Friday, February 02, 2007
Battered athletes may suffer the consequences
We see it on the field, in the rink and in the ring. Athletes in high-contact sports suffering concussions - a brain injury caused by a strong blow to the head that can cause dizziness, headache, memory loss, and even a loss of consciousness.

Every year players in the National Football League suffer concussions and risk life-altering consequences, particularly those who experience multiple concussions.

For decades athletes have called them "dings," and some shook them off, "playing through" the injuries that some doctors now link to depression, dementia and even suicide - once an athlete's playing days are over. In a study of nearly 2,500 former NFL players by the Center for the Study of Retired Athletes at the University of North Carolina, the rate of depression for players who had five or more concussions was three times that of players with no history of concussion.

And what about children who play sports? Studies spanning the last 20 years show that nearly 20 percent of high school players - nearly 250,000 kids - suffer concussions yearly, moving experts to call for better education among players, trainers, coaches and parents.

If you've had one concussion your brain needs time to heal because head injuries can cause lasting problems. And we know that a player who has had a concussion has a greater risk of having another one. But if your brain hasn't healed from the first, your next concussion could be fatal.

There's a lot that we don't know about concussion, but with all we do know, do players, coaches and parents need to start taking them more seriously.

Has your child suffered a concussion playing high school sports? How long did you make him or her wait before resuming play?
As a high school student I have see all too many players 'playing through' and disregard the fact of how hard they really get hit. Sure it's a game, but out on that field, one right blow is the difference between them and a plant. there have been occasions where fellow students have passed out on the tennis court and football field but like you said, most avoide showing their weakness and get right back in the game.
Ironic that this came up, I was just at a high school wrestling match where one of the key varsity players had suffered a concussion in a match last week and still competed in tonight's dual tournament.

Another friend of mine felt absolutely miserable for the 4 weeks he wasn't allowed to compete in wrestling tournaments because he broke his finger.

As a high schooler myself, I know the pressure and almost obligation to carry on in the competition even if my body can't handle it. We feel weak when we can't, we feel it's a shortcoming and it's our failure.
Concussions are indeed a danger in any sport, the contact and collision (such as football) sports see the majority, but even sports classified as non contact sports such as baseball have them. I could not agree more that these types of injuries be examined by a physician. Getting the athlete to this point though requires recognition of the injury and proper early evaluation to make the best choice possible for the athlete.

As a Certified Athletic Trainer I am responsible for making on the field decisions regarding the play status of my athletes who have sustained a concussion. The National Athletic Trainers Association has released a position statement in The Journal of Athletic Training (September 2004) on this very subject.

www.nata.org/publicinformation/files/concussion.pdf

Knowing how to deal with these types of injuries and guarding against second impact syndrome are key points to successful resolutions in these cases. Thank you for the article the more everyone is aware of these issues the safer we can make our athletes.
It surprising in a world that new technology ,science and medicine show the results of lasting concussions have on people , we still don't believe the data

Perhaps, individuals will believe things when their memory starts to fade.
When I was a child I had two car accidents where I had sustained concussions as a result of the accidents. Do you have to be an athlete to have problems as an adult? While going to school, I had problems with math and still do. Is this a result of my concussions? I don't have any other learning problems.

Please change the report from athletes to children who have had concussions and what they face throughout their lives. You don't have to be only an athlete to have a concussion.
Our son has been benched after suffering his second minor concussion of the season recently (wrestling). The first didn't seem to be one at all (who knows, maybe it wasn't)...the emergency room doc who examined him had a couple of sons who had wresteled, and didn't think that there was really much to be concerned about...after a couple of weeks off, he was wrestling again. The second seemed to do it. He's been suffering from migrane symptoms since (severe headaches and light sensitivity) though they've been gradually improving.

It's tough to tell someone who's competitive that they've got to heal with something that doesn't involve a cast or surgery...but going back too soon is probably the reason that things are noticably worse now.

Lessons learned...and I hope someone else will benefit from ours...
My son had 2 concussions playing freshman football. Both hits took place in practice. The only way we found out about the hits were my son was unable to get up from bed normally and also was totally unable to get out of the shower since he lost control of his legs. My son was supposed to play in a playoff game that day and had been hiding the hits from us so as to be able to play. We made a doctors appointment for him that day and did not allow him to play in the game ( doctors orders since he had suffered a double concussion ). When my wife picked him up from school a math teacher was in the hallway and asked to speak to her, The teacher told us we needed to get my son to a doctor he had not been homself, basically was on another planet. He told us to speak to his girlfriend or teammates. 2 players happened to be in the office so she spoke to them. They told her he had taken 2 enormous hits to his head in practice. Further he had only been able to play a few minutes each practice before having to sit because he was to dizzy or sick. Did the football coach make us aware of course not. The doctor ordered him out of sports for a month and told my son he was lucky he wasn't hurt even more seriously and told him he risked brain damage if he played further. My son was mad he is a big kid goes 226 already as a freshman. All i had to do was mildly flick him in the forehead with one finger and he instantly was in pain. When he went to see his coach with a note the assitant coach told him oh yeah we aren't surprised we kinda figured you had a concussion. Well all I can say is nice job coach no he didn't have a concussion he had a double concussion. Education needed oh yeah for sure. When i heard at the banquet the varsity and JV had suffered some bad injuries but the Freshman were clean of injuries my blood boiled. Yes education is needed. Thanks for putting out the forum and hopefully some coaches will wake up and not risk a kids life down the road. Howard King
I'm a 20 year old college student and have no children. During my High School football career I experienced multiple concussions over a two year span. I completely agree with the article and think it may even underscore the effects of multiple concussions. For you to fully understand I will tell you the story of my experience in hopes of creating a broader understanding.

I went to a 4A High School in Washington State and was a popular outgoing student. I played safety as a sophomore on a very successful team that reached the state semifinals. That summer during football camp I received my first concussion and in my realm the worst of all I received. I had asked the coach to let me take out the middle backer, in my attempt at crack blocking from WR I left my feet. At the last second the LB saw me and turned his head. His helmet caught me directly in the chin ( I wore a chinstrap the had the hard plastic protective covering ). The next thing I knew I was in the training tent sitting on a bench with some people staring at me. The sides of my face were tingling like crazy and I had no clue what happened. They explained to me what had happened to me and that I had a concussion, then I was sent to a doctor. When I reached the doctor's office, we spoke for at most two minutes and then I left, must of our conversation I don't even remember, but no tests were given or even recommended, though I was instructed not to play for the rest of camp. For the 30 minute span after I received my concussion and even the minute before to this day I have no recelection of what happened, all the info I know has been observed from film of the incident and from a player who was also injured and with us the whole time. Other then that I felt fine, I had a headache and felt a little dizzy for the rest of that night, but by the end of camp felt fine.

When football resumed the next season ( I had been participating in all other workouts and activities, refering here to CONTACT ) I felt completely normal, but I was very wrong. I received my second concussion on our second day of practice with full pads. This concussion and all the ones I received following it were completely different in that I remember everything but would have vision problems in my left eye instead for up 45 minutes after the impact. I would still be able to see but everything would be blurry in my left eye( the closest thing I can compare it to is when you push on the bottom or top of your eyelid ) Normally I would try to battle through it but I was really shaken... it really scared me and I had no idea what to do about it. I would usually try to sub out a lot or tell my position coach I needed some plays off, he would leave me alone and when the effects would diminish to where I felt comfortable I would sub myself back in. That season I played 3 games...one day in practice after having a worse then usual vision problem after receiving a concussion I couldn't handle it anymore and talked to the trainer about it. I then visited my family doctor and was instructed to sit a full year out of all activities that involved contact. During practice and those three games I played I would estimate I received 7-10 concussions. I could not play as tough as I used to and it seemed I could no longer take a hit to the head without getting a concussion. When I had been informed I would miss all physical athletics my junior year ( football, basketball... I ran in track )I had a CAT-SCAN on my head and went to the eye doctor to see if it was just a problem with my eyes. The results from both came back showing signs of all good, though I was still instructed to sit out for the year.

During this year away from sports is when the first mental symptoms started showing up but never were they attributed to my concussions. I began having anxiety and panic attacks. Sitting in the lunchroom or walking in the halls seemed to overwhelm me. All the noise would take me over and make me very dizzy. I then became very anxious around big crowds and at home would suffer from panic attacks for no given reason. They lasted for about a year and finally I got a grip on them after reading about some progressive relaxation techniques on the internet.

I returned to football my senior year...I had a great love for the game and still do. I completed my senior year of football and in the time suffered around 5 more concussions similar to the previous ones. I would never say a word to anyone though, I felt like I would let down my team if I couldn't play. I was moved from safety to corner back and was even given a revolution helmet with a special mouth guard ( one of those brain pad mouth guards ). Largely because of the new position, my new mind frame to avoid direct contact, ( hit them in the legs ) and the specialized protective equipment I feel I didn't receive more concussions.

As I said i'm now 20 years old and am a full time college student. I continue to battle depression and still find myself having anxiety problems. I have never thought that my concussions could be the cause of the problems I face now. My life is completely different know. I can tell my personality has taken on major changes.

I think this is a very important subject and everyone who is involved in football or any sport that has mild contact, weather through family or if you actually play should be aware of the risks and dangers when receiving a concussion and considering returning to play.
Dr. Gupta;

Have you ever considered the injuries to the unprotected head in the playground, let alone the lone bone injuries. There are more than 500,000 injuries in the playground per year that seek medical attention. The CPSC guidelines and most national standards provide inadequate protection and most state laws that require compliance to CPSC and Standards are not enforced.

For more information you could go to http://playgroundadvisory.com/news.htm or http://www.ciwmb.ca.gov/Tires/Pubs.htm for more information. The latter is a just released study and you might go the last chapter on protection of children from head injury.

Your recent work, while valid focuses on the youth and adult athletes that can understand the risk of the injury and the consequences for the rest of their lives. It might be time to focus on the child, who understands that risk is an important part of learning, but does not understand the injury potential and expect their parents and caregivers would not take them to a place that could result in a life threatening injury.

I watch you reports with interest and the ones on head inujury are most interesting as there are standards that provide protection, but in most cases more can be done.
My son had a concussion playing football in high school. He stayed in the game for 1 play after the hit, and snapped the ball at the wrong time. He took himself out. He was confused and had a headhache. He talked out-of-his-head on the way home. The trainer examined him (she is very experienced and looks after the welfare of the players) and told me what to look for and I took him home. He was better the next day. He wanted to play again, but the trainer and coaches wouldn't let him until he was completely symptom free for 7 days. But he wanted to play badly due to a sense of competiveness and not wanting the team to suffer because of his absence. I am an RN and nurse practitioner. But I had feelings like his. I wanting him to play, because being unable to play upset him so badly. But I didn't share my feelings with him. The coaches and trainer were concerned about him and they know the dangers of concussions. We are lucky we have good coaches and trainers who understand the consequences of concussions.
As a former college athlete who has suffered multiple concussions, I know first hand that they are dangerous. I do questions one other component with this study. Most college athletes who suffer concussions do so because they play extremely hard. These are also the same athletes who are so passionate about the game where it makes it difficult to enter into their post-sports life. These are the athletes who often suffer from mental illness and depression due to some of these adjustment issues. Maybe there is validity to this part of the issue?

Bottom line...as long as athletes are toted as heroes in our society and are taught that their self-worth is wrapped up in their performance, they will continue to push themselves to the extreme, including ignoring concussions in order to play.
My 15 year old son received his first concussion during high school soccer practice. He was blindsided by the soccer ball. Prior to the season, he had been given a baseline concussion test. After the concussion, he took the test again and there were marked descrepencies. He started having migraine headaches and missed a lot of school. He could tell he was having trouble remembering things and his personality changed. He was much more irritable. His grades suffered. He dropped from all A's to B's and C's. He was not allowed to play again until the concussion test showed no abnormalities. It took about 6 weeks, basically the whole season. His headaches diminished and now 5 months later he seems much better.
My daughter recieved a concussion in soccer she set out for 2 weeks, no practice or games, 9 months later she suffered one more, this time she sat out for 6 weeks, we were informed that you starting counting after they go 2 days without a Headache-then the 6 weeks started from that point. So she actually went alittle longer than 6 weeks. Each time she had a CT scan (normal) her only symptom was that she would start to vomit.
As a certified athletic trainer, I fight a constant battle to educate coaches, parents & athletes about the signs, symptoms & consequences of concussions. Unfortunately, many times I also have to fight with doctors who still allow athletes to return to activity while they either still have symptoms, or are within the recovery period after symptoms have abated. It is up to every parent to become educated about the consequences of concussion. Guess what - concussions don't just happen in collision sports. They happen to roller bladers, bike riders, sledders or your kids wrestling around with the dog - use your imagination.

The CDC has done a great job putting together the FREE "Heads Up-Concussion in High School Sports" educational package. Visit http://www.cdc.gov/ncipc/tbi/coaches_tool_kit.htm to view, download &/or order this very effective & sobering package.
My siblings play basketball, baseball (older brother) and soccer (younger sister). They've never had a concussion, but sometimes I do worry they will have one. In my Rehab Services class I took in the Spring 2006 term, I learned that there is no such thing as a mild concussion. A few years ago, I went to the doctor because I was sick. They tested me for mono and strep throat. The nurses poked me about three times before they found a vein and drew my blood. I felt so weak and dizzy. As a result, on the way out to my Mom's car, I passed out. I was unconcious for about a half a second. I remember waking up trying to move and panicing. Could I have had a concussion? I had a headache, but I was also having a sinus infection at the same time as I was having strep throat.
Traumatic injuries aren't the only risks high school athletes face.

The Journal of the American Medical Association recently published research suggesting that the prevalence of obesity among high school football lineman is severe enough that athletes, parents, physicians and the athletic staff should consider the risks of adolescent obesity on the players� short- and long-term health.

One of the most dangerous health problems linked to adolescent obesity is heart disease. Heart ultrasound (echocardiography) is a proven, safe and comprehensive examination of young athletes� heart health.

You can learn more at www.SeeMyHeart.org

That is the public education site of the American Society of Echocardiography, with which I work.
Dr. Gupta;
ESPN has been reporting on the NFL's concussion research for the past year. According to NFL statistics the N.E Patriots have the lowest concussion rate in the league annually. Why? more than 70% of the Players are fitted with a retainer llke medical device that was designed by a Tufts University head and neck specialist. It was specifically engineered to counteract the boxers "Glass Jaw" Marvin Hagler was the first to wear it and Patriot players have benefited from it for decades. Since its recent patenting, it is now available nationally through a network of dental labs. Dentists are trained to evaluate and make this device. Candidates are athletes who have had concussion or its symptoms of dizziness, the sensation of seeing stars, headache, nausea and more. Dr.Gupta a CNN story would do a great justice to let the public know about this silent epidemic and the efforts one man is doing to help eradicate concussions from blows to the jaw. Of which Riddell themselves say 70% come fron the jaw area. Blows to the crown of the head are from improper takling and ESPN has connected them with damage to the pituatary cord. Please look at my web site and contact me through the contact info. Tufts, a Harvard researcher and the MIlitary have taken action, CNN would be a great venue for this story.
My 16 year old plays rugby. Six weeks ago he suffered a concussion in which he was tackled. His head hit the ground and he passed out. He came to, tried to get up, passed out again. He again came to and tried to get up and passed out. The then helped him off the field and he was out the rest of the game.

We did the ER route, and followed up with his doc. His doctor felt that he would be able to go back to play in a weeks time, but said that he had to be symptom free for a week.

It took a full 4 weeks before he felt he was symptom free. Constant headaches being the most prevelant symptom. He went back to play, and again hit his head, and suffered more headaches.

He is just now feeling that his headaches ARE totally gone, sort of happened in an instant when his head cleared.

Now however, he is having blurry vision in just one eye.

This has been THE most shocking experience for us all. I never in a million years, had this vision or impression of a concussion. Everyone makes it out to be a simple head bump that isn't real serious.

Well it IS and can be very serious, and I really believe that more needs to be said about it. Coaches need to be more aware of the total impact of a concussion.

Most of the coaches out there now, are from the old train of thought about them being 'bumps' or 'dings'.....

Fortunately our coaches have been very supportive, but my son has felt like he is 'less than' because with a concussion people sort of either believe you or they don't. There is no cast, or stiches to 'prove' your injury.

My biggest prayer for this is that people will take this more seriously than they do and that people will take them more seriously for each other!!!
On Thursday, November 8, 2007, my 15 year old freshman in high school daughter, who is also an athlete, was doing layups in free time in PE. On one layup a boy surpised her and body slammed her into the wall and fell on top of her. He got up and walked away. Being the athete that she is and having been told by us and her coaches all her life to ignore the pain and keep playing jumped up off the floor. She didn't remember much after that. She told us what happened after school. She was too sore get out of bed and go to school the next day. The following Monday, Tues and Wednesday were the high school basketball tryouts. She actually made the JV/Varsity team. By Thursday morning while showering she got dizzy, her left side went numb and she threw up. Her left side gave out on her and she collapsed in the shower and on the way down she hit the left side of her head just behind her ear on the soap dish sticking out of the shower wall. By Friday we were in the emergency room with her. We found out that she had a double concussion. They now believe she had a seizure in the shower caused by the first concussion, which also gave her the second concussion. She now experiences memory loss, slow speech, slow reactions and doesn't understand conversations people have with her. You can ask a question and she usually doesn't understand what you are saying. She doesn't have much memory of what she did yesteday and that happens every day now. She sleeps alot and has a constant headache. Her social life is almost non existent now. She has been through numerous tests and we are still waiting on the results of her latest which is an EEG. She now has no memory of either concussion. She just feels stupid now. It has affected her ability to do school work too. We don't know how long it will take her to heal. Time will tell. This is the short end of the story
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