Frankye Myers: From Riverside Health system. This is the Healthy you podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I am really excited to have with me today in the healthy youth studio, doctor John Barley. Doctor Barley is a sports medicine physician with Riverside orthopedic specialist. In this episode, we're going to be understanding sports related concussions. Insights from a sports medicine doctor. Welcome.
John Barley IV, D.O.: Well, thank you so much for having me back. This is my second time around, so I really appreciate it.
Frankye Myers: You're always welcome. You're always welcome.
So today we're going to be discussing a critical topic in sports and general health, concussions. Concussions are significant concerns for athletes at all levels, from youth sports to professional leagues. Despite their prevalence, there's still a lot of confusion and misinformation surrounding sports related concussion. What exactly happens when an athlete gets a concussion?
John Barley IV, D.O.: So that's a really good question. And honestly, there is still some speculation at times about what actually happens. There's been a lot of thought process that it was the brain, when it gets hit with the impact and the brain gets pressed, and there's the compression and a kind of bruising thought of the brain, actually, that's been proven to not actually be what goes on. A lot of the thought process now is there's kind of a coil recoil, tight movement in the brain, and that can change a lot of the cellular level mechanics in terms of the way things process through the cell membrane. And that can really affect how the brain processes in different areas. Yes.
Frankye Myers: I can remember early in my career hearing a lot about even shaking an infant too much. Is it similar to that in some ways?
John Barley IV, D.O.: Well, somewhat. But the thing about it is it doesn't require an impact directly to the head, which is what is really difficult about this diagnosis, and just like you said, is that a lot of this can be misdiagnosed. Because ultimately, I've seen concussions where people don't get hit in the head. It's a whiplash injury, or it's somebody gets hit in the body, but they still have some degree of force that's transmitted up through, and they're now having these symptoms.
Frankye Myers: Wow. I was just in a car accident and I was hit in the back. And so I had a severe case of whiplash.
John Barley IV, D.O.: Yes.
Frankye Myers: So should I be on the lookout. So that goes into the next topic as we talk about what are signs and symptoms? And could something like that, a high impact accident, do the same thing?
John Barley IV, D.O.: Yeah, absolutely. And that's. I mean, I will say the vast majority of concussions actually are not sports related. Obviously, with what I do and how we practice in sports medicine, we focus mostly on the sports related concussions. However, the vast majority are exactly like you said, it can be a motor vehicle accident, it's a fall, a lot of other things. Now, when it comes to the signs and symptoms, they're many. And again, they can mirror many different issues.
I mean, the classic is if someone gets knocked out cold and lose consciousness, well, yes, that may be a concussion, it may not. And so, yes, those are the easy, those are the easier ones to say, okay, that's a big sign or symptom, but even the symptoms of neck pain, headache, confusion, dizziness, blurred vision, all these things can be there. And honestly, on the sideline as a sports concussion and physician, where we're managing these, one of the things that I use as a really good predictor is just when someone says, you know what, I just don't feel right at this moment. And if you're in that state, that's when I have a pretty high suspicion that something's going on.
Frankye Myers: Gotcha. Well, I was remiss. How did you end up in this line of medicine? Like, what is the path to specialize in this field?
John Barley IV, D.O.: Yeah, so I'm a primary care sports medicine doctor. And what that is, is we are a specialist in the area of athletics and taking care of athletes. But I mean, I kind of go by the old statement by Bill Bowerman, who's an old coach, of saying, hey, if you have a body, you're an athlete, which I agree with. But in the realm of what we do, I went through family medicine, so I'm trained as a family medicine physician and then did an extra year of fellowship in sports medicine. There's different tracks you can take to be here, both er in terms of emergency medicine, pediatrics, internal medicine, and PM and R as well. But that's how I got here. My story to it. Well, I mean, this is a pretty close topic for me. I played football for about 15 years. I played in college, and I sustained my years and number of concussions throughout. And I was actually lucky enough to be. I grew up in the city of Pittsburgh, and so the UPMC and the University of Pittsburgh was very big on concussions and research, and a lot of the early studies came out and I was actually involved in some of those studies I found out later on based on data and so. But it's been something pretty near to my heart for a really long time. And obviously now having three boys and a little girl who all play sports, this is something that's going to be pretty prevalent for me.
Frankye Myers: Are you a Pittsburgh Steeler fan?
John Barley IV, D.O.: I am, yes. Yeah. I'm sorry.
Frankye Myers: And were you any hopes to go to the NFL yourself?
John Barley IV, D.O.: I mean, obviously anybody who plays at the college level, there's always that, those dreams and aspirations. And I had several of my friends who ended up getting to be there, but I decided somewhere along the line, a couple injuries kind of slowed me down, but kind of pivoted and said, I want a little bit of control, and decided, let's do something else. And always had a passion for, for taking care of athletes. I was always the guy who, even if I wasn't injured, I was kind of hanging around the training room. They'd always want to kick me out. But I really enjoyed it and seeing this. So this has been a passion for a long time.
Frankye Myers: Thank you. Thank you for your commitment. Position.
John Barley IV, D.O.: Quarterback.
Frankye Myers: Quarterback.
John Barley IV, D.O.: Quarterback and safety in high school, quarterback in college.
Frankye Myers: Okay. Okay. Wow. Good stuff there. So I wanted to talk a little bit about one of the famous NFL quarterbacks. Patrick, how do you say that name?
John Barley IV, D.O.: Mahomes.
Frankye Myers: Mahomes.
John Barley IV, D.O.: Yes. Mahomes.
Frankye Myers: Mahomes. During the AFC divisional playoff game in January 2021. And it was a shocking moment that was broadcasted live by millions. Can you talk a little bit more about that situation?
John Barley IV, D.O.: Yeah. So there's been a few of these over the years with professional athletes in terms of getting hit, and then it looks really bad on tv. And the hardest thing about professional sports is, look, you have multiple camera angles. It's going to slow mo. You're seeing everything 20 times. Okay. And so what happens a lot in these situations is there's a blow, whether it's the person, I can't remember this one specifically, but whether their head bounces off the ground, they get to take a big hit and they get up and either look a little woozy or trip and fall, stumble a little bit and it looks bad. And then the question always becomes, well, why aren't we pulling these guys? And taking a look now, at the NFL level, they do have a lot of precautions. So they have both primary care sports medicine doctors as well as orthopedic surgeons. And then they actually have an independent neurologist specialist, whether that could be a neurosurgeon or a neurologist that's there to help with this. Okay. In those settings, what they do is they do an evaluation and bring them back in if they feel that they're capable of doing so now, or can we play Monday morning quarterback and say maybe they shouldn't have or should or shouldn't have? It's tough to say that, and I never like to speculate without having all the facts. Without having all the facts. But the hard part about this is it does look bad sometimes. I mean, several. A year or two later, the Tua Taglavoa with the Miami dolphins, same thing. And then he came back and got a concussion the next week. And so it can look really bad. But I think this is where, when I always talk to people, and especially when I'm training other physicians or talking to athletic trainers, what most important for me is, look, if you have signs or symptoms or you're concerned for it, that person needs to be pulled and evaluated at that time. And that honestly, out of everything with concussions, if you're going to be in athletics, that's the most important thing for you.
Frankye Myers: Okay. And you already talked briefly about some of the, the causes of concussions and specifically as it relates to sport.
Oftentimes, I think many of us associate concussions with football, and we talked about that and other impact sports, but it can occur in other sports and just in other accidents in everyday life.
What are immediate symptoms that if you were to educate layman, that they should be looking for?
John Barley IV, D.O.: Yeah, I mean, again, like we said, the hard part, it can be a lot. Okay. But if you have somebody who comes off the field, a, whether it's normal life or an athlete, no matter, not football, any sport, but they're just not completely there. They're having issues with light, they're having issues with sound, they have headaches.
Frankye Myers: Nausea.
John Barley IV, D.O.: Nausea can be, yes. Now, if you see somebody who's vomiting profusely, that raise your concern to another level, okay. But if you have somebody who's like, I just don't feel good in the stomach, 100%, that's something that I'm gonna be worried about a concussion right away. But just like I said, I mean, it can be as bad as just saying, I just don't feel right, and it might not be something you completely see. And this concussions are kind of like this silent disease that goes, that happens and can be missed because you'll see an athlete who, whether it's football or anything, gets hit in the head, but they're not going to come off the field to be evaluated and then next thing you know, they start having symptoms.
Frankye Myers: Yeah. And you know what? There's never a wrong answer. If you do something right, it can be ruled out. So just err on the side. Side of caution is what I'm hearing.
John Barley IV, D.O.: Yeah. And that's. I mean, look, we're here to make sure we're protecting kids, especially in athletics, is that I always try to tell people, look, I don't want to be the bad guy, but that's my job sometimes, is that we're here to protect you. And if we rule it out and we say things, you're back to normal and you're not having any symptoms and this isn't a concussion, then, yeah, we can safely put you back into the game, but we're going to make sure we're doing that before we make that determination.
Frankye Myers: So my son played football as well up through high school and a little bit in college. I remember when he was about seven and wanted to start playing football. We were told, hey, he shouldn't do contact, just do flag until nine. Is there an age parameter that, or what? What age would you allow your son to play impact football?
John Barley IV, D.O.: That's a good question. There isn't any parameters. Okay. I mean, any Saturday you can go around in the fall and find the kids who they're, how much bigger than their body, that are running around playing football.
Are they wrong for doing that? No. Okay. If you as a parent, feel that you're being responsible and making the right choice and you're, and I think the big one is understanding the risks that come along with this. Okay. Educating, I mean, part of this right here is really important. Knowing the risks that come along with putting your child into that is something that goes along with it. But I mean, I would like to say that it's only football, but I mean, women's ice hockey has a huge risk. And I mean, soccer. Soccer, exactly. My kids all play soccer and baseball.
Frankye Myers: If the bag goes the wrong way.
John Barley IV, D.O.: So all of these sports, too. And so everything carries a risk. And we always are going to say, hey, what is that risk? I mean, that's where it comes down to now, as a parent, I've chosen not to have my kids play tackle football yet. And that's my own personal decision. Okay. And it's not that they won't. We just have not yet engaged in that. And it's, and I think with, with time, if my kids come to me and say, hey, we want to play.
Frankye Myers: Football, I think they will probably
John Barley IV, D.O.: We will. Yeah. I mean, look, it's in great family. Yeah. I mean, if they do at that point, then we're going to have that discussion and sit down and have it. And I want them to have some part in that and express their understanding. And I'm never one to say I'm going to hold my sons from never playing football. It's just if we as a family, and my, my sons feel that they're all right doing that, then we're gonna do that.
Frankye Myers: That's a really good perspective on it because people have their own individual views around that. So I'm glad to hear you, you know, really put that in the hands of the parents. Yeah. And just being aware and then monitoring and looking for things that may come up.
John Barley IV, D.O.: Yeah.
Frankye Myers: All right. What about if someone suspects an athlete of having a concussion?
John Barley IV, D.O.: Well, if. So, if you're on the sideline, whether you're a physician or just a parent, and say you're a parent at a game and you're there and you see your son or daughter get hit or fall at their head, and they come off and someone checks them, if they start showing signs and symptoms again, let's go back to the most important thing. Pull them from that game. Okay. Monitor them. And even if that's just my. And even if they say, mom, dad, I'm fine, nothing's wrong, monitor them. Okay.
1015 minutes. See how they do. Okay. Sometimes that initial symptom goes away and you're fine. What I typically do on the sideline is we're gonna initially pull that person.
And then what we do at that point is there's a couple things as a physician, we do. There is what's called the saline concussion assessment tool and it's called the scat six. If someone really wants to, if you really want to get into the weeds on this with concussions, there has been some international consensus statements. There's a 6th one that recently came out last year. That's how we manage concussions. That's our international consensus statement through all of sports medicine.
Frankye Myers: And is it like a step? It is a step by step guide.
John Barley IV, D.O.: It is. So the way it works is the sideline assessment tool. It is a, a pretty labor intensive, about 1520 minutes test that we can put you through, which is good. Most of the studies saying up to about three days after concussions. After that it can go out to seven. But typically it's very good in that first three. I wouldn't say as a parent, it's probably going to be easy to do, but I mean, from a parent perspective, I would say really, at about 1520 minutes, mark, if they're starting to feel better, let's get them doing a little exercise. Okay. Let's move them around, change directions. So I'll have them do burpees. I'll have them squat, I'll have them jump. I'll have them run, cut. And if they don't show any signs or symptoms, they're completely normal. Their pupils can be reactive. They're acting normal. They're saying no symptoms. They look normal. Then obviously, yes, there can be. I would say if you're going to make that call, though, it probably should be a medical professional to put them back in, in my opinion. Okay, if you're not a medical professional or not trained in how to do this, I would say, if you suspect a concussion, hold them that day, hold them that.
Frankye Myers: Is there a follow up plan that would be a part of that step by step for reevaluation?
John Barley IV, D.O.:: Yeah. And I mean, what I tell. Yeah, most of the time, it's if you're gonna. If we see something on a Friday night, say one of our athletic trainers sees them on a Friday night and they suspect a concussion, they're typically gonna reevaluate them probably within 24 to 72 hours, depending on when they see them next.
Frankye Myers: And I ask that just because there's so much out there now in the media and in the press of these athletes that have done all the right things, kept up with themselves while playing sports, and then they have these huge shifts in personality and different things happening. What do you think? You know?
John Barley IV, D.O.: Yeah.
The continual monitoring is important. It doesn't need to be like it used to be, where you'd wake your kid up every 20 minutes. Okay. Right. So we don't need to be doing that. Actually, a lot of the research is saying, let them sleep. With concussions, there can be sleep disturbances. They can sleep more, they can sleep less. Okay.
Frankye Myers: Okay.
John Barley IV, D.O.: Now what you are going to be looking for is altered consciousness. So, like, if. If they're walking along and all of a sudden they're becoming extremely fatigued to the point like they're lethargic or not being able to be aroused, obviously, that's very, very bad. Okay. These uncontrolled headaches after. So say it's a Friday night during a football game, your son gets hit. There's symptoms. They suspect a concussion. When you go home, obviously, if there's change in consciousness, they start having complaint of numbness, tingling. Other places, they're vomiting, uncontrolled headaches. You should be taking them for further evaluation. But in those settings, I mean, a lot of we're going to see those, hopefully sooner, but obviously keep an eye out on that is really important.
Frankye Myers: Are the other things I'm referring to some of the longer and some of those longer term things that can occur from concussion.
John Barley IV, D.O.: Yeah, and that's a little bit about that. Yeah, that's the big one. So, I mean, in terms of when they come to see me in clinic, a lot of times this isn't same day, okay. I mean, some of my contracts, I have very close contacts and we see them very quickly, but for the most part, I'm seeing people within a week of the injury.
And so what we're really trying to do at that point is reevaluate them and see what their symptoms are, how we can intervene in those symptoms. And if we can, it might just be, hey, this is going to take time.
If they're having neck pain, maybe getting them into some physical therapy is going to be important to kind of calm some of those symptoms down. If they're having what we call oculovestibular symptoms, where it's their eyes or their inner ear, where the balance systems are off, we can do physical therapy for that. Okay. There are some of these ways we can treat this type of stuff. And what we do is we put together a plan in terms of exercise. We actually want you to exercise. The old school way of managing this when I was growing up, don't do anything, stay in a dark room, and let us know when you're better. It's not like that anymore. No, we want people to exercise now. It's to a threshold. Okay. So if you start, if you were sitting around and you have a very small headache of like one or two, and you go and start jogging a little bit or walking or riding a stationary bike and doing some stuff, and your symptoms go up. Say your headache score, the pain score goes up to like a five. Well, then that might be too much. Okay. But if you have a one and it goes up to a two, I'm fine with that. And in physical therapy, we actually have a treadmill test that we do that has been shown through studies to be very valid. And what we do is we put together an exercise program for people with concussions to exercise to a certain level, and it can be very helpful in recovery from concussions. So then on top of that, what we do is the two big areas of concern are going to be that all patients have and all parents have are what we call return to learn and return to play. Okay. In return to learn, this is really trying to get people back into school for that, for that high school element. Middle school, elementary, high school, all the way up through grade school, up to the college level. But it's going to be, how do we get you doing that? Because that's most important for a student athlete because they're students first and then an athlete second.
And so we have that process. And so anybody who does that, like I was saying, in all that, all that information and paperwork, if people are looking for that, it's online and they can reach out. We'll have that on our riverside website for that.
And then on top of that, we go through a graded return to play progression.
So say you wake up two, three days later and you feel great. It doesn't mean you go back and play that next day. Okay, there's a five day return to play progression that we have to put you through. And each day gets a little bit more. So we go exercise, then a little bit more exercise, then we do some non contact sports related activities. Then we're going to get you into an non contact practice, and then we're going to get you into contact practice and we're going to grade you and see how you do with that. And if you have any setbacks, then we take a step back. But that way we can, as physicians and providers, be able to tell a patient and a parent, look, we can get your son or daughter back to that playing field safely. And that's what goes to your initial question of what about long term patients? And this is where I think we've gotten better over the years. Okay? I mean, back in the day, people just play through it. It's like, like suck it up and play. And long term, yeah, you can have some issues from. And the question always is, is it due to the concussion or is it due to microtrauma, these repetitive micro trauma, which is where a lot more of the research for the chronic traumatic encephalitis, which is the CTE that you're hearing about, that's where a lot of the literature is looking at. Is this, is it due to the number of concussions? Is it due to the number of just minor head injury? So that, that kind of pounding in football, like an offensive lineman who's always hitting their head every single play. We don't. There's still more and more literature that's coming out.
The hard part about it, it's not like you can run any studies on this to determine where it is a lot of this is autopsy, and there are scan studies that are looking at things out there. And we'll continue to learn more and more information. But I think, again, this is where we factor in these discussions with parents about not just, hey, should we play contact sports, but also long term, when do you pull the plug and say, maybe we shouldn't be playing contact sports?
Frankye Myers: Yeah, that is really great information. Thank you. What are some preventative measures? So I know with my son it was certain type of helmet that could support high impact.
What are some things that parents or even adults.
John Barley IV, D.O.: Yeah.
Frankye Myers: Who up to college should be looking for as it relates to headgear?
[00:23:01] Speaker B: Yeah. I will say there's nothing out there that is perfect. Okay. So there's a lot of tools, there's a lot of different helmets and equipment that are trying to say we can prove it helps prevent. There's no literature on any of it that says this will prevent a concussion. Now, is there ability to hopefully lessen the symptoms that come along with it? Maybe. Okay. And you can look at some of that. Now, I will say important things. Obviously, there is some literature that says, like, in hockey and some of these other sports, actually wearing a mouth guard is really important. Okay. And so that's going to be really important for that.
They looked at not checking in younger, in younger ages that was able to help prevent it. Now, to your question of, like, is there certain equipment? Well, here's what I would say. Your equipment should be fitting appropriately. Okay. Your helmet should not be popping off all the time. You should be wearing a mouthpiece. Okay.
And properly fitted mouthpiece. Okay. And so if you're gonna be a football player or you're gonna be doing these types of things, wear the equipment and wear it appropriately. I find a lot of athletes, trust me, I try to cheat it myself. When I played back in the day, I didn't like the tight fit, so I let a little bit. I let a little bit of air out to try to make it feel it isn't safe. Okay. And so properly fitted equipment is going to be the most important part. If you are in a youth sport, those helmets should be checked every year, and they should go back to the company and be re evaluated, and they should have a stamp on it saying that this has been checked. Yeah. Yes. And so if you're buying your own helmet, you should be doing the same thing. Okay. So a lot of people are buying their own helmets, but this isn't going on. So. And that's the. Those are big things to look for. Because what you don't want to do is get into a situation where it's not that you're not wearing the appropriate equipment, but the appropriate equipment isn't up to date and. Right. Okay. And especially with football, you have a tendency to watch a lot of football players during practice chew on their mouthpiece. Okay. And it just gets beat up. So properly fitting mouthpieces are going to be important.
All this is really.
It all goes back to that beginning of the year with fittings for equipment and everything else. Taking your time and doing it right is really important.
Frankye Myers: All right, great information. As we wrap up, are there any myths you would like to debunk?
John Barley IV, D.O.: Yes. That's a good one. Well, I mean, I think the one I love, that I love to tell patients right away, is kind of what we talked about. Like, do not, like, if they have a concussion. And everybody, we know that neurologically, they're all right, please don't wake your child up repetitively, like, every couple hours to make sure that everything's all right. Now, going in and just peeking in and seeing. They're fine. I'm fine with that. But you don't have to wake somebody up all the time. That is one. Number two is the old school way of just suck it up and deal with it is not real. Okay. Like, concussions are real. Even though you can't see them, take them seriously. Okay? Follow the return to play progression. Follow the guidelines. If you suspect a concussion, please see somebody who is trained in diagnosing and managing concussions. It's not one to mess with.
This is an injury that is not preventable. Because, look, if you're going to play sports just like we talked about, you're at risk for it.
Frankye Myers: At risk.
John Barley IV, D.O.: But the most important thing is when you suspect one, be evaluated, because if. If you have it, we need to treat it appropriately and do it in the right way. And that could be done. It's just got to be done in the most up to date fashion, because this changes, I will say, since I was playing to now, we're night and day difference. And even in my time, in my training, we've gone through three iterations of our recommendations, and they do reevaluate that every four to five years and come.
Frankye Myers: Out with new recommendations based on research.
John Barley IV, D.O.: Exactly.
Frankye Myers: The more we know, the more we can educate. Exactly that information.
John Barley IV, D.O.: Absolutely. And so that's. That would be important. And with us at Riverside sports medicine, please, like, we're here, we have multiple specialists, and myself, including several other primary care sports medicine doctors, who were trained in managing this, and we've been doing this for a long time, and we're passionate about it. And we also have trained physical therapists who do vestibular rehab and are trained in helping manage concussions and go through this process. So we know how to do this. And if people are interested, just like we talked about, kind of going back to the parents where they're trying to make these decisions, should I let my kid play? Shouldn't I? The Internet is a tough place to find that information because you're going to find a lot of different things out there.
If people are interested, make an appointment to come talk to us. Just about that. I would love to have an appointment with a preventative or just a discussion of like, hey, what can we do? These are the easy discussions.
Frankye Myers: So you're informed. Absolutely. In helping them make that decision. If they want to contact you, would you tell our viewers how to do so?
John Barley IV, D.O.: Yeah. So, I mean, the best way to get through to our sports offices and our sports hotline is our phone number. It's 757-534-6767 that's our sports hotline number that can be reached pretty much throughout the day, I will say, and even into the evening. So if you're, if it's a Friday night, Saturday, whatever day of the week, and your son or daughter's injured, please give that phone call. A call that goes to my athletic trainers who are exceptional at knowing what to do and how to manage it. And even if you're just looking for some advice there, if like what to do in that setting, and even if you're going to say, I'm going to schedule, but I'm really concerned about this, obviously, some of that can be, be helpful.
Frankye Myers: And we do have athletic trainers out in the schools.
John Barley IV, D.O.: We do. Yes. We have contracts at multiple areas, including Newport News.
Well, we contract with them. We have athletic trainers at York County, Isle of White, and then up at Williamsburg, James City County middle schools. So those, if you ever see them out on the sideline and they're wearing Riverside, if you have questions, feel free to reach out to them, too.
Frankye Myers: Right. Great. Doctor Barley, thank you so much for joining us today on the podcast and sharing all this invaluable information. I know you're busy and your commitment and passion is evident, and I enjoy having you. To all our listeners, thank you for joining us. If there are topics you're interested in learning more about on the podcast, please email your idea to Riverside Strong.
John Barley IV, D.O.: Yes.
Frankye Myers: Thank you again.
John Barley IV, D.O.: Thank you so much for having me again.
Frankye Myers: Always.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
