Treating And Preventing Concussions

There is a growing awareness of the potential long-term cognitive and physical impacts of concussions at every level of sports.

A 2011 survey on behalf of Safe Kids USA found that 42 percent of parents worry to some degree about their children suffering a concussion while playing a team sport. Parents surveyed also indicated they and the coaches need to be trained in sports-injury prevention and sports safety.

While there is still much to learn, parents also felt they are more knowledgeable than they were a decade ago and take more precautions to keep their kids safe.

Due to advances in medicine, greater knowledge of the seriousness of concussions and other head injuries, and a concerted effort by professional athletes to educate youth athletes, there is now much more awareness of the long-term health implications of getting just one concussion--let alone multiple concussions.

At the professional level, a number of well-publicized athletes have suffered the long-term consequences of multiple concussions. As a result, many of the athletes have had their careers cut short.

These types of tragedies emphasize today’s need for better concussion care for athletes--especially the youngest competitors.

The Basics--What Is A Concussion?

Contrary to popular belief, a concussion is not a bruise to the brain caused by hitting a hard surface. In most cases, no physical swelling or bleeding is seen on radiological scans.

The injury generally occurs when the head either accelerates rapidly and then is stopped, or is spun rapidly due to a bump, blow, or jolt to the head or body that causes the head and brain to move quickly back and forth.

The numbers are frightening and tell their own story. According to the Centers for Disease Control, a total of 135,000 children between the ages of 5 and 18 are treated in emergency rooms each year for sports- or recreation-related concussions and other head injuries.

And, with 30 to 40 million kids playing sports every year, the chance of suffering a concussion is more common than most people imagine. Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury.

A concussion can result in a change in a child’s behavior, thinking, or physical functioning. Coaches report their youth athletes may appear dazed or stunned, are confused about their assigned position, forget an instruction or play, and/or are unsure of the score or opponent.

Other signs of a possible concussion include moving clumsily or with poor balance, answering questions slowly, briefly losing consciousness, showing mood or personality changes, and/or being unable to recall events prior to the hit or fall or after the hit or fall.

Trickle-Down Effect From The Pros

We often hear news stories about the forced retirements of amazing star quarterbacks or renowned boxers because of the numerous concussions they have suffered. But the awareness goes beyond that, and that awareness thankfully trickles down to the college-level athletes and eventually, although to a lesser degree, to high-school and middle-school athletes.

In 2010, the NFL released new rules to prevent head injuries. These rules prohibited a player from launching himself off the ground and using his helmet to strike a player in a defenseless posture in the head or neck area. Play was to be stopped when a player lost his helmet.

The NFL also instituted more stringent return-to-play guidelines implemented for players who suffered concussions. Teams also had to consult with an independent neurologist whenever a head injury occurred.

Further measures announced in February 2011 required that new test rules be used by all teams before sending a player back to the field. A focused exam was incorporated so that the injury was immediately identified and athletes with head or spine injuries could be removed at once from play.

The Importance Of Baseline Testing

One of the most important changes in the diagnosis and treatment of concussions over the past few years has been the increased use of baseline cognitive testing for athletes. This allows tests to be conducted at the beginning of a particular sport season under the supervision of a parent, coach, or trained clinician. The time for such tests is generally under half an hour.

The results can then be compared to the same test that is repeated post-injury. The two results are compared to determine if there has been a concussion.

Taking The Best Care Of Youth Athletes

Coaches and parents need to enforce safety rules and the rules of each sport. If a parent sees a coach not following the rules, that person needs to speak up and not be worried about “butting in” or being pushy. His or her child’s safety is at risk, and no athletic scholarship or glory on the field is more important than that.

The parent also needs to explain to the child the importance of good sportsmanship during each game and practice.

If an injury is suspected, the child needs to sit out the game and be examined neurologically for a possible concussion. He or she should cease doing any type of activity that could cause the symptoms of a concussion to worsen. The child should return to the sport only after he or she is symptom-free.

Parents and coaches should be reminded that nothing, and I mean nothing, is more important than the health, welfare, and safety of their children--regardless of what sport they are playing.

Dr. William Spangler is the worldwide medical director for Travel Guard, a Chartis Company that provides travel medical, security, and travel assistance. He is the spokesperson and physician for Chartis’ aHead of the Game campaign, which seeks to inform the public about the dangers of concussions in youth sports. He also serves as the team emergency physician for the NFL’s Houston Texans. He is board-certified in emergency medicine, with 25 years of experience in this specialty. For more information, visit