Heading towards safer sports

Having grown up in the Deep South –Tallahassee, Florida to be exact–I spent many weekends watching college football (Go ‘Noles!!). At the time it seemed everyone was enthralled with the action on the field, but few seemed overly concerned about the future health of the players. Many people cheered for yard gains and devastating blocks, but few seemed to think about the long-term effects those hits could have for the boys on the gridiron. Fortunately things are changing.

There is now growing awareness of the effects of repeated head trauma and concussions based on the experiences of professional football players and other athletes like Mohammed Ali. In response the NFL just passed new rules governing hits in the league, hoping to reduce the amount of head injuries sustained by its players. A good move for protecting the long term health of the athletes, and one that’s likely to be replicated by college and high school sports programs as well. It’s a step in the right direction, but based on my experiences there’s still a great deal of information that patients, parents and coaches still need to learn about concussions.At the Children’s Hospital Boston’s Emergency Department I take care of a fair number of kids every year for sport related head trauma. One of the first questions the parents

Lois Lee, MD, MPH

ask is whether or not their child should have a CAT scan to check for a concussion. I’m glad the parents are taking such an active role in their child’s care, but their understanding of concussion diagnosis is misdirected. A CT (computed tomography) scan alone can’t determine if a person has a concussion. It can be useful to determine if there has been any bleeding in or around the brain, but by definition a concussion is a brain injury caused by a bump or blow to the head, and isn’t necessarily associated with bleeding. That’s one of the tricky things about concussions: they don’t have a lot of universal symptoms. A concussed athlete may or may not lose consciousness—they may seem very slow and confused or just a little dazed, or they may demonstrate no symptoms at all. In fact, it’s not unusual for a person with a concussion to go days, even weeks, without realizing it.

To avoid these problems, here’s a few warning signs athletes with concussions may experience:

  • Headache
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish or foggy
  • Trouble with concentration or memory
  • Confusion
  • Just doesn’t feel “right”

Even if an athlete says he or she feels fine, parents of a concussed athlete may notice the following:

  • Appears dazed or stunned
  • Seems confused—if still playing, may be confused about their position
  • Forgets instructions
  • If in a game, may be unsure of score, opponent
  • Moves in a clumsy way
  • Slow to answer or respond
  • Loss of consciousness—may be brief
  • Changes in behavior or personality
  • Can’t remember things that happened before or after the head trauma

If your child does sustain a concussion, the best treatment is to be assessed and followed by medical providers, who will recommend rest followed by a gradual return to play, giving the brain enough time to heal. Repeated concussions, especially if the brain is still recovering from the first injury, may lead to permanent brain damage. Although no one wants to keep a child from playing a favorite sport, the long term brain effects of repeated concussions is not worth the risk of putting a kid back in the game too early.

This summer the state of Massachusetts passed a sports concussion bill to protect student athletes if they sustain a concussion while playing a sport. The bill mandates stricter rules limiting playing time for kids after a head injury.

  • Any athlete suspected of having a concussion must be removed from the game.
  • The student may not return to play until they have been cleared by a medical provider.
  • Coaches, trainers, parent volunteers, medical personnel involved with school activities, athletic directors, marching band directors must participate in annual concussion training so they can identify students who may have sustained a concussion during play.

The CDC has information for coaches, parents, and athletes on their website.

If you are concerned your child may be suffering from symptoms related to a concussion or if you are interested in baseline testing for your student athlete Children’s Hospital Boston has a Sports Concussion clinic that you can contact for an appointment.