Recent weeks have given us a flurry of major news stories about concussions in young athletes. In Mamaroneck school district
there have already been 4 concussed football players reported this year. It is estimated that nationwide there may be as many as 3.8 million recreation and sports-related concussions every year.
Maybe you saw the shocking story of the University of Pennsylvania football player who committed suicide at the age of 21 and whose brain at autopsy showed signs of chronic traumatic encephalopathy or CTE. CTE is the pathological finding that is coming to light in the brains of middle aged NFL players who suffer from dementia. It is their devastating demise that has the NFL looking to more conservative policies on the field. With this finding in a young athlete we should all pause to consider.
Or maybe you saw the subsequent New York Times report on results of a new study that quantified the number of “concussion grade” head impacts that happen during practices of amateur football players. We tend to focus on what happens in competition, but it turns out that a great deal of trauma happens during practice to players who may not even play in actual games. Experts are starting to wonder if we should be counting these episodes the way we count pitches for young baseball players. And it’s not just about football. Girls basketball is equally dangerous. And then there is soccer where heads butt all the time.
As a pediatrician long concerned with this issue, I was relieved this week to see that the American Academy of Pediatrics has given us an extraordinary report in the organization’s official journal, Pediatrics. “Clinical Report-Sport-Related Concussion in Children and Adolescents” is the most current, cogent and comprehensive report I have ever seen on this subject. It is truly worthwhile reading and needs to be disseminated to coaches, athletes, parents, trainers, superintendents, teachers and physicians.
They make many important points but I will list the top seven here:
- Concussions can be difficult to diagnose at the time of injury and sometimes are only apparent as the symptoms evolve over the days following the impact. Hence any head injury needs to be monitored carefully by adults who understand what to watch for.
- Loss of consciousness is uncommon and is not a requirement for diagnosis. Nor is LOC necessarily a sign of more serious injury.
- Most symptoms resolve in 7-10 days but some athletes may take months to recover completely. Recovery in younger athletes generally takes longer.
- Premature return to play can significantly prolong recovery and increase the risk of complications.
- Athletes should never be returned to play on the same day as the impact even if they show no symptoms at all.
- Athletes with concussion should rest, both physically and cognitively (sometimes staying home from school and staying away from video games) until their symptoms have resolved both at rest and with exertion. This return to play should be supervised by experienced coaches, trainers or clinicians.
- “Education about sport-related concussion is integral to helping improve awareness, recognition, and management.”
At Mamaroneck High School we have developed and implemented a policy designed to address these state of the art concerns and protect our students. I am available to talk with any members of the community to help educate and promote understanding of this complex subject that frequently demands a cultural shift in our thinking.