I've come to accept that the life of a frontrunner is a hard one, that he will suffer more injuries than most men and that many of these injuries will not be accidental - Pele


image by: Steven Pisano

Whether you are a professional athlete, weekend warrior, or something in between - a sports injury is likely to occur sometime in your lifetime. But the biggest controversy in sport injuries, besides sudden death, drugs and spinal injuries is without a doubt concussions.

A concussion or traumatic brain injury (TBI) results from a blow or jolt to the head and can also result from simply a blow to the body that causes the head or brain to be jarred vigorously resulting in temporary disruption of brain function.

Previously, concussions were considered a hazard in sports, something that athletes learned to live with. But, it's now clear the repeated concussions or head injuries can lead to CTE (chronic traumatic encephalopathy) which manifests as early dementia.

And it has now been determined that several high profile professional players who committed suicide in the past decade were suffering from CTE. About the same time a series of lawsuits were filed in 2011 against the NFL by both current and retired players who claimed they were not informed and were not provided ample protection against repeated head injuries that could lead to CTE.

Unfortunately, there is also evidence that concussions occur long before an athlete reaches the professional level. According to the Sports Concussion Institute, 5 to 10% of athletes will experience a concussion in any given sport season. Not surprisingly, professional sports and organized medicine has been consumed with a mission to decrease the incidence of concussions at both professional and amateur levels.

American football is associated with the highest concussion risk with a 75% chance for concussion and hockey and soccer aren't that far behind. A professional football player will receive an estimated 900 to 1500 blows to the head during a season. The impact speed of a football player tackling a stationary player is about 25 mph. This is despite the fact that football players wear protective gear, including a helmet. Linemen are especially vulnerable.

According to Robert Canu, co-director of the Neurological Sports Injury Center at Boston's Brigham and Women's Hospital: “Linemen who've had almost no concussions have the majority of cases of chronic traumatic encephalopathy, because on every play they get their brains rattled, trying to block with their head".

Here are things that still should be done

Earlier recognition at the high school level - In professional and collegiate leagues, it is now usual to have certified athletic trainers and medical personnel trained to evaluate concussions soon after they occur. Unfortunately, at the high school level, this is not the case. It needs to change.

According to Anthony Alessi MD, co-chair of the American Academy of Neurology's sports neurology section: “There's not usually a doctor on the sidelines at a high school football game to evaluate an athlete after a concussion. And most high school football teams don't have athletic trainers”.

Prescreening for prior concussions - Recognizing the importance of a concussion history, and appreciating the fact that many athletes will not recognize all the concussions they may have suffered in the past, a detailed concussion history is of value. Such a history may pre-identify athletes that fit into a high risk category and provides an opportunity to educate the athlete in regard to the significance of concussive injury.

Consistent RTP (Return to Play) issues - Following a concussion, how soon can a player return to the field remains an enigma. There are varying opinions on this, as well as conflicting evidence from research studies. Essentially there is no easy or right answer. Optimally, athletes under 18 should be treated more conservatively even though the resources may not be the same as for an older professional athlete.

In 2008, the 3rd International Conference on Concussion in Sport was held in Zurich, Switzerland which produced a consensus statement from sports medicine experts on managing sports concussions. The statement included recommendations on the diagnosis of acute concussion on the sideline, concussion in children and management and therapy. It also addressed the long-term issues: •Are there specific patient populations at risk of long-term problems? •Is there a role for additional tests (eg, structural and/or functional MRI, balance testing, biomarkers)? •Should athletes with persistent symptoms be screened for depression/anxiety?

According to some studies supported by the NFL players can RTP even on the same day without a risk of recurrence or side effects. However, data from collegiate and high school showed that athletes may demonstrate neuropsychological deficits post-injury that may not be evident on the sidelines. In fact, in younger age groups, onset of symptoms is likely to be delayed.

The best available evidence suggests that complete rest exceeding three days is probably not helpful, gradual resumption of pre injury activities should begin as soon as tolerated (with the exception of activities that have a high TBI exposure risk), and supervised exercise may benefit patients with persistent symptoms.

Continuing research – Besides developing better helmets more emphasis needs to be placed on studies that follow players who have sustained concussions. In this vein the Sports Laboratory Assessment Model (SLAM) 1 was used by researchers to monitor the effects of concussions on athletes.

Initiated by the University of Virginia, more than 2300 football players at 10 universities were assessed before the football season with brief neurocognitive tests. When a concussion occurred in these players, the same preseason battery was administered 24 hours, 5 days, and 10 days post injury.

The results showed: Poorer neurocognitive test results during the 24 hour and 5 day assessments among those injured and after 10 days players who had sustained a concussion were performing at nearly the same level. However SLAM followed the athletes only on the short-term. What about the effects 1 year, 2 years, 10 years from now?

Meanwhile here’s what you (or your children) can do. Know the signs and symptoms of concussion. Remember you don’t have to be ‘knocked out’. •Wear protective gear. Helmets do not come with sure-fire 100% protective guarantees but they do help. And newer ones are on the way. Be sure to use specialized helmets for each specific sport. Make sure helmets are properly fitted and maintained and worn correctly. Since children outgrow their gear fast, be sure to upgrade well in time. Other protective gear includes mouth guards. •Discourage too much aggressive and violence in sports. The competitive/aggressive nature of sport which makes it fun to play and watch should not be discouraged. However, sporting organizations should be encouraged to address violence that may increase concussion risk. Fair play and respect should be supported as key elements of sport. •Take each incident seriously. Remember, concussions do not necessary result in loss of consciousness. Seek medical attention, even if the injury is mild and keep the injured under close observation. Don’t just rely on your doctor’s advice regarding RTP. Try to find a health professional familiar with the latest RTP recommendations.

The Bottom Line: Concussions remain an integral part of contact sports with long-term consequences which can manifest years or even decades from now. Know the risks. If you are not willing to run these risks for you or your child, then avoid contact sports. Now more than ever the appropriate management of TBI especially in teenagers and young adults is essential.

Source: Concussions and Sports: Can We Have One Without the Other? HWN, November 2, 2012.

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Last Updated : Wednesday, August 26, 2020