There are more than 300,000 reported concussions every year in high school athletics in the United States. The hot topic for the last several years surrounding contact sports is management of those concussions, particularly when it comes to football players. But, did you know that football is NOT the top contact sport for concussions in high school athletes?
For the past several years many of us have watched (and often complained about) the NFL changing its helmet to helmet contact rules all in an effort to make the game safer. With all the emerging research on Chronic Traumatic Encephalopathy (CTE) and pending lawsuits, who could blame them? However, how many concussions have those athletes sustained before they got to the professional level? Less 1% of people who play these sports actually make it to the professional level, so what is being done at the early levels of sport participation to ensure safety and proper management of head injuries when they occur? To best answer this question, we need to clearly identify what a concussion actually is, what are the symptoms associated with it and how do you best manage it’s treatment as well as help prevent it.
A concussion or mild traumatic brain injury (mTBI), is defined by the CDC as, “ A bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”
Yes, you can get a concussion without having a direct blow to the head. We see this in car accidents quite a bit as well as contact sports where participants take a hard hit to the body causing the neck and head to “whip.” It’s not always initially apparent that someone has sustained a concussion. Some symptoms may come on much later after the trauma has occurred. Common concussion symptoms can include headaches, dizziness, balance and coordination loss, mood swings, trouble concentrating, memory lapses, fatigue, sensitivity to light and sound, and neck pain.
I have heard a lot of people ask, “Don’t you have to be knocked unconscious to sustain a concussion?” No. In fact, less than 10% of people who suffer a concussion will lose consciousness.
Concussions can affect several different areas of function: neck function, balance, eye sensitivity to light and sound, and memory loss to name a few. There are a lot of theories behind how to manage these symptoms particularly when they cause problems with concentrating on school work and when it’s actually safe to put them back out on the field of play. Some healthcare providers suggest rest, limited electronics, limited activity, dark rooms, and taking the athlete out of school for a period of time. I have had the unfortunate reality of treating people who were told to do nothing but rest. Years later they’re still suffering from the same symptoms as adults. In response to this, I will pose this question: if you broke your arm, would you sit in a room, rest it, stop going to school or working, to wait for it to get better? Rhetorical. So why do we do this when it comes to concussion management? The brain, just like any other body part, needs to be rehabilitated after injury. Now, that doesn’t mean that rest isn’t an important step in the process; however, there needs to be more intervention done to completely recover as the symptoms tolerate those progressive interventions. This can include several different levels physical therapy from vestibular ocular (VOMS), which deals with the eyes and ears and ultimately helps recover balance and/or exertional therapy to prepare you to return to sport and all that sport demands of your body.
Coming full circle here: did you know that girls soccer is actually the number one sport for head injuries among high school athletes? I’ll bet that stat gave you the side head tilt, confused puppy dog look. While football has been both scientifically and colloquially associated with the highest concussion rates, a 2017 study presented at the American Academy of Sports Medicine found that girls, and especially those who play soccer, may face a higher risk. (Wellington Hsu, MD, professor of orthopaedics at Northwestern University’s Feinberg School of Medicine)
This study was done over a 10 year period (2005-2015) involving 9 sports and 41,000 injuries, 6,400 being concussions, and it concluded that females actually have higher rates of concussions in sports played by both genders.
So what should we do to make sure our young athletes are staying safe? First and foremost, a baseline cognitive test is an essential component of concussion management and should be performed prior to participation in any contact sport. I typically use the ImPACT test for this. This gives me a baseline of cognitive function that I can then compare subsequent tests to following a concussion in order to be able to accurately tell when someone is ready to return to their regular activities/sport. You can read more about it here www.impacttest.com. This test helps us as healthcare providers understand the direction any particular athlete’s rehab progression should go and identify where they are still lacking in their recovery process. Many high schools have certified athletic trainers on staff during most sporting events and these professionals are taught how to properly test and identify for potential head injuries. Encourage your young athlete to visit their athletic trainer – many athletes will avoid mentioning injury due to the fear of being taken out of their sport. There is a definite problem with young athletes not being 100% honest regarding their injuries.
Secondly, there is no substitute for proper coaching when it comes to technique, particularly when we are talking about tackling in football. If you have plans to place your child in peewee sports, recreational sports, middle school sports, and/or high school sports, please make sure there are qualified coaches and certified athletic training personnel on hand that know what they are doing and what they are teaching.
Lastly, if you suspect your young athlete has a concussion, keep them out of their sport until they have seen a proper healthcare provider that deals with concussion management proactively and with a more in-depth plan than just advice to go rest. Be aware of mood changes, fatigue, trouble sleeping, nausea or vomiting following any potential head injury as these could all be signs of a head injury that needs medical attention.
Let’s all do our diligence in keeping our young athletes moving safer, smarter, and stronger. Play safe!
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by: Daniel Tribby B.S., ATC, CEAS, ITAT, CNP
Clinic Director Activcore Orlando