Ice Network

Concussions in figure skating: How to treat them

Flatt shares scary details of past accidents; Leng recounts slow recovery
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Rachael Flatt said her first on-ice concussion occurred during a spin gone awry. -Getty Images

This is the second article in a series about the occurrence of concussions in figure skating. In this installment, we look at the aftermath of skating-related concussions. Please read the accompanying piece on former competitive skater Savannah Lavenstein and her battle with post-concussion symptons here. Read Part I, on the ways in which concussions in skating can happen, here.

Rachael Flatt suffered her first on-ice concussion when she was about 10. She was practicing spinning in the opposite direction, lost her balance and hit her head.

"At first I thought it was nothing serious -- just a headache and I would be fine," said Flatt, the 2010 U.S. champion who graduated from Stanford with a degree in biology last year. "But it was a pretty loud snap and everyone was pretty concerned. My eyes were dilated, and I went to the pediatrician.

"If it had been up to me, I probably would've popped right back up and skated; I am pretty resilient," Flatt continued. "But I ended up taking the next day off from school, which was a really big deal for me, and about four or five days off the ice."

Doctors advised her to rest. Over the next couple of days, she had a persistent headache.

About a year and half later, while on a pairs training session (she skated pairs as well as singles early in her career), Flatt suffered another concussion -- and this one was even worse.

"I blacked out," she said. "I was skating backward, and I hit the back of my head. Then I took a couple of steps and hit my face. I woke up thinking someone else was crying."

After that concussion, Flatt said she took two weeks off from training. Doctors suggested she do everything from stopping skating altogether to wearing a helmet when practicing. While she didn't take their explicit advice, she was cautious in her return.

Flatt's mom, Jody, said her daughter underwent a couple of medical scans, which showed that Rachael had suffered mild concussions.

"After the last concussion she had, Rachael made a very slow progression back onto the ice," Jody said. "And I made sure I was there for every session to make sure she was OK. As a parent, there are a lot of outside forces when your child is training at a high level. We needed to adhere to the doctors' advice, but I also needed to listen to my child."

Most of the skaters interviewed for this story said that the best treatment for a concussion is to take time off the ice. The decision to pull away from training -- even when your own well-being is concerned -- isn't always an easy one for someone like Flatt, who had so much riding on her skating career.

For former pairs skater DeeDee Leng, her recovery from a concussion suffered last April has been gradual. Leng and then partner Simon Shnapir were practicing their throw triple flip, when things went south.

"As I fell, I thought, 'Oh no, this is going to be bad," Leng recalled. "I sat on the ice for a couple of minutes and had a huge bump on my head. I definitely did not think the injury would be anything to this extent."

When she was interviewed a few months later, in July, she was still being treated for her symptoms. She tried acupuncture, electric therapy and, when possible, sleep.

"It has been a slow process," Leng said at the time. "The last time I was on the ice, it was only for 15 minutes. I could not go any longer.

"The brain's pretty tricky. For me, it felt like my brain was shaking in my head. I remember right after I fell being blinded by the sun and just being really tired and nauseous all the time."

Leng, who lives at home with her family in the Chicago suburb of Naperville, said she has only skated a couple of times since her accident. When she has been on the ice, it has often resulted in headaches.

These days, Leng has all but left skating behind. She is taking classes at a local college and is considering a career in industrial design.

"I had to stay busy," she said. "I just couldn't be a potato."

In response to cases like Flatt's and Leng's, U.S. Figure Skating has taken a more proactive role in treating skaters for concussions and in educating coaches, officials and parents about the subject.

Peter Zapalo joined U.S. Figure Skating five years ago as its director of sports science and medicine. When he started, the organization was in the initial phase of crafting its own concussion policy. It's his responsibility, he said, to help skaters at all levels -- from elite athletes to beginners in learn-to-skate group classes -- understand concussion injuries better and how to treat them.

According to Jimmie Santee, who heads the Professional Skaters Association (PSA), there is regular educational programming for coaches regarding concussions, and at the organization's annual conference last year, there was a panel discussion about the topic.

Tom Zakrajsek, who coaches U.S. silver medalist Max Aaron as well as Olympian Mirai Nagasu, said he recently completed a PSA course about concussions.

"Certainly, head injuries are something to be taken very seriously," Zakrajsek said. "There are no negotiations. It is tricky because sometimes a skater falls and you think the skater has hit his head, but really didn't, or you think it is a concussion, but it's not a concussion. But either way, as a coach, you have to err on the side of precaution. And a skater must be cleared by a medical professional to return to the ice."

Below are some guidelines U.S. Figure Skating has laid out for when a skater is believed to have suffered a concussion:

• A skater should be immediately removed from the ice and from competition/training if a concussion is suspected.

• The parent or guardian of a minor skater should be notified.

• The skater should not return to skating (including competition/training) until the skater undergoes medical evaluation by a licensed healthcare profession who is trained and experienced in concussion management and the skater receives written clearance to return to skating. 

 • After the skater has been evaluated and receives clearance to return to skating, the skater's return should involve a supervised step-wise/managed return-to-play plan. 

• While most skaters will recover quickly and fully following a concussion, some will have symptoms for weeks or longer. A repeat concussion that occurs before the brain recovers from the first -- usually within a short period of time (hours, days or weeks) -- can slow recovery or increase the likelihood of having long-term problems. 

• Young athletes are particularly susceptible to the effects of a concussion. Appropriate conservative management is essential for reducing the risk of long-term symptoms and complications. 

Largely through educational seminars for coaches and skaters, and because of the tremendous amount of media coverage the subject has gotten (most notably as it relates to the NFL), treatment of concussions is taken much more seriously nowadays than it was in the past.

The International Skating Union does not have a standard protocol for handling concussions, but Jane Moran, chair of the ISU Medical Commission, said the organization is in discussions with a number of international federations and ISU members to get one in place. She lauded U.S. Figure Skating and Skate Canada, which have shared their educational materials and research on the topic of concussions with the ISU.

"Educating coaches, skaters, parents and all support staff is key," Moran wrote in an email. "The media has done a very good job in recent years of making the general public aware of concussions."

Flatt, now a coach in San Jose, California, has noticed that younger skaters are more well-informed on the topic.

"I was just at the rink about a week ago, and a little girl fell and hit her head," said Flatt, who estimated that the girl was 9. "About two or three other girls picked her up immediately, and she was off the ice. She was very disoriented. The other girls told her, 'Look, you're coming off the ice.' The girl is OK, but she took time off. It was good to see that younger skaters understood."

Flatt said that it is important for skaters and coaches to be on the same page when it comes to concussions and the precautions they should take when one is believed to have occurred. As much as she would like to think that more skaters and coaches would be agreebale to taking time off the ice for health reasons, competitive juices can sometimes make the gray matter a little more gray.

"If your world standing depends on taking off an event, then you might be a little more hesitant," Flatt said. "It really depends on the relationships between coaches, skaters and parents. It can be difficult. But the good part is that the conversation has gotten started."