Patrick Wupperman, MD, an orthopedic and sports medicine physician with Azalea Orthopedics, discusses five points on concussion management and prevention for young athletes. He is involved with treating young athletes in his community.
1. Educate yourself about the issue. Over the past several months, a heightened awareness of concussions among professional and young athletes has spurred debate across the country about concussion prevention and management techniques. A study published in Pediatrics released over the summer reported emergency room visits for young athletes with concussions nearly doubled from 3,800 in 1997 to 8,000 in 2007. "We are really trying to figure out why this is and what we can do for young athletes to prevent concussions," says Dr. Wupperman.
Additional studies on professional athletes who incurred multiple concussions during their career linked the damage to an ALS-like condition the players developed after retirement. Incurring multiple head injuries, especially before the initial injury is healed, could result in memory loss and dementia-like symptoms, in addition to other neurocognitive conditions. There are several indicators of concussions that injured athletes might experience, such as dizziness, but not all people who undergo concussions experience these symptoms and a disappearance of symptoms does not always mean the concussion has healed.
A heightened awareness of what constitutes a concussion could be responsible for additional reports in head injuries among athletes, but so could the level of play and competitive among young people. The combination of these studies has resulted in additional research into concussion management, legislation in many states regarding youth athletes who receive concussions and regulation changes in the NFL and NHL.
2. Concussion prevention. Sporting leagues for young athletes should consider which practices could potentially lead to concussions and eliminate them, says Dr. Wupperman. For example, soccer players are allowed to hit the ball with their heads during games, which could result in a concussion or other damage. A national study conducted at the Sports Concussion Clinic at Children's Hospital Boston and the Center for injury Research and Policy of The Research Institute at Nationwide Children's Hospital examined concussions among high school athletes and found that 76 percent of the concussions occurred during collisions with other players and 53 percent of the time they were head-to-head collisions.
The NFL has taken notice of the danger in head-to-head collisions and re-evaluated regulations on head-to-head collision tackles for the current season. The league increased penalties and fines for the illegal hits. The NHL also issued Rule 48, which prohibits blindside hits to the head last year to prevent concussions among the players. Dr. Wupperman says he expects youth sporting leagues to follow suit and ban hits that could put players at an increased risk for concussions, though the injury is sometimes "part of the risk of playing sports."
3. Preventative equipment. Using modern and safe gear when engaging in sports activities is essential for all athletes to prevent concussions, says Dr. Wupperman. The recent scrutiny on the cause of concussions among young athletes has prompted many athletes and school districts to examine the equipment more closely. The Cleveland Clinic's neurological institute partnered with Rawlings, a helmet manufacturing company, to conduct research on the equipment's ability to minimize impact on baseball and football athletes. Riddell, the official helmet supplier of the NFL, has also been working to develop a helmet that is more likely to prevent concussions. However, the new equipment designs won't be "concussion-proof," which means athletes still must be weary of dangerous hits.
Researchers at Stanford University Hospitals & Clinics partnered with the San Francisco 49ers to study the biomechanics of football injuries through placing sensors in different places around the athletes' bodies to see where the trauma is the greatest. The researchers hope to assess where athletes are most likely to incur injuries and help fuel more effective equipment to prevent injuries in the future.
4. Neurocognitive testing of young athletes. While it may be impossible to completely eliminate concussions, new technology has made it less likely young athletes will suffer a second concussion before the first has fully healed. Neurocognitive testing, such as the ImPACT test, gathers individual neurocognitive data on each athlete prior to incurring the concussion, so when the athlete is injured, there is baseline data to compare with his or her neurocognitive function after the injury. When the athlete has returned to baseline, he or she is safe to return to play, says Dr. Wupperman. "Kids in particular had larger heads per body ratio, which means it takes them longer to recover from concussions," he says. "At this age, if you have multiple concussions, there could be cognitive issues."
Some states, such as Indiana, are considering or enacting legislation requiring young athletes to receive a physician's note to return to play after suffering a concussion or suspected of suffering a concussion. It's more difficult to assess whether the player has completely recovered from the concussion without some sort of neurocognitive testing, says Dr. Wupperman, which is why he advocates for testing of all players. "We try to make the neurocognitive testing part of the participation physical before the season begins," he says. In addition to filling out medical history forms that are required before the student can play, Dr. Wupperman gives the athletes one or two pages of neurocognitive testing.
5. Holding children out of play. Studies show high school athletes who go through neurocognitive testing sit on the sidelines longer than those who don't after incurring a concussion. "The athletes who are tested are held out of play longer than those who are not tested because the neurocognitive testing is more accurate than what physicians have used in the past," he says. "Earlier in my career, coaches were resistant to holding their star players out. But with the recent media attention surrounding concussions and two players dying in 2008 from head injuries, coaches are less resistant to holding their players out. It is rare now for coaches to argue about players if a physician says they shouldn't play."
If the player doesn't have neurocognitive testing to determine whether he or she has returned to baseline, the physician makes sure no symptoms of concussions are present before allowing the athlete to return to play. However, the athlete is usually kept out for at least the remainder of the game in which a possible injury occurred to ensure he or she is fully healed.
Learn more about Azelea Orthopaedics.
Read other coverage on concussion management:
- Montana Sports Medicine Physicians Make Recommendations on Concussion Management
- NFL, NATA Join to Promote Concussion Awareness
- NHL Concussion Prevention Rule 48 Prohibits Blindside Hits to the Head