Concussions and Your Young Athlete
By Dr. John Stavrakos
Ah, springtime – sunshine, kids playing outside, the resumption of outdoor sports…and more opportunities for head injuries. Given the recent media attention on concussions in NFL players, I thought a few words on the subject might be helpful for those families whose child suffers a concussion in a game and then wonder “now what?”
A concussion is defined as a head injury with a temporary loss of normal brain function, with potential for problems that can range for a few seconds to a lifetime. According to the Center for Disease Control, it ranks only second to vehicle accidents as a cause of brain injury in 15-24 year olds. A 1999 study in JAMA found football to have the highest incidence of concussion, followed by wrestling, girls’ soccer and then boys’ soccer. It’s estimated that in a given football season, 10% of all college and 20% of all high school players may sustain a head injury. Defensive backs tend to lead the pack in terms of highest incidence of head injuries, followed by kick returners and then receivers, according to a 2006 study of NFL players.. Chances are, if you’re a “football dad” or “soccer mom” and if your child has not received a concussion, you’ll know of at least one who has by the time your own kids get their high school diplomas.
Of larger concern lately is the potential for long term effects of repeated head injuries; in boxers, this was formerly labeled “Punch Drunk Syndrome.” One more commonly used term is Chronic Traumatic Encephalopathy (CTE), which may be linked with increased risk of depression, substance abuse and suicide. Recent news has highlighted the inspection of the brains of former NFL players who have donated their remains to research. These players had a history of repeated head injuries, and researchers found that their brains showed signs of premature aging. The brain of one player, for example, who committed suicide in his mid-40’s, had the appearance of that of a man in his 80’s.
Don’t Hang Up the Jersey Just Yet.
Before every parent reading this throws away their children’s football helmet or soccer shoes, you should know that the majority of concussions sustained are mild in severity and usually resolve. While statistics show that sustaining a concussion a second time is roughly four to six times more likely after the first, most athletes, if properly evaluated and held from play until symptom free, do return to their sport without incident.
So, how to evaluate a concussion? Well, one problem lies in the fact that there are over forty different grading systems in existence, and even world experts don’t agree on certain points, such as when it’s safe to return to play. In 2001 in Vienna, a panel of experts did all agree to the following: 1) that an athlete with signs of concussion needed sideline evaluations and repeated assessments until all post concussive symptoms (e.g., nausea, headache, lack of coordination, etc.) resolved, and that 2) neuropsychological testing played an important role in management of the injury. No matter what system your sideline evaluator uses, I’ve found that most physicians I’ve spoken to about this tend to agree on the following:
1. Athletes age 18 or younger sustaining a concussion during a game or practice should not be allowed to return to play the same day. This is not a universal agreement, but most sideline doctors follow the motto “when in doubt, sit them out.”
2. An athlete cleared to play should be watched closely for symptoms on his or her first game or practice back. Headache with activity is the most common symptom, but lack of coordination, slurred or garbled speech and other signs can occur. Any of these warnings means sitting the athlete right away. Receiving a second concussion while still symptomatic from the first can lead to Second Impact Syndrome, a rare but often fatal condition where blood entering the skull cavity exceeds blood leaving it, causing the brainstem to herniate or be forced through the opening in the base of the skull (yes, it’s as bad as it sounds).
With concussion, the saying “never underestimate a headache” should be taken as gospel. As some concussed athletes aren’t aware they’re hurt and may try to re-enter a game, a good practice is to take away their equipment until they’ve been cleared to return (for example, hiding or holding on to their football helmet or cleats).
Luckily, some schools in our area have invested money into neuropsychological testing programs that “baseline” athletes prior to a season and use that as comparison in case of concussion. This aids in determining when the athlete is ready to return to play. While not foolproof, this testing has the benefit of allowing parents and coaches to be proactive. The testing is easy to administer and doesn’t tend to be cost-prohibitive. They do require a licensed psychologist to interpret the results, and the tests themselves are not immune to ‘cheating’ by athletes; by ‘dumbing down’ their responses on the baseline testing, athletes try to make their impaired state look more ‘normal’ in an effort to retake the field sooner.
If your young athlete suffers a concussion, a team approach to evaluation, treatment and recovery is necessary to give them the best chance of improvement, and a hopeful return to playing. Be sure to ask questions and keep in close contact with your child’s physician and athletic trainer regarding any symptoms you see at home that might raise concern. Armed with knowledge and working as a team, we stand the best chance of getting our superstars safely back to the sports they love.