As an assistant team physician for Rutgers Athletics and the former medical director for Sky Blue FC, Dr. Jason Krystofiak works with hundreds of athletes every year to safely return them to play after a concussion.
In the old days, the prescription for a concussion was generally to rest for weeks and sometimes months and avoid loud noises and bright lights. But Dr. Krystofiak has supported an entirely new approach to concussion treatment rooted in cutting-edge research.
Now, the lessons he learned to treat NCAA Division I and professional athletes are being incorporated with patients at the Matthew J. Morahan III Health Assessment Center for Athletes at RWJBarnabas Health, where he is the medical director.
“We’ve incorporated the same tools that we would have used on elite athletes and molded them to fit every day people who suffer from a concussion,” Dr. Krystofiak said. “They may not be getting back on the field, but they can get back to their normal activities of daily living much faster.”
Most people who have concussions do not have access to the same level of care as professional and high-level college athletes, who often receive immediate care from trainers or team doctors who are on the field or in the locker room. Doctors can also analyze video footage of the injury, often from multiple angles.
“For the weekend warriors, or for the other injuries that are non-sport related, we typically see them a few days later,” Dr. Krystofiak said. “So we're relying on a really good history and emergency department or primary care physician evaluation, if applicable.”
Concussions from non-sports athletes are typically either younger age or middle-aged adults who were involved in a motor vehicle accident, been hit in the head by a falling object, may have slipped on ice, or fallen off a bicycle.
“Very often, these people don’t go to the emergency room, they just shake it off, or sit on the sidelines,” Dr. Krystofiak said. “Then later, they start feeling confused and irritable, start having a headache, become light and sound sensitive.”
In these cases, the previous typical treatment was physical and cognitive rest until the symptoms resolve. Dr. Krystofiak said recent research has called that approach into question.
“Recent research has found that prolonged physical and cognitive rest may not be as effective for concussion management as previously thought,” he said.
At the heart of Morahan Center’s treatment is a technique called active recovery — basically returning to a prescriptive exercise plan under clinical supervision soon after the injury.
The injured patient must first undergo a treadmill testing analysis to determine an exertional threshold right below the level that would cause symptoms.
“This is a way to increase blood flow to the brain without causing a rise in symptoms,” Dr. Krystofiak said.
At the same time, Dr. Krystofiak administers other tests that allow him to determine when patients can begin cognitive loading, meaning a return to academics or work.
“Prolonged cognitive rest is no longer recommended for anyone who has a concussion,” Dr. Krystofiak said. “We can give a prescription for accommodations to make sure they can do the work. For example, we could tell them to take breaks; they can go to the nurse. They can avoid certain classes or work tasks, if they're more cognitively taxing.”
In addition, Dr. Krystofiak said he makes sure patients are sleeping well and maintaining good nutrition because calories are important to make sure the body stays fueled and heals.
“Hydration is critical,” he said. “Dehydration can cause headaches and can worsen a concussion headache.”
“When you look at all these treatments we can do for the individual, we can really set them up to be healed a lot faster,” Dr. Krystofiak said. “It's basically augmenting, the natural healing process that the body needs.”
Dr. Krystofiak said he will continue to be guided by the latest concussion research and patients will benefit from the advancing knowledge.
“We know more about concussions today than we did 10 or 20 years ago, but we’re still at the tip of the iceberg,” Dr. Krystofiak said. “How we treat concussions is likely going to change in the next five to 10 years. It’s a constantly evolving field.”
The Matthew J. Morahan III Health Assessment Center for Athletes at RWJBarnabas Health serves over 30 school partnerships in New Jersey and has completed over 40,000 screenings since 2010.
To schedule an appointment for a concussion or sports-injury evaluation contact the center at 973-322-7913 or schedule online by visiting www.rwjbh.org/morahanappointment.