Triple Salchows, Accurate Looking, and the Role of Exercise in Concussion Rehab

Although it was a typically sunny day in Colorado Springs, it was cold beside the ice rink in the Olympic Training Center. On assignment with the Good Athlete Project, a fellow coach and I stood against the glass watching elite athletes make toe loop, axel, and salchow jumps look easy. We stood there in awe, wondering how many hours it must have taken them to reach that level of expertise. Soon, a pair of young skaters approached our end of the rink. The female partner had successfully completed a triple loop off a throw twice before, but on the third attempt her toe caught and she hit the ice, hard.

In addition to bumps and bruises on the body, it is safe to assume that there was some effect on her brain.

The high speeds she reached (due to the speed of their approach and rotational inertia) might have approached 360 RPM. The impact incurred upon landing (ice is unforgiving…) would have certainly produced the shearing effect and minor structural damage in the brain we call “concussion.” With or without symptoms, it is safe to assume this level of impact would have had some negative effect on her brain. Degree and frequency determine how dangerous these falls can actually be (a nearby coach estimated a skater falls 20-30 times per session), but the obvious fact remains: figure skating is dangerous. I say this not to demonize the sport, but to reinforce the idea that concussions are not limited to contact sports. And since the vast majority of the 2.5 million people who visited the emergency room for TBI (traumatic brain injury) went for falls unrelated to sport, it is clear that concussions are a human issue.

If concussions are indeed a human issue, we should take care to look at the issue accurately. Football, the NFL in particular, has received the bulk of the concussion concern, with some calling for its elimination. Hockey, rugby, and wrestling are under increasing critique. While we should look closely at these notably high-contact sports, we should not stop there; a responsible approach will aim to protect all athletes.

And since sports are a potential mechanism for concussion, we need to increase preventative strategy during practice and competition, limiting the number of overall impacts incurred throughout a season. Governing bodies need to continue to implement and reassess the rules of all games. Local institutions should mandate preemptive strength and conditioning programs which protect the core, neck, and head. Upon injury, we should continue to improve our readiness and strategy for quick and conservative identification of concussion; and when a concussion has been diagnosed, mandate participation in diligent and directed rehabilitation under the guidance of a professional. If sports are not going anywhere, productive allocation of resources will be aimed at making the games safer, not misguided attempts at their elimination.

Physical Educators play a huge role in prevention with improvement and widespread implementation of strength and conditioning programs. Recent research suggests that there might be a role for Physical Educators in rehabilitation as well, as exercise has been linked to improvements in TBI patients. NYU professor and author of Healthy Brain, Happy Life, Wendy Suzuki, paired with Teresa Ashman to design an experiment to measure these effects. Their results were encouraging. Participants who exercised two times per week for eight weeks demonstrated significant improvement in mood and quality of life, and scored lower on measures of depression and fatigue (Lee, Ashman, & Suzuki, 2014). There seems to be an opportunity here for Physical Educators. The opportunity will begin to take shape after asking 5 essential questions:

  1. How often do Physical Educators communicate with the school’s Athletic Training Staff?
  2. Are you familiar with your school’s Return-to-Play protocol following concussion?
  3. How strong is the relationship between your school’s Athletic Training Staff, Athletic Department, and Physical Education Department?
  4. If exercise were to be used in Return-to-Play recovery protocol, who would be the experts on campus? (I hope the answer is you!)
  5. What opportunities are there in the existing school day for individualized exercise programs? Before school (zero hour)? During free periods? After school strength programs?

Recognizing the potential of exercise in the rehabilitation of concussion is essential, acknowledging that there are exercise experts on campus (PE teachers) is key, but answering those 5 questions will begin to build a path toward implementation. It works. The next step is to figure out how it works for you, at your school. Each school will be unique.

Among many benefits, exercise has been repeatedly linked to improved cognitive function (Cotman & Engesser-Cesar, 1985; Voss, et al, 2013), decreased stress and anxiety (Herring, O’Connor, & Dishman, 2010; Adlard & Cotman, 2004), and now demonstrates positive effects on those effected by TBI. Physical Educators can play an important role on both ends of the injury spectrum: prevention and recovery. That is, if they chose to take full advantage of their platform.


The skater’s partner helped her up off the ice and she dusted herself off. She did not appear symptomatic. Her coach called out to her. She took a moment and gave a quick “thumbs up” before skating on, prepping for her next attempt. She’s probably fine. The minor damage she could have incurred will more than likely fully heal. But it’s worth taking a look. Accurate looking, cautious care, deliberate thinking… that’s the whole idea.


*this article was originally published on SlowChatHealth


  • Voss M.W., Vivar C., Kramer A.F., van Praag H. (2013). Bridging animal and human models of exercise-induced plasticity. Trends in Cognitive Science 17(10) 525-544.
  • Herring M.P., O’Connor P.J., and Dishman R.K. (2010). The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review. Archives of Internal Medicine, 170: 127-133.
  • Adlard P.A., and Cotman C.W. (2004). Voluntary Exercise Protectts against Stress-Induced Decreases in Brain-Derived Neurotrophic Factor Protein Expression. Neuroscience 124: 985-992.
  • Cotman C.W. and Engesser-Cesar C. (2002). Exercise Enhances and Protects Brain Function. Exercise and Sport Science Reviews 30: 75-79.
  • Lee Y.S., Ashman T., Shang A., and Suzuki W. (2014). Brief Report: Effects of Exercise and Self-Affirmation Intervention after Traumatic Brain Injury. NeuroRehabilitation 35: 57-65.


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