MMS Physician Focus Commentary
By Alan B. Ashare, M.D.
The past decade has seen a growing awareness about the dangers
of head trauma, or concussions, in contact sports. The
National Football League, prodded by Congress and with research
from the Center for the Study of Traumatic Encephalopathy at Boston
University that demonstrated the serious short- and long-term
physiological and psychological dangers posed by repeated blows to
the head, has announced it would act on the increasing problem of
concussions.
The NFL has confirmed a partnership with Boston University
Center for Research on Head Trauma and has offered more than one
million dollars to fund projects by the Center. The NFL has
also teamed with the Center for Disease Control (CDC) in creating
public service announcements about the dangers of concussions aimed
at young athletes.
These steps have helped raise public awareness about
concussions, and the recognition that a simple blow to the head can
lead to lifelong debilitating injury is spreading, from the
professional ranks down through colleges, high schools, and even to
parents of the youngest athletes. This is all good news. But more
can be done.
Medically, a concussion describes a mild traumatic brain injury,
but the impact can be anything but mild. A concussion is the result
of a blow to the head that jars the brain's soft tissue, which can
hit the hard skull, resulting in malfunction of the brain. A common
fallacy is that a person must be knocked unconscious to suffer a
concussion, when, in fact, loss of consciousness occurs in less
than ten percent of cases. A better measure of the severity of the
concussion is the duration of symptoms, such as headaches,
confusion, blurred vision, sensitivity to light and noise, and
other behavioral abnormalities. The longer the symptoms persist,
the more severe the injury. Serious short- and long-term health
effects can result if not treated properly. Remember: This is a
person's brain we're talking about.
Coaches, trainers, athletes, parents, and the public in general
have begun to appreciate the severity of concussions. The notions
of "toughing it out" or "walking it off" are thankfully giving way
to the common sense approach of deciding what's best for the health
of the athlete. Coaches who suspect players who have suffered a
concussion should be quick to act on the mantra, "When in
doubt, sit them out." This is especially critical with
younger athletes, who may be more likely to get concussions and may
take longer to recover.
While football has brought notoriety to the issue, awareness
must spread beyond the gridiron. Female athletes, who are often
forgotten in discussions about concussion, are not immune. In
high-school sports, the leading cause of concussions for females is
soccer, a sport in which girls sustain just as many concussions as
boys.
Concussions don't discriminate by age, gender, or activity.
According to the CDC, sports and other recreational activities
cause as many as 3.8 million concussions a year. Emergency rooms
annually treat an estimated 135,000 such injuries in children ages
5 to 18. The five leading causes are bicycling, football,
basketball, playground activities, and soccer. Note that two
of these activities - bicycling and playground activities -
generally occur outside the confines of organized sport, without
coaches, trainers, or health professionals present. As warmer
weather approaches, keep this in mind when considering the use of
helmets and other protective headgear.
While a need clearly exists for more research into both the
causes and the treatment of minimal traumatic brain injuries, right
now awareness and education are our best defense. The CDC (www.cdc.gov/concussion)
offers valuable information and the Massachusetts Medical Society features a
coach's guide that includes an evaluation card, guidelines for
return-to-play decisions, and effective ways to decrease the risk
of concussion.
Sports and recreation offer much in the way of health and social
benefits for people of all ages, particularly the young. But it is
incumbent upon everyone - coaches, trainers, parents, players, and
physicians - to educate themselves to take effective steps to
reduce the risk of head trauma and to improve the treatment of
those athletes who may be subject to minimal traumatic brain
injury.
Alan B. Ashare, M.D., a physician at St. Elizabeth's Medical
Center of Boston, is chair of the Massachusetts Medical Society's
Committee on Student Health and Sports Medicine and Chair of the
Safety and Protective Equipment Committee for USA Hockey.
