By Charles Hallman
A bill that would establish education and return-to-play standards for youth athletes following a concussion currently is moving through the Minnesota Legislature. Five states this year already passed such laws: South Dakota, Iowa, Wyoming, Colorado and Utah. Bill supporters are optimistic that it will be passed before this year’s session concludes in May.
A concussion is a type of brain injury that changes the way the brain normally works. It is caused by a bump, blow or jolt to the head, and can also occur from a blow to the body that causes the head and brain to move rapidly back and forth. Signs and symptoms of a concussion may include the person being dazed or stunned and unable to recall events either prior to or after the hit, bump or fall.
The Center for Disease Control (CDC) estimates that 3.8 million sports-related concussions occur each year in the United States. About 40 percent of youth athletes who have suffered a concussion return to play sooner than they should.
Minnesota Athletic Trainers’ Association (MATA) President Brent Millikin points out that the state bill does not expect coaches and officials to become doctors, but instead to “recognize and respond,” as well as have the authority to pull an athlete from participation if they suspect a concussion. MATA says that the bill also would inform and educate coaches, officials, youth athletes and their parents or guardians about the symptoms and treatment of concussions.
“The sports-related injuries are the top of iceberg,” states Thomas Jefferson University Medical College neurological professor Dr. Jack Jalio. He, Princeton University Head Team Physician Margot Putukian and Dr. Mark Grady, Children’s Hospital of Philadelphia pediatric sports medicine specialist, all spoke on head injuries in sports, one of several panels held during the annual Association of Health Care Journalists (AHCJ) conference in Philadelphia April 14-17.
“The majority of the population get head injuries” by simply falling, says Jalio. “Most head injuries and concussions don’t go to the emergency room. The lower socio-economic groups have a much higher incidence of [head injuries], and the outcomes aren’t as good” because too many cases go untreated, he points out. Also, persons who are “most susceptible” to repeated concussions often develop “Alzheimer-type dementia,” especially in professional athletes, notes Jalio.
“It’s not the force of contact but the force that’s transmitted to the brain,” notes Grady. “That force can be a blast injury, a whiplash injury or a direct contact.” Football players too often take risks because they believe they are protected by wearing helmets, which according to him don’t “decrease the incidence of concussions.”
Putukian says that “purposeful hits” also occur in other sports such as hockey, soccer, wrestling and lacrosse.
“If that ball hits your head at the right spot, in the right way, it can definitely cause a concussion if that blow is strong enough,” notes Ryan Dotson, a graduate assistant at the University of Minnesota Athletic Medicine Department. “[With] a sprained ankle or a torn ACL [a knee ligament], you put a brace on it or you are going to have crutches; there is visible equipment that says the person is hurt. As far as concussions go, there’s no brace to put on your head.”
Who makes the ultimate call in deciding when the injured player returns to action? The coach? The athlete’s parents or guardian? The athlete?
“The physician makes the key decision at most high schools and colleges,” notes Putukian. “At the younger levels, unfortunately, [youth athletes] will go [from] one doctor to the next, to the next” to get permission to play, she points out.
Dotson says all U-M athletes take a 20-30 minute baseline test at the beginning of the school year. He explains, “It assesses the athlete’s reaction, coordination and memory. Once they sustain a concussion, we have them take the test again, and you compare the two to see if they are okay or they are not quite at [the] level they should be yet. That takes it out of the hands of the athlete because we have objective numbers to go by.”
When a player is suspected to have a concussion during play, among other checkpoints he usually asks them to repeat a series of words he says aloud in the same order he says them — a “pretty quick assessment,” explains Dotson. “Then you have the person walk and watch their coordination. If they struggle with it dearly, then you are going to take [the person] off [the field] for a further evaluation. At this level, we just don’t take their word for it that they’re okay.”
According to a recent survey published in the USA Today in April, the NFL (2007), MLB (2007), NHL (1997) and NASCAR (2003) all have in place concussions policies. Even the new Madden: NFL 12 video game now has a concussion feature. “I like [it] when it says if one of your players gets the concussion, they’ll be out for the rest of the game,” notes Dotson. “That’s a pretty good teaching point — it is putting out a decent message.”
The NBA, however, reportedly has no league-wide concussions policy, and it varies by team who decides when a player returns after an injury.
Matt Blair, who played both college and pro football at Iowa State and Minnesota (1974-85), testified earlier this year before the Iowa Legislature in support of its concussion law that later was passed. He says he suffered his first concussion during a 1971 game against Nebraska after a helmet-to-helmet hit during a tackle. “I knocked [the opposing player] out, and they carried him off the field. I’m back in the huddle celebrating, and then I fall out. I didn’t know I had a concussion until I woke up in the hospital — I didn’t remember anything,” he admits.
No one cleared him to return to action, says Blair. “When I got back to Iowa State, they [officials] looked at me and basically the coach kept saying, ‘Are you ready to get back into the game? What do you want to do?’ I just said ‘Coach, I don’t feel good today.’ But the next day, I was getting better and before I knew it, I was ready to play the next week. I did not get cleared by anybody except the trainers.”
His second concussion occurred during a 1976 NFL playoff game, Blair adds. Despite not being completely ready to play, he said he wasn’t going to sit out the NFC championship game that season: “I told the trainer, ‘I’m playing,’” he recalls.
As a result, Blair adds that he probably suffered some lasting effects from the two concussions: “I think my brain was shaken around a little bit. I don’t remember every little detail that happened in my life.”
Dotson says the proposed Minnesota concussion bill “takes away any ambiguity” and clearly defines who decides a player’s fit to play. He strongly believes that anyone “who’s in charge…and you are responsible for their health and safety” should be educated in recognizing signs of a concussion as well.
Seeking help when a head injury occurs, whether you are an athlete or a ‘weekend warrior,’ is important, stressed Dotson. “If you have a concussion, and you sustain another one and [the first one hasn’t] healed yet, you are talking about potentially prolonged post-concussion symptoms that could lead to brain damage and could lead to death.”
A concussion is “a hidden injury but still a significant injury” he emphasizes. “It’s a serious matter, and if people can understand that, then these things can be managed a whole lot better.”
Charles Hallman welcomes reader responses to firstname.lastname@example.org.