steps to ensure the athlete’s emotional well-being from the get-go.
Making sure the athlete has the support from his coaches, his teammates, his family and his friends is essential. He must feel comfortable to talk about his situation without feeling judgement, regardless of his environment or his entourage. All of the healthcare professionals supporting the athlete during this period must address the emotional aspect of concussions. Nevertheless, the help of a psychologist can become necessary in certain situations. One such situation is post-concussion syndrome.
- The Mental Aspect
The primary objective of a mental intervention is to conserve motor capacities and maintain technical movements. To achieve this, mental imagery techniques such as internal and external imagery can be used. Mental imagery is, by definition, a symbolic repetition of a particular action or motion without actual physical movement of any part of the body.
Considering that mental imagery is a skill that needs to be learned and practiced, for this type of intervention to be effective, the athlete should already have a certain familiarity with imagery before the concussion. The acute phase following a concussion is not the time to learn a new skill! Usually, the team’s sport psychologist is the one who will take charge of this aspect.
- The Physical Aspect
Many factors will influence the choice of techniques that should be used to counter physical losses caused by detraining. For this reason, the athlete should be referred to a kinesiologist specializing in the care of concussions.
First, the intervention plan can include passive mobilizations as well as stretching allowing the retention of muscle memory. Electrostimulation can also be an interesting method depending on the condition of the athlete. This technique however, has yet to be scientifically validated in regards to concussions. It is a commonly used technique to slow down atrophy of muscles immobilized in a cast. The goal is to stimulate the nervous fibres surrounding muscles, provoking muscular contractions which mimic a voluntary contraction initiated by the brain.
Lastly, a submaximal physical exercise protocol should be included. As corroborated by many studies, exercise following a concussion is beneficial when correctly planned and supervised by a professional. A kinesiologist specializing in the care and management of concussions will be able to plan and supervise a safe training program that will optimize recovery and counter the effects of detraining.
The Action Plan
The action plan against detraining for any athlete who sustains a concussion, professional or recreational, should:
- Be individualized and adapted to the needs of the athlete
- Take into account:
- Factors affecting symptoms of the concussion
- Time since injury
- Initial physical condition of the athlete
- Factors affecting symptoms of the concussion
- Be interdisciplinary and include multiple healthcare professionals:
- Doctor
- Kinesiologist
- Sport psychologist
- Physiotherapist
- Etc.
Detraining following a concussion can unfortunately never be completely avoided. However, with a properly elaborated intervention plan including the three aspects described above, it is possible to minimize the negative effects and allow the athlete to safely return to play, as fast as possible.
References
Castile, L., Collins, C. L., McIlvain, N. M., & Comstock, R. D. (2012). The epidemiology of new versus recurrent sports concussions among high school athletes, 2005–2010. British journal of sports medicine, 46 (8) : 603-610.
Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concussions among university football and soccer players. Clin J Sport Med 2002;12(6):331–8.
Gagnon, I., Grilli, L., Friedman, D., & Iverson, G. L. (2016). A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion. Scandinavian journal of medicine & science in sports, 26(3), 299-306.
Leddy, J., Hinds, A., Sirica, D., & Willer, B. (2016). The role of controlled exercise in concussion management. PM&R, 8(3), S91-S100.
Mujika, Iñigo, and Sabino Padilla. “Detraining: loss of training-induced physiological and performance adaptations. Part I.” Sports Medicine 30.2 (2000): 79-87.
medicine & science in sports, 26(3), 299-306.
Mychasiuk, R., Hehar, H., Ma, I., Candy, S., & Esser, M. J. (2016). Reducing the time interval between concussion and voluntary exercise restores motor impairment, short‐term memory, and alterations to gene expression. European Journal of Neuroscience, 44(7), 2407-2417.
Reynolds, Erin, et al. “Establishing a clinical service for the management of sports-related concussions.” Neurosurgery 75 (2014): S71-S81.