A concussion is a mild brain injury caused by a hit, fall or sudden force that makes the brain move quickly inside the skull. They can be devastating for athletes, as they must refrain from intense physical activity during the recovery period. For Addison, a 15-year-old cheerleader from Sellersville, Pennsylvania, she sustained a concussion when she took an elbow to the face during practice.
In cheerleading, there are various positions, and those positions all must work in harmony to complete the stunts performed in routines. When every team member is not successfully doing their part, mistakes arise and injuries occur. Addison’s position is a “base,” meaning she is one of two people responsible for holding up the “flyer” who gets raised into the air. The other base in this group was a novice, and a false movement caused the flyer to fall. To ensure the flyer didn’t forcefully hit the floor, Addison tried to catch her, and in the process, was elbowed in the nose.
Addison had initial head pain that did not subside through the following weekend, so she went to an urgent care center in Doylestown, Pennsylvania. The urgent care center referred her to Shriners Children’s Doylestown, and she was seen that same week. She saw Sara Kaskowitz, D.O., a sports medicine physician. During a comprehensive evaluation, Dr. Kaskowitz diagnosed Addison with a concussion after identifying symptoms including headaches, nausea, dizziness, fatigue, brain fog and balance difficulties following her injury. She developed an individualized treatment plan that included concussion education, guidance on a gradual return to school and activity, close follow-up, and referral to specialized physical therapy (PT).
Addison's story is a wonderful example of why concussion recovery is different for every child and athlete.
Over the following weeks, Addison made excellent progress with her rehabilitation. Her nausea, dizziness, fatigue and cognitive symptoms resolved, allowing her to return to many of her normal activities. However, she continued to experience pain at the base of her skull (suboccipital pain), along with lingering headaches and balance difficulties. Since Addison's remaining symptoms were localized to the suboccipital region and had not resolved despite otherwise excellent recovery, Dr. Kaskowitz recognized she was an appropriate candidate for targeted botulinum toxin injections. She referred Addison to Bethany Lipa, M.D., a physical medicine and rehabilitation physician who performs the injections.
Addison traveled to Shriners Children's Philadelphia to meet with Dr. Lipa and receive the injections. After numbing cream was applied, she received two ultrasound-guided injections at the base of her skull. One targeted a painful muscle trigger point, and the other targeted the suboccipital nerve that was causing her remaining symptoms. The procedure took only a few minutes, and within days Addison was pain-free and no longer experiencing headaches.
Dr. Kaskowitz performed a repeat concussion evaluation and determined Addison was back to her baseline before the sports injury. Dr. Kaskowitz said, “Addison's story is a wonderful example of why concussion recovery is different for every child and athlete. She worked incredibly hard throughout her recovery and when she continued to experience lingering symptoms, we kept looking for the reason why. Once we identified the final piece of the puzzle, she was able to make a full recovery and safely return to the sport she loves. Knowing she can return healthy and confident is incredibly rewarding."
Addison no longer attends PT and can now return to the activities she loves: cheerleading, swimming and going to the beach. We look forward to seeing her thrive in all her future endeavors.
Concussion care at Shriners Children’s Philadelphia is dynamic and prioritizes the patient’s ability to comfortably return to normal activities. Our team helps with all aspects of concussion care: from medical management to rehabilitation expertise and a custom recovery plan – all under one roof. If you know of someone who could benefit from our care, call us at 215-430-4000.
