Tuesday, October 14, 2014

Concussions, The Silent Epidemic In Sports

  It's another Friday night under the lights, and just like every other high school football team in America, the Tipton Cardinals are trying to win another game.  But this game was special, it's the first round of the Missouri state playoffs.  It's a chilly Halloween night as Chad Stover, a 16 year-old defensive back, leads the Tipton Cardinals on the field to stop their opponent.  In the third quarter Tipton is trailing Sacred Heart 27-18.  Sacred Heart has the ball and is looking to score again.  The ball is snapped and the running back takes the hand-off.  Chad Stover zeros in on the running back and goes in for the tackle.  As Chad collides with the running back, his head violently strikes the running backs thigh.  That was the last tackle that Chad Stover would ever make.  

     Chad managed to make it to the sidelines, but something wasn't right.  Twice his coach asked if he was okay.  Chad said he was and went back into the game.  In the huddle he told his teammates, "Somethings wrong."  Chad's legs went weak and he collapsed on the field.  His parents watched in horror from the bleachers.  In the state of Missouri, or any of the 50 states for that matter, it is not required by law for an ambulance to be present at a high school football game.  911 was called, and shortly arrived to tend to Chad.  He was placed on a stretcher and life-flighted to near-by Columbia University Hospital.  Chad had sustained a severe traumatic brain injury (TBI) comparable to a motor vehicle collision.  He would remain on life support for two weeks until he passed on November 12, 2013 with his family by his side.

     Head injuries in sports has become a serious topic of discussion in recent years.  In a court filing made public on September 12 the NFL estimates that nearly one-third of former players will develop dementia, Alzheimer's disease or other neurological  disorders like Parkinson's and ALS.  These statistics are a stark contrast to the NFL's position for years that there was no risk of neurological disorders after a career of taking blows to the head.  
     A recent study published by the Journal of the American Medical Association followed 25 college football players with no formal concussion history and found that the players had significantly less than normal volume in the hippocampus, the region of the brain that is in charge of memory.  In another study conducted by the University of Rochester, researchers found a significant decrease in white matter in the brains of college football players who were relatively concussion free.  

     If you think that just college and NFL players are at risk of head injuries because they have more violent collisions, then think again.  Children are at much greater risk of sustaining head injuries then adults because their brains are still developing.  Virgina Tech's biomedical-engineering department tracked 19 boys ages 7 and 8 during the 2011 and 2012 seasons.  The researchers counted 3,061 blows to the heads of the boys, 60% of which occurred in practice.  None of the boys sustained a concussion, but the hits were violent nonetheless.  11 of the hits registered a g-force of 80 or greater, which is what you would see in a motor vehicle collision.

     In light of the shocking research that has been released, many parents are thinking twice before letting their sons or daughters play collision sports.  From 2007 to 2013, tackle football participation has fallen 26.5% among U.S. kids ages 6 to 12, according to the Sports & Fitness Industry Association.  

What is a Concussion?

     So what is a concussion?  A concussion occurs when their is trauma to the head, neck, or body that results in damage to the brain.  When the body sustains a violent blow, the brain is shaken inside the cranium.  The brain has billions of nerve cells and some of them may be injured or even broken when the head or body takes a hit.  

Signs and Symptoms of a Concussion

     It is important for everyone to know and understand the signs and symptoms of a concussion, including the athlete, the coaches, and the parents.  Here are some of the signs and symptoms of a concussion.

Loss of consciousnessSeizure or convulsionBalance problemsNausea or vomitingDrowsiness
More EmotionalIrritabilitySadnessFatigue or low energy Nervous or anxious
"Don't feel right"difficulty rememberingheadacheDizzinessConfusion
Feeling Slowed down"Pressure in head"Blurred visionSensitivity to lightAmnesia

Concussion Treatment 

     Whenever a concussion is suspected in an individual it is important to have a trained provider perform a thorough orthopedic and neurological exam of the head and neck to determine the extend of the injury.  The best treatment for a concussion is physical and cognitive rest.  This means no physical or mental exertion until the signs and symptoms of the concussion have subsided.  The individual should slowly return to their normal activities as their symptoms decrease, but if their symptoms worsen they should return to their previous level of activity where they had no symptoms.

Return to Play Protocol

  1. Rest until signs and symptoms go away.  
    • Must remain symptom free at each step.
    • Minimum of 1 day at each step.
  2. Light aerobic activity
  3. Sports specific activity and training 
  4. Non-contact training drills
  5. Full contact training drills
  6. Competition
7 Tips to Concussion Prevention

     It is important to understand that as long as you or your child are involved in a contact sport, you are at risk of getting a concussion.  No helmet or piece of equipment can fully prevent a concussion, but there are some steps that you can follow to reduce the risk of a concussion.
  1. Educating the athletes, coaches and parents on the signs and symptoms of a concussion.
  2. Base-line concussion testing of all athletes in the pre-season.
  3. Proper training and technique on how to tackle and take a hit.
  4. Proper equipment.
  5. Stricter rules that punish unnecessary roughness. 
  6. Proper strength training, especially of the neck.
  7. When in doubt, hold them out.
     We live in a dangerous world.  Whether we are walking down the street, driving down the road, or playing a contact sport, there will always be inherent risk.  Hopefully as doctors and scientist continue to do research and learn more about concussions, we will be able to find a middle ground of preventing concussions and enjoying some of our favorite sports.  Until that time, educate yourself on concussions, play safe, and when in doubt, sit them out.  

1. Gregory, Sean. "The Tragic Risks Of An American Obsession."  Time. September 2014: 32-39. Print