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Concussions in SportMitigating Risks in the Student Athlete

High School Concussions

Over 50% of concussed high school football athletes do NOT report their injury to medical personnel

McCrea, M., Hammeke, T., Olsen, G., Leo, P., and Guskiewicz, K.M. (2004). Unreported concussion in high school football players: implications for prevention. Clin. J. Sport Med. 14, 13–17.

Soccer, lacrosse, basketball, softball, baseball, and gymnastics 14,591 injuries in male and female athletes 5.9% of all injuries were classified as concussions Males Game Injury Rate / 1000 exposures

Soccer 1.40 Lacrosse 1.46 Basketball 0.47

Females Soccer 2.10 Lacrosse 1.05 Basketball 0.73

Collegiate Concussions

Perceptions

Survey 300 players, 100 coaches, 100 parents, 100 ATCs If a player complains of a headache , should return to play?

Players 55%, Coaches 33%, ATC 30%, Parents 24% Percentage who would play a concussed star in a title game?

Players 54%, ATC 9%, Parents 6.1%, Coaches 2.1% Level of concern for concussions (1 = most concerned; 4 = least)

Players 3.5, Coaches 2.4, Parents 2.1, ATC 1.6 Is a good chance of playing in the NFL worth a decent chance of

permanent brain damage? Players 44.7%, Coaches 19.4%, Parents 15%, ATC 10%

Classification of concussions

A concussion is a concussion

There is no such thing as a mild concussion

No grading system

Most symptoms resolve in a short period of 7-10 days

Post concussive symptoms may be prolonged in children

Symptoms

Headache (83%) Dizzy (65%), dazed, fog Light and sound sensitivity Visual disturbances “Everything seems slow” “My colors changed” Teammate, “Eric’s not right, coach” Appearance can be delayed several hours

Physical Signs You do not have to lose consciousness Amnesia (“Doc, I don’t remember the first half”) Emotional labile (crying, talkative) Poor balance Difficulty concentrating Difficulty remembering

On-Field Evaluation

Standard emergency management Exclude cervical spine injury Return to play determined by a physician “When in doubt, sit them out” No player shall return to play the same day Sideline assessment of concussion (SCAT2) Monitor for any deterioration over time

Concussion Management

Complete physical and cognitive rest until symptom free

No sports No horseplay No school, if necessary No texting, video games, internet, TV, driving

Graded program of exertion prior to full return to play

Exertion effects

Symptoms are worsened by physical activity mental effort environmental stimulation emotional stress

Risk factors for complicated recovery

Re-injury before complete recovery Over-exertion early after injury Significant stress

Unable to participate in sports Medical uncertainty Academic difficulties

Prior or comorbid condition Migraine Anxiety ADHD, LD

Post-concussion syndrome

Multiple Concussions Second Impact Syndrome

A concussion prior to recovery from a prior concussion Athlete is still symptomatic Mostly males < 21 years old Rapid increase in intracranial pressure Rare but almost always fatal

Cumulative effects

Risk of concussion is 4-6 times greater after one concussion

Risk is 8 times greater after sustaining two concussions

Prolonged or incomplete recovery

Increased risk of later depression or dementia

How many is too many ?

Graduated return to play protocol

Day 1 Light aerobic exercise

Light jog/stroll, stationary bicycle

Goal: elevate HR

Day 2 Sport-specific exercise

Running drills in basketball

Goal: add movement

Day 3 Non-contact training drills

Passing and shooting, light resistance training

Goal: coordination, cognitive load, valsava

Day 4 Full contact practice only after physician clearance

Day 5 Return to competition

Any symptoms at any stage, return to complete rest

Mechanism of Injury Hockey

Body checking 86% of all injuries in 9 – 15 year old Contact leagues 4x injury rate, 12x fracture rate 45% legal body checks, 8% illegal body checks Direct fatality and injury rates for football are half of hockey Spinal cord injury and brain injury rate

2.6 per 100,000 high school hockey players .7 per 100,000 high school football players

Helmets and Mouth Guards

Helmets prevent skull fractures Helmets do not prevent concussions, they cause

concussions Mouth guards prevent dental injuries Mouth guards do not prevent concussions