Sports medicine used to be the field of sprains, strains and broken bones — firm orthopedic territory. But today, with more focus on the damage that a simple concussion can cause and the knowledge that it can lead to long-term, detrimental brain injury, the realm of sports medicine has moved into the arena of neurologists.
Defining Concussion
As explored in our previous post, a concussion is a mild traumatic brain injury sustained from a blow to the head that results in the brain crashing rapidly into the inner wall of the skull. The CDC estimates that as many as 3.9 million sports and recreation-related concussions occur in the United States each year. Contact sports are the most common risk-factors, such as football and soccer, where another object, whether it a ball, a body part or even the ground, comes into contact with a player’s head.
Multiple Concussion Risk
One concussion is not necessarily dangerous, but it’s the repeated concussions, especially in close proximity to each other, that’s of the greatest concern. It’s known that multiple concussion can lead to Chronic Traumatic Encephalopathy (CTE), a degenerative condition that causes thinking, memory and personality changes. This field is still young, and researchers are still exploring the exact effect multiple concussions have on the brain over time, both with cognitive and mood issues.
It is known that multiple concussions change the composition of the brain, impeding its ability to function like it’s supposed to. It is through the breakdown of the brain over time that you start to see athletes with mood issues such as rage, volatility and severe depression that can lead to suicide. The other side of the coin is early-onset dementia and the development of Alzheimer’s disease, though these symptoms often don’t develop until late middle age.
The Popularity of Big Hits
Since the beginning of the sport, big hits in football have been heralded, even encouraged, a true hallmark of a game well-played. During the game, players who’d had their bell rung were encouraged to shake it off and get back into the game ASAP. Not wanting to be soft, players often ignored concussion symptoms or even hid them from trainers. After all, they didn’t want to let down their teammates or, in the case of NFL players, put their job security at risk. However, as the severity of multiple concussions took its toll on some of the country’s favorite aging athletes, there’s been global awareness surrounding sport-related traumatic brain injury, from little league all the way up to the pros.
The Rise of Sports Neurologists
Football programs now employ sports neurologists who join the orthopedic specialists and athletic trainers on the sidelines. They are specifically engaged to look for and treat concussion symptoms, which may include headaches, neck pain, problems falling or staying asleep, mood swings and sensitivity to light, noise and motion.
Risk of Inadequate Recovery
According to an article in Sports Health, the majority of players who are concussed during a game or practice recover within 10 to 14 days. However, if a player returns to play before they are fully recovered they are more susceptible to a repeat concussion with greater severity. After a concussive event, the brain experiences metabolic changes that make it more vulnerable to cell death upon a second injury — and this is key — even a concussion of less intensity.
Foregoing adequate recovery time impedes the brain’s natural regulatory systems that enable it to protect against head injury. This makes concussion patients that much more vulnerable to post-concussive risk, including brain herniation and even death.
Concussion Protocol
Athletic trainers and team physicians have specific training that enables them to diagnose on the sideline and remove players from the game if necessary. The most common tool to determine if a player has been affected is the Sports Concussion Assessment Tool, 5th Edition (SCAT 5). Some of the tests include:
- Eye-tracking problems
- Basic tests for balance
- Basic tests for cognition
- I.e, What year is it?
- Basic tests for memory recall
- I.e., Name three simple words and asked to repeat three minutes later
Immediate Concussion Treatment
If a player is found to be concussed they are immediately taken out of play. The very best treatment they can get is total rest for their brain. This usually means reducing all stimuli, keeping lights turned down low and limiting noise. Much to players chagrin, this also means taking away cell phones.
Post-Concussion Assessment
Trainers and doctors look for all symptoms to be completely resolved before reintroducing the player back into their sport. Protocol at The University of Arkansas, and followed at universities across the country, is as follows:
- Looks for signs of improvement in concussed athletes after the first 48 hours.
- If there is improvement, they are introduced to light, non-strenuous exercise, such as riding a stationary bike for 15 minutes.
- But if symptoms worsen while exercising, it is stopped.
- If they can handle the exercise, the activity is slowly increased in intensity and duration.
- Student-athletes also received academic monitoring, to access:
- Reading comprehension
- Whether or not they can follow conversations in class.
- Once they receive the all-clear, they’re allowed back into practices with close monitoring.
Room for Improvement
Concussion education and prevention has made great leaps on the college and pro levels. The number of educated coaches and medical personnel being present at practices and games has reduced the number of concussion-related injuries. However, the youth level, where most sports are coached by volunteers, the level of education is lacking. Local youth sports organizations are starting to take steps to ensure the safety and health of their young athletes. The next level of education is getting parents up to speed.
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