By City Beat
March 30, 2015
Luis H. Urrea II, M.D.
Participation in organized sports is at an all-time high in the United States. The number of student-athletes in high school sports increased for the 25th consecutive year to nearly 7.8 million, according to an annual survey conducted by the National Federation of State High School Associations (NFHS 2013-14). The increased participation in sports and recreation has led to an increased incidence of injuries. Overall, the CDC estimates that 1.6 to 3.8 million concussions occur annually in the US. . In 2009, an estimated 173,000 children (age 19 or younger) were treated in emergency rooms for concussions and nonfatal traumatic brain injuries related to sports and recreation activities. The evening news and the sporting events of the day inform us that concussions are on the rise and are the subject of much focus and attention. The increased awareness of concussions is crucial as an unrecognized or poorly managed concussion can result in serious consequences.
What is a concussion?
A concussion is a type of traumatic brain injury that affects the ability to think and the way the brain normally works. A concussion is caused by a direct blow, bump or jolt to the head, or an indirect blow to the body. When this occurs, the brain moves quickly back and forth in the skull. The resulting dysfunction of the brain typically resolves spontaneously, but not necessarily quickly. A concussion should be understood to be more of a functional disturbance of the brain. The old line “nothing to see here” is true of concussions as there is no lesion nor bleed nor bruise to be seen. There are other traumatic brain injuries that result in damaged tissue and bleeding in the brain which produces dangerous pressure inside the skull. These overt visible brain injuries share many signs and symptoms with concussions. Therefore, any time a head injury is suspected, or an athlete acts unusual after a hit, it is very important to follow through with proper evaluation. Do not simply hope the injury will clear up or be “shaken off.” All brain injuries are serious and potentially catastrophic.
What are symptoms and signs of a concussion?
Symptoms that an athlete may report after suffering a concussion include headache, nausea or vomiting, light sensitivity or irritation due to noise, altered vision and/or balance problems. Some common observable signs of a concussion include an athlete appearing dazed or confused, having difficulty answering questions, exhibiting extreme emotions such as crying and the inability to recall events surrounding the injury. The vast majority (95%) of concussions occur without loss of consciousness, thus loss of consciousness should not be a determining factor in deciding if a concussion occurred. The presence of any one of these signs and/or symptoms should always be taken seriously and the athlete should be removed from play. When in doubt, keep the athlete out of play and sit them out.
What should I do if I suspect a concussion?
When a concussion is suspected, it is most important to immediately remove the athlete from play and not allow the athlete to return until cleared by a physician. Playing with a concussion can lead to long term problems and even be fatal. In rare cases, if an athlete’s demeanor or exam changes such as worsening headache, weakness, repeated vomiting or slurred speech, then they should be transported to the hospital immediately. Fortunately, high schools in El Paso are staffed by athletic trainers who oversee games and practices. They provide evaluation and can determine appropriate referral for athletic injuries.
In Texas, Natasha’s law mandates evaluation by a physician or other qualified health care professional to clear an athlete prior to starting a return to play protocol. A complete evaluation will include a survey of the athlete’s signs and symptoms, neurological examination and balance evaluation. . The need for imaging studies or special tests is not usually necessary. The physician will take into account the athlete’s past history with head injuries in determining the status of the athlete. It is critical that an athlete with a concussion be allowed to rest until his/her symptoms resolve. This type of rest should include a break from schoolwork (even keeping the athlete home), television, computers, texting and of course, physical activity. As with any other injured body part, it is crucial to provide adequate rest and opportunity to heal. Failure to provide proper cognitive rest will result in a lingering of symptoms and a slower recovery time. An athlete is in danger of more serious health consequences if he/she returns to activity before a concussion has completely resolved. Second Impact Syndrome, which may result in brain swelling, permanent brain damage and even death, occurs when an athlete sustains a repeat concussion before an existing concussion has resolved. This is the reason why emphasis is placed on rest and proper care to allow a concussion to fully heal before a return to activity. The consequences otherwise could be fatal.
When discussing about concussions and safety, it should be noted that while concussions are problematic for athletes of all ages, special concern should be given for athletes under the age of 18. Young athletes take longer to recover from concussions. A young brain is not fully developed and any disruption can alter its healthy development. We know that concussions cannot be completely eliminated from activity, or life for that matter. As a community, we can protect our young athletes by limiting the amount of exposure to hits or trauma. Proper coaching, supervision and elimination of unnecessary hitting drills all contribute to a safer approach for athletes.
We often only associate concussions with football due to extensive media exposure. Although the incidence of concussions is the highest in football, it is followed closely by girls’ soccer. In fact, no sport is safe from concussions and we need to be vigilant of the possibility of this diagnosis.
Another consideration is the prevailing belief that expensive or new equipment will prevent a concussion. There are many products on the market including headbands, mouth guards, padded skull caps and expensive football helmets that many parents assume (or are misinformed) will prevent a concussion. Current scientific literature indicates that there is no single piece of equipment that can prevent a concussion or minimize the chances of a concussion. No piece of equipment can prevent brain movement inside the skull after a hit or fall.
The El Paso Alliance for Sports Safety is a non-profit organization recently formed to educate our community about concussions and other sports safety concerns. The mission of EPASS is to create outreach and educational programs to fill the knowledge gap that prevails. EPASS aims to change the culture surrounding concussions, raise the level of care among practitioners and create a consistent regional standard of care for our young athletes. Visit www.elpasoallianceforsportssafety.org to learn how our children may excel in sports in the safest possible manner.
Dr. Urrea is a second generation El Paso physician who has been practicing with EPOSG since 1995. He specializes in arthroscopy and surgery of the knee and shoulder. He enjoys the interaction with student- athletes and volunteers as team physician of UTEP, EPCC and several high school teams.