The topic of concussions among teenage athletes is a subject that often appears in the Louisiana news. With sports being year round for our older children and with almost no sport being immune to head injury, this topic is one that many families face.
A state law passed last year was designed to help athletes and coaches understand the seriousness of head injuries that result in a concussion. The law also was written to help delineate the safe steps that an athlete should follow under the direction of his or her physician in order to return to playing sports.
Under the 2012 law, athletes are not allowed to return to practice or a game if an official (coach, referee, trainer, medical personnel) feels a concussion took place. The athlete will be required to be properly evaluated and will be put on a step-wise program involving gradual daily changes in intensity of activity, starting from complete body rest to returning to practice and then to games. Only a medical doctor or a doctor of Osteopathy can give final permission to return to play.
A concussion can be caused by a direct blow to the head or elsewhere to the body and transmitted to the head. It typically causes rapid short lived functional impairment to the brain that clears on its own and is a functional disturbance not a structural injury such as a bleed.
Symptoms can vary in intensity and might not involve a loss of consciousness. Resolutions of symptoms follow a step-wise course, but can sometimes be prolonged. Physical symptoms include headache, vomiting and loss of balance. Cognitive symptoms include feeling slowed down, difficulty remembering or concentrating and forgetful of recent events. Emotional symptoms include irritability or sadness. And, sleep-related symptoms include drowsiness, increase or decrease in sleep and difficulty falling asleep.
There are up to 3.8 million recreation and sports related concussions in the United States each year. Approximately 9 percent of all high school athletic injuries are concussions. Data is lacking for younger athletes. Girls have an increased rate of concussions than boys in similar sports, perhaps because of weaker neck muscles and smaller head mass. Football is the sport with the highest incidence of concussion overall, followed by lacrosse and soccer. For girls, the sports with the highest incidence of the condition is soccer and basketball.
Attempts at preventing concussions have been made but more study needs to take place. Prevention efforts include education about the danger of concussion, rule changes in various sports, and protective gear. Helmets and headgear reduce force to the head. Mouth guards reduce incidence of dental trauma but more study is needed to determine if it will decrease the incidence of concussion.
Long term effects of concussion are a major concern. There is a lack of long term follow up studies of high school and younger athletes. Current short term studies show that students with two or more concussions show significantly lower grade points averages, and persistent deficits processing complex visual stimuli. They also had similar findings on neuro-psychological testing as did an athlete who had his or her first concussion a week earlier.
Second impact syndrome occurs when a second head injury occurs before the first head injury clears. This can progress to diffuse brain swelling and death. Although rare, more than 90 percent of reported cases occurred in younger athletes (high school or younger). Catastrophic football head injuries are three times more likely to occur in high school than college athletes.
A concussion is a common injury that should not be “toughed out” and requires a physician evaluation. Appropriate management is essential for reducing the risks of long term symptoms and complications.