DocBottsNY (@docbottsny)

Rest is not the treatment. For example, Cocoon, quiet room, no stimulation. No. After the first day or two, start exercise. I do not clear on rest.

More padding outside the helmet does not decrease the risk of concussion. High school players using the Guardian Cap showed no difference in concussion risk. Rotational and acceleration-deceleration forces still deform the brain inside a hard skull.

#sportsmedicine #concussion #athletictrainer

Stop testing your injuries. Hamstring strains, gastroc strains, rotator cuff strains: athletes start feeling better, they want to get out there and test it, and they re-injure themselves. The key to success is a stepwise, graded return to play. When you start feeling good, don't ramp up from zero to 100 miles an hour. Take those incremental steps so you can test with guardrails and prevent re-injury.

Kneecap subluxations and patella dislocations. Sometimes these can be treated without surgery, but if it keeps happening and becomes a chronic instability, it needs to be fixed surgically. If your kneecap hurts or it's popping out of the groove, get evaluated.

Perfect is the enemy of good. It's one of my favorite sayings. Whether you're a student athlete chasing the next level or a recent grad training for a marathon, perfectionism is working against you. In sports medicine, the goal is to meet your body where it is. Your body may or may not respond exactly how you want it to, so listen to what it's giving you.

I'm a big believer that your feet can do amazing things for your balance and proprioception if you train them. Too much padding between you and the ground can impair your body's ability to know where it is in space. Minimalist shoes have a place, but if you're moving from regular padded shoes to barefoot shoes, take your time and build resilience in your feet first.

Training for life is the goal, for me and for most of my patients. When you're thinking about athletic injury, I like the 80/20 rule: 80% of your workouts relatively easy (60% HRmax), 20% a little more high intensity (80+% HRmax). That can apply to a single workout or your training overall. The goal is to not get injured and keep training.

If you don't want CTE, the main thing we're trying to prevent is chronic repetitive trauma to your head. If you're fighting, you're not sparring heavy every day. If you're playing football, it's not a live practice every day. You don't use your body or your face as a weapon.

After a concussion, we often prescribe the joint position error test to help improve head and neck control. We also want to get back to sport-specific movement as fast as possible, and we can start with something as simple as single-leg balance, eyes open and eyes closed, to improve balance and proprioception.

Training journal = intensity, duration, pain score. That’s not busywork — it’s a vital piece of return-to-play after injury, and a smart way to stay mindful of how your body responds to training demands.

When symptoms plateau 24–48 hours after a sports-related concussion, don’t keep resting as “treatment.” Start zone-one active recovery — walking or light bike — and get evaluated by a sports physician quickly. Don’t delay.

Overuse and stress injuries aren’t one-cause problems. Sleep, recovery time, ramp-up, and training load all matter — and biomechanics (like with shin splints) can tip you over the edge. Address the whole picture, not just the sore spot.

When you get back to the weight room after a concussion, don’t overdo it. First day of resistance work: roughly 50% of your prior load and total reps — just enough stimulus to confirm heart rate and blood pressure are responding appropriately.

After a concussion, imaging is not automatic. Red flags on sideline or with your athletic trainer or team physician can mean an urgent CT scan to rule out bleeds and fractures. No red flags? We treat you based on the symptoms, exam, and computerized testing — although MRI technique is improving, we currently cannot diagnose acute concussion with imaging. MRI is emerging tech, but not prime time yet.

During concussion recovery we want to get to re-integration of sport-specific skills ASAP. Isolated exertion is first though. When tolerating controlled exercise around 160–170 bpm on treadmill or stationary bike, then we progress sport-specific training — because reconditioning those athletic skills helps prevent the next injury.