Physician Focus Special: October
By Alan B. Ashare, M.D.
Coaches, trainers, athletes, parents, and sports fans at all
levels now recognize that a concussion can lead to lifelong
debilitating injury. This growing awareness is good news.
A concussion is a traumatic brain injury caused by a blow to the
head that jars the brain's soft tissue, which can hit the hard
skull, resulting in a malfunction of the brain. A common fallacy is
that someone has to be knocked unconscious to suffer a concussion,
but loss of consciousness occurs in less than ten percent of cases.
A better measure of the severity of the injury is how long symptoms
last, such as headaches, confusion, blurred vision, sensitivity to
light and noise, difficulty concentrating, and other behavioral
abnormalities. The longer the symptoms persist, the more severe the
injury. Serious long-term health consequences can occur if not
treated properly.
The Commonwealth has also recognized the dangers of concussion
for its young athletes. A new state law on sports-related head
injury passed last year that applies to all public middle and high
schools and those playing under the rules of the Massachusetts
Interscholastic Athletic Association.
The law has four major requirements: (1) athletes, parents,
coaches, athletic directors, school nurses, and team physicians
must learn about the consequences of head injuries through training
programs and written materials; (2) athletes and their parents must
inform coaches about prior head injuries at the beginning of a
season; (3) athletes must be removed from play upon becoming
unconscious or suffering a known or suspected concussion during a
game or practice; and (4) written certification from a licensed
medical professional must be provided to return to play.
Thankfully, the notion of "toughing it out" is giving way to the
common sense approach of what's best for the health of the athlete.
Coaches must now act accordingly: When in doubt, sit them out.
Head injury is hardly confined to male athletes. The leading
cause of concussion in females in high-school sports is soccer - a
game in which girls sustain just as many concussions as boys.
Cheerleading is risky, too, accounting for 65 percent of
catastrophic injuries to high-school female athletes.
Age is no barrier either. Elementary school youngsters (who
aren't covered by the new law) who play little league or youth
sports and whose games may not have a health professional in
attendance are also at risk. These younger athletes can be more
susceptible to injury and may take longer to
heal.
Nor is concussion confined to organized sport. The Centers for
Disease Control lists the five leading causes of concussions as
bicycling, football, basketball, playground activities, and soccer.
Note that two of these - bicycling and playground activities -
occur mostly outside of organized sports, without coaches,
trainers, or health professionals present. So even a game at the
local playground can present risk.
Coaches and parents, especially those of the youngest athletes,
should be ever alert to head injuries. Awareness and education are
the keys, and good resources are readily available. The CDC (www.cdc.gov/concussion)
has valuable information, and the Massachusetts Medical Society (www.massmed.org/sportssafety) offers a
coach's guide that includes an evaluation card, guidelines for
return-to-play decisions, and ways to decrease the risk of
concussion.
Sports and recreation offer great benefits for people of all
ages, and we should encourage participation. But it's prudent to
keep our "heads up" about concussions; doing so can prevent serious
lifelong health effects. Remember: When in doubt, sit them out.
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, chair of the MIAA
Sports Medical Committee, and Chair of the Safety and Protective
Equipment Committee for USA Hockey.
