Jan 29, 2015
All Eyes On Concussions

dawncomstock-head.jpgBy Dawn Comstock

Because of the high incidence and serious nature of concussions, the Brain Injury Association of America (BIAA) designates every March as brain injury awareness month. This year, the BIAA is dedicating their efforts to concussions in youth sports. Dawn Comstock examines this important issue and provides guideline analysis and communication tips for treating and educating high school athletes.

If it’s not already on your calendar, consider joining in the BIAA’s mission by making a concerted effort this month to talk with your athletes about concussions. If most of your athletes have already heard your lecture, consider switching it up by finding a new way to convey the message. New research on concussions means the current state of knowledge is continuously evolving. Keep up to date on concussion facts and materials and learn new ideas for talking with your athletes by visiting the BIAA Web site. Another great resource is the Centers for Disease Control and Prevention web site, where you can order a free concussion toolkit.

The primary focus for athletic trainers is to keep athletes as strong and healthy as possible so they can play sports and have fun while doing so. Part of this involves properly managing injuries so our athletes are fully recovered when they return to play. We all know that being fully recovered helps prevent the risk of re-injury. Of course, keeping an injured athlete out of the game is not always as easy as it seems. Athletes desiring to compete might try to mask their symptoms. Coaches, parents, or other teammates who are not aware of potential adverse, long-term consequences might encourage injured athletes to play through the pain in order to help out their team.

Return-to-play decisions become particularly concerning when the injury in question is a concussion. Concussions account for almost one in 10 sports-related injuries. The Centers for Disease Control and Prevention (CDC) estimate that individuals in the United States sustain over one million sports- and recreation-related concussions every year. More than simply a bump on the head, concussions can be serious injuries if not properly treated. Athletes who return to play before fully recovering are at risk of negative outcomes, including serious lifelong physical and mental health problems or even death.

Properly managing concussions includes two separate issues: 1) Diagnosing concussions when they occur. 2) Ensuring a concussed athlete complies with recommended return-to-play guidelines.

For success, a multifaceted approach is needed that engages the entire sporting community, including medical professionals, coaches, athletes, and parents/guardians.

Too many concussions go undiagnosed because the athlete is unaware they sustained an injury or because they fear having to sit out during the next big game. As coaches and athletic trainers, we need to educate and remind our athletes and parents on the signs and symptoms of concussions. Reinforce that it is better to sit out one or two games now than to sit out for an entire season if an undiagnosed or untreated concussion results in additional problems down the road. Remind athletes that most concussions do not result in a loss of consciousness, and that they can sustain a concussion even if they do not receive a direct blow to the head.

Concussion signs and symptoms:

• Headache • Nausea • Balance problems or dizziness • Double or fuzzy vision • Sensitivity to light or noise • Feeling sluggish or tired • Feeling foggy or groggy • Trouble concentrating • Trouble remembering • Confusion

Deciding when an athlete should return to play following a concussion can be confusing, especially given that over 20 return-to-play guidelines currently exist. In 2001, concussion experts from across the world convened during the inaugural International Symposium on Concussion in Sport to establish a consensus for concussion identification and management. These guidelines were subsequently updated in 2004 during the 2nd International Symposium on Concussion in Sport in Prague. The Prague guidelines represent the current consensus on return-to-play.1 Ensure that all medical and coaching staff on your teams are familiar with these guidelines.

Following a simple concussion: • No return-to-play on the same day. • Player should not be left alone. Monitor them regularly for deterioration • Player should be medically evaluated. • Follow a step-by-step return-to-play protocol. Athlete should continue to proceed to the next level if asymptomatic at the current level. If symptomatic, the athlete should drop back to the previous asymptomatic level and attempt progression after 24 hours.

The following is an example of a progression: (1) No activity, complete rest (2) Light aerobic exercise (walking, stationary cycling, etc.), no resistance training (3) Sport-specific exercise, progressive resistance training (4) Non-contact training drills, progressive resistance training (5) Full contact training after medical clearance (6) Game play

Recent, unpublished findings from the National High School Sports-Related Injury Surveillance Study, which has collected data on 1,308 concussions since the 2005-06 school year, found that a large number of adolescent athletes are returning to play before fully recovering from concussion.

• Under Prague return-to-play guidelines, at least one in six concussed high school athletes returned to play too soon • In soccer, basketball, baseball, and softball, boys were more likely than girls to be non-compliant with Prague return-to-play guidelines (22 percent and 12 percent, respectively) • During the 2007-08 season, one in six football players who sustained a concussion and lost consciousness returned to play the same day

These results indicate that we still have a ways to go in educating our fellow coaches and athletic trainers in concussion management. Take the opportunity now to be proactive in spreading the facts about concussions in order to ensure our athletes are able to recover as quickly and completely as possible.

REFERENCE 1) McCrory P, Johnston K, Meeuwisse W, Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Kelly J, Lovell M, Schamasch P. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 2005;39(4):196-204.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at: [email protected].

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