Concussion (From 8/18/14)

Fall is just around the corner and we are just a week away from the start of school. This means that fall sports are already underway for most schools, and both athletes and fans alike are looking forward to the competition, and rivalry that awaits. As health care professionals we have been preparing the competitors for peak physical performance, and preparing ourselves for the inevitable injuries that will occur. Once again, the injury that most health care providers will be most cautious of is concussion. Concussion has been the hot button topic of the last 5+ years in athletics, and even though the processes and protections for this condition have improved immensely, there is still work to be done.

Let’s start with the progress that has been made.

  1. 1. All 50 states now have some form of concussion related legislation on the books.
  2. 2. South Carolina (along with many others) now requires several things:
    1. a. School districts must publish and provide to students, coaches and parents, and informational sheet on the risks, and assessment of concussion
    2. b. Any student athlete who is suspected of concussion must be removed from play immediately
    3. c. Student athletes who are evaluated and diagnosed with concussion cannot return to play until cleared by a physician
  3. 3. Head’s Up youth programs emphasize mechanical excellence in tackling, blocking and hitting.
  4. 4. Significant advances in equipment technology have been made, such as the Riddell Revolution Speed Helmet, which is designed to reduce the risk of concussion for football athletes.
  5. 5. Health care providers are more aware of the serious nature of concussion and are better trained to diagnose and treat this condition.

Despite all the positive progress that has been made, there are still some things that need to be done. This is what you should be aware of:

  1. 1. The law, as written, clearly applies to public school districts. However, it is not clear (at least to me) if these provisions also apply to private schools.
  2. 2. While a specific provision in the South Carolina law includes cheerleaders under these protections, cheerleaders are no longer legally considered student athletes. This means they may not be protected in all states or arenas of play. Parents and athletes need to be aware of the rules and laws in each area.
  3. 3. There has been significant emphasis on improving concussion outcomes in football, but other sports may also need more attention (I’m looking at you soccer)
  4. 4. The best current evidence suggests that removing concussed athlete from play may not be sufficient. Many parents are not aware that athletes who suffer concussion need to limit exposure to lighted screens and excessive cognitive activity. This means:
    1. a. Students should not attend school, or should not attend for the full day
    2. b. Use of cell phones, computers, or televisions should be limited.
  5. 5. After a concussion, physical rehabilitation may be needed to improve balance, neck strength or other impairments that may arise.
  6. 6. Although equipment has advanced, some of the available technology is very expensive and as a result may not be readily available to some athletes. Parents need to be aware of what the school supplies and be prepared to buy a helmet for their child. I would recommend the Riddell Revolution Speed Helmet.
  7. 7. Many healthcare providers diagnose concussion based on an old battery of symptoms, which may or may not accurately identify affected individuals.
  8. 8. While the South Carolina law applies to “Student Athletes”, many states and areas only cover athletes age 11 to 19, which excludes most youth athletes, and college athletes.

While progress has been made, there is still much to be done. Many leagues have already implemented rules to try and prevent concussion. It is still too early to tell what effect these new rules will have, but I find it highly unlikely that increasing penalties, fines and ejections for certain types of hits will achieve the desired result. The current rules are often difficult to enforce consistently, and don’t address the primary risk factor: contact. Whenever two bodies collide there is reasonable risk that concussion will occur. Ultimately, rules must be implemented that penalize coaches, referees, health care providers and parents who do not take this condition seriously. Concussion is a brain injury that can result in death or other serious consequences if not properly managed, and the majority of plaintiffs currently involved with the NFL lawsuit would probably not have suffered memory loss, motor difficulty or other health problems if they, their coaches, and athletic trainers had taken the issue seriously.

This generation of athletes has a chance to survive without serious brain damage, if only concussion are treated properly. Coaches and parents who have the attitude, “I had concussions, and I played through them,” need to change their way of thinking. Once these attitudes are left behind, concussion will no longer threaten to destroy our sports, or more importantly, our athletes.

Patrick

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