The University of Kansas Health System

Concussion Puts Hoop Dreams on Hold

Caroline Hoppock Gets Assist from Sports Neurologist

Caroline Hoppock, 19, can spin a basketball on one finger, hit a mid-range jumper and make a driving layup. After all, she's been practicing since she was 5.

At Olathe East High School, Caroline started on the varsity squad her sophomore through senior years. After her 2017 graduation, she signed on with the Lady Blue Devils at Kansas City Kansas Community College.

"I have the best teammates, my coach is phenomenal and I like going to college close to my mom and dad in Overland Park," says Caroline.

Freshman starter gets stopped

At the beginning of the 2017-18 season, Caroline helped her team achieve a 6-game winning streak. Then, on November 15, the Lady Blue Devils hit the road for an away game against North Arkansas College.

Caroline remembers every detail. "I was going up for a rebound and got tied up with another girl," she says. "I got an elbow to the nose, fell backward and hit my head on the floor. But I held on to the ball!"

When Caroline stood up, she had a bloody nose and a concussion. "I knew right away," she says. "I had a headache and saw stars."

The next day, the team returned to Kansas City, where Caroline took a computerized concussion evaluation. It measures attention span, memory, problem solving and reaction times. She scored dramatically lower than she had before the season began.

J.P. Darche, MD, is one of the team physicians for the Lady Blue Devils and a sports medicine physician at The University of Kansas Health System. He diagnosed Caroline with a concussion and restricted her activities until she was symptom-free. Once she started to feel better, she followed concussion guidelines to help her safely return to play.

Two steps forward, one step back

In December, Caroline was released to play and suited up for her first game back. She was only on the court a few minutes when she noticed things weren't right. "The headache came back," she says. "I felt slow and foggy."

Dr. Darche and the Lady Blue Devils head athletic trainer Rodney Christensen agreed that Caroline should pull back from team practice and play. She focused on light workouts and noncontact activity.

Around this time, she developed vertigo. Just lying in bed could cause the room to spin. Looking up and down from her notes to the front of her classroom made her dizzy and nauseated.

Caroline didn't know whether her symptoms were related to the concussion, being out of shape after not playing for several weeks, a recent head cold or her history of ear and vision problems.

Her ear, nose and throat physician at another healthcare facility treated her for ear and sinus infections. He then recommended vestibular therapy, an exercise program often prescribed for balance disorders. Sitting on the bench for the rest of the season was hard for her, and to make matters worse, her grades started to slip. "It was frustrating," she says. "I just wasn't 100%."

Dr. Darche remained in contact with Caroline's athletic trainer. They were concerned about her inability to make a full comeback. She could shoot a 3-pointer with no problem, yet she became dizzy when she drove to the basket and leaned her head back.

"As a sports medicine doctor and athlete, I've seen a lot of concussions," Dr. Darche says. "They're not always easy to diagnose. The symptoms are the same for a long list of other illnesses. And Caroline's case was complicated because she had several pre-existing ear and vision conditions."

It was time to call in a specialist.

Team support

When Caroline's symptoms did not completely resolve, Dr. Darche reached out to an expert at The University of Kansas Health System. He referred her to Michael A. Rippee, MD, a sports neurologist at The University of Kansas Health System.

Caroline's mom, Nancy, knew they were in good hands. "We are big believers in The University of Kansas Health System," Nancy explains. "My dad was there for 9 weeks with myasthenia gravis, and they saved his life."

Dr. Rippee addressed Caroline's neurological symptoms. He said she probably experienced both a head and neck injury. "If you move the head around enough to cause a concussion, you will probably move the neck around enough to damage it, and perhaps the spine, too," he says.

Some of the neurological wiring that contributes to dizziness and headaches is located at the top of the spinal column. Vestibular therapy or strenuous activity can aggravate the neck problem, making symptoms worse.

"Dr. Rippee was amazing," says Caroline. "He spent more than an hour with my mom, my team athletic trainer and me. He answered all our questions. After our appointment, I was no longer worried or scared. I was confident he could help me."

Time out for therapy

Caroline needed cervical (neck) therapy performed by a specially trained physical therapist. Dr. Rippee referred her to sports medicine physical therapist Emily Volker at KU MedWest in Shawnee, Kansas.

During cervical therapy treatment, Emily led Caroline through stretches and exercises designed specifically for the muscles and ligaments in her neck and shoulders.

The goal of cervical therapy is to improve flexibility, range of motion and strength. Emily also performed manipulations on Caroline's neck to relax the neck muscles and get her joints moving properly.

"The neck therapy really kickstarted my improvement," says Caroline.

Her mom agrees. "Once she started the cervical therapy, her headaches started to go away. That was key to getting her released to play again."

Defending the brain

Athletes are often in a hurry to get back to their sport after a concussion, but it's important to take the time to heal. It's also critical to seek a specialist who has expertise in brain injuries.

As a sports neurologist, Dr. Rippee's goal is to care for the overall brain health of casual, amateur and professional athletes of all ages.

"We focus on concussions, spine injuries, repetitive-use issues and peripheral nerve damage," says Dr. Rippee. "We also help athletes with chronic neurologic problems who want to keep playing or improve their performance."

The sports neurology team works closely with physicians like Dr. Darche and therapists like Emily at our Sports Medicine and Performance Center to provide interdisciplinary care for athletes. Dr. Rippee also communicates with athletic trainers, physicians and coaches on his patients' teams.

"Athletic trainers make my job a lot easier," Dr. Rippee adds. "I can recommend a recovery plan, but athletic trainers keep the patient on track."

Caroline's athletic trainer agrees. "She had a complicated recovery. It really took a village to help her," he says.

Back on the court

On July 12, 2018, Dr. Rippee cleared Caroline to play basketball again. It had been 240 days since her concussion.

Caroline hugs a basketball and smiles as she talks about her experience. "I'm lucky Coach Mac (Joe McKinstry) didn't give up on me. And now I hope to prove myself to him again. I want to get back in the starting lineup and help my team win."

She has big plans for her sports career, too. "Someday I'll go to a Division I school, then play pro ball in Europe," she says. "Ultimately, I'd like to coach at the high school or college level."

But for right now, Caroline is focused on the Lady Blue Devils, "I'm just excited to get back on the court with my teammates."

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