Concussion expert Dr. A. Chainey Umphrey has assessed the damage youth sports can inflict. He has seen it ruin lives.
It happens in one form or another every day: A high school senior leaps to head a soccer ball. She takes an elbow from an opposing player going for the same ball. Woozy, she shakes it off and stays in the game.
Six months later, her blistering headaches have subsided but she still experiences occasional lapses in memory. She finds it difficult to concentrate for more than a few minutes at a time.
According to Dr. Umphrey, practicing at Kaiser Permanente’s department of physical medicine and rehabilitation in San Jose, this teenage athlete is experiencing the “sequelae” (the ongoing consequences) of a concussion.
“Simply put, a concussion is caused by a blow or jolt to the head or body that disrupts the function of the brain,” Dr. Umphrey said. “The paradox of a concussion is that initial symptoms often appear quite mild but can lead to significant and lifelong impairment.”
A study from McGill University in Montreal found 60 percent of college soccer players reported concussion symptoms at least once during a season. The University of Pittsburgh estimates 34 percent of college football players have had one concussion while 20 percent have endured multiple concussions.
The lifelong consequences of these types of injuries compelled author and social observer Malcolm Gladwell to denounce high-contact sports during a recent sit-down interview.
“Let us teach sports in school that people can play their whole life,” Gladwell said. “I’m opposed to football being the central sport in schools. It’s the ultimate non-sustainable sport. The longer you play football, the less capable you are of exercising past your physical prime. This is an argument for tennis. It’s an argument for running. It’s an argument for a whole different set of priorities in schools.”
Parents have long grappled with the idea of putting their children in harm’s way with organized sports. Yet many remain unaware of concussion symptoms or in denial about the potential risks to their child’s health.
And until recently, even the medical community had very limited understanding of concussions. Consequently, mild to moderate concussions were often dismissed as inconsequential. Fortunately, our medical knowledge of concussions has expanded greatly over the past few years. Doctors and researchers everywhere have come rushing in to explore new approaches to diagnosis and treatment.
As a result, Dr. Umphrey said that what we doctors know about concussions — and our methods for helping athletes recover from them — is rapidly changing for the better.
What doctors now know about concussions
Let’s start with what doctors know about the ongoing realities of sports today. We know coaches don’t want their best players sitting on the bench. We know many competitive athletes are inclined and encouraged to “shake it off” so they can stay in the game. We know some coaches and trainers still use smelling salts, administer an aspirin and send players back into action far too quickly.
For some kids, particularly those with repeated concussions, it’s the modern-day equivalent of being thrown to the lions.
Decades of under-diagnosing and under-treating concussions is finally catching up with sports organizers. The NFL and NHL both face lawsuits from players while new legislation is taking aim at protecting young athletes with enhanced testing and equipment.
Expanded interest nationwide has led to an uptick in educational programs for parents, coaches and school administrators.
Still, the Center for Disease Control (CDC) estimates that as many as 3.8 million sports-related traumatic brain injuries occur in the United States each year, most of which go unreported and untreated.
The CDC has clarified the impact that this complex pathological and physiological process has on the brain and provided treatment recommendations. Neurologists and sports medicine physicians have started to recognize that when the brain is not given enough time to heal from injury, concussions produce a wide range of chronic problems that affect the way individuals think, learn and act.
In contrast, when kids are rapidly and accurately diagnosed and given the appropriate treatment, the outcomes are very different.
Early diagnosis is key to eventual recovery
Early recognition is critical. People who exhibit symptoms after a concussion should see a physician immediately. Of course, that’s easier said than done.
Unlike a muscle or bone injury, a bump to the brain can be relatively painless. And unlike an illness, a concussion may present parents and coaches with no structural or anatomic damage to witness firsthand. Therefore, they can’t recognize the magnitude of the problem.
But even without visible damage, we now understand that there are major internal chemical and metabolic consequences that can produce a cascade of brain-cell dysfunction.
Unfortunately, even those concussions that initially appear mild can lead to serious consequences. The most pronounced symptoms include painful headaches, dizziness and changes in balance and vision.
In addition, some affected individuals may experience emotional instability and unexplained sadness or nervousness. Others might see a change in sleep patterns or quality of sleep.
When there is a question about the patient’s diagnosis, doctors can use neuropsychological (NP) testing. NP testing is designed to test brain function and identify elements of cognitive damage and recovery that may not be discernible through self-reporting.
Several schools and pro-sports teams are now performing shorter computer-based NP tests prior to the start of the season then repeating them after a potential concussion. Establishing a baseline provides a point of comparison and allows the most accurate diagnosis should there be a subsequent head injury.
New return-to-play recommendations could minimize long-term damage
The latest and most widely accepted treatment guidelines for concussions are based on the Consensus Statement on Concussions in Sport created at the fourth International Conference on Concussion in Sport in Zurich.
The concussion in sport group panel concluded that for 80-90 percent of concussions, symptoms will resolve themselves within 7-10 days for adults and up to one month for children and adolescents.
The recommended “return to play” protocols for athletes are grouped into six stages. The panel recommends that athletes should be symptom-free for 24 hours at each stage before progressing to the next:
Stage 1: No activity, allowing for complete physical and cognitive rest.
Stage 2: Light aerobic conditioning with no resistance training.
Stage 3: Sports specific drills like skating in hockey or running in soccer with no head-impact drills.
Stage 4: Non-contact training drills that may include resistance training.
Stage 5: Full contact practice after medical clearance.
Stage 6: Return to play.
Likewise, cognitive activities should progress in a step-wise fashion, beginning with complete rest (no reading, TV, texting, video games, or schoolwork) and a slow introduction of homework and normal school activities as symptoms resolve.
Teachers, school nurses, and counselors should be notified about any symptoms lasting more than a few weeks. The federal 504 plan, established to assist students with a variety of disabilities, requires schools to offer the necessary accommodations.
Until symptoms abate, students may need shortened days, frequent breaks during class, reduced homework/classwork, and allowances for extended time to complete assignments and tests.
Curbing the effects of concussions for good
For as much as the medical community has learned about concussions in recent years, our understanding of this complex process is still in the early stages.
As Dr. Umphrey explained: “While we still struggle in the health care community to fully understand concussions, our recent advancements have taken us closer to unlocking the keys to diagnosis and treatment. Despite these large advances, however, there is still a need for more research in the areas of prevention and long term management as evidenced by the recent explosion of pro players coming forward with chronic impairments.”
Parents, coaches and trainers must remember that winning the game is never worth the price of permanent damage to a child’s brain or life.