New Missouri measure means more concussion precautions
BY CYNTHIA BILLHARTZ GREGORIAN cbillhartz@post-dispatch.com > 314-340-8114
Posted: Thursday, May 26, 2011 4:30 am
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Not so long ago, when an athlete was dizzy from being conked on the head in a game or practice, his coach would often tell him to shake it off. "You got your bell rung," was a common sideline diagnosis.
This month, the Missouri Legislature took a step toward putting that way of thinking to rest when it passed the "Interscholastic Youth Sports Brain Injury Prevention Act."
Now, athletes who are suspected of having a concussion or brain injury during practice or play must be sidelined immediately and not allowed back on the field for 24 hours. They must also be analyzed by licensed health care providers who are trained in evaluating and managing concussions to get a written clearance to play.
"I'm a late '70s football player, and they didn't even think of those things. It was just get up and go back in," said Harvey Richards, associate executive director of Missouri State High School Activities Association, which helped write the legislation.
The act also requires mandatory education of coaches, athletes and their parents about the signs and symptoms of a concussion and the possible long-term effects of playing with one before the season starts. In addition, it calls for the creation of a coalition of groups to collect data and publish a report each year about the long-term impact of concussions and head injuries on student athletes. Several other states have passed similar legislation.
Both chambers of the Illinois Legislature have passed versions of a similar bill and are now working out differences.
Nathan Wilmes, director of sports medicine for Excel Sports Physical Therapy in St. Charles, likes the precision of the Missouri law's language. "I've had experiences where athletes will doctor-shop to find one who'll clear them to play in two or three days because some doctors aren't trained in concussion management," he said. "It's really kind of scary."
BIGGER, STRONGER, FASTER
Young athletes are bigger, stronger and faster today than ever before, making for more forceful impacts during collisions. And in football, helmets offer a false sense of security.
According to a study published in the medical journal Pediatrics last year, concussion rates among athletes ages 18 and under more than doubled from 1997 to 2007. The Centers for Disease Control and Prevention estimates that 3.9 million concussions related to sports and recreation occur nationwide each year.
On top of that, growing evidence shows an increased risk for degenerative brain disease in athletes who have had multiple concussions.
Anthony Breitbach, director of the athletic training education program at St. Louis University, said the new law is a move in the right direction, but he worries about the soccer player who's dizzy when she gets up from a play, but doesn't tell anyone.
Athletic trainers on sidelines during practice and games can detect a lot of concussions that would otherwise go unnoticed, he said. But not all schools hire athletic trainers.
Excel, which hires out (athletic) trainers, now administers a Standardized Assessment of Concussion test that measures the memory and cognitive skills of football players before the season starts. They give the test again on the sideline when they suspect players have suffered concussions during play or practice to see whether their scores have changed dramatically. It also helps them gauge changes from season to season.
"When I watch a play, I don't care what happens as far as getting a touchdown or scoring," Breitbach said. "I watch how they go to the ground and how they get back up. That determines what questions I'll ask them as they come to the sideline."
Richards said he's heard people express concerns that parents or kids may hide a concussion, because they don't want to be sidelined. "We have to be diligent in letting them know that missing that one play, or even the next game or two games, is not more important than how you live the rest of your life," he said.
Each player must now read and sign an information sheet about concussions and have their parents do the same. Richards believes that will help.
WHAT HAPPENS TO THE BRAIN?
Medical experts are not sure yet what happens inside the brain when it suffers a concussion.
"We are concerned that younger kids have developing brains, and we don't know if they take injury differently," said Dr. Mark Halstead, director of the sports concussion clinic at Washington University. "We do know that the amount of recovery time is longer for young adults, so there's a difference in the way they tolerate injury."
They also know that continuing to play with a concussion makes a young athlete vulnerable to greater injury and even death should they suffer another jolt to the head.
Most research on sports-related hits to the head have focused on NFL players.
The Center for the Study of Traumatic Encephalopathy at Boston University has found the same neurodegenerative disease in more than 20 deceased players, including former Chicago Bears player Dave Duerson, 50, who died after shooting himself in the chest in February.
What little research that has been done on younger athletes has found that pulling them off the field after a concussion may not be enough.
Last fall, the same researchers at Boston University reported that the brain of Owen Thomas, a University of Pennsylvania football player who hanged himself in April 2010, also showed signs of degenerative brain disease.
The researchers seemed stunned when interviewed for a PBS "Frontline" report, because Thomas was only 21 and had no known history of concussions.
In 2009, researchers at Purdue University equipped the helmets of 21 high school football players with sensors, and compared the impact data from them with brain-imaging scans and cognitive tests performed before, during and after the season.
Many of the players who did not suffer concussions performed increasingly worse on cognitive tests as the season wore on. And those who put their head down and took blow after blow to the top of the head were most impaired.
"We're looking at very sensitive organ of body and the nervous system," Richards said. "You don't even have to have a collision, it can be whiplash. Helmets don't protect against that. They're made to stop you from getting a skull fracture."
Football players run the highest risk of getting a concussion, but other athletes aren't impervious to them. In fact, Richard says, female athletes — particularly in soccer and basketball — run a higher risk of concussion than men in other sports because of a physiological difference.
"The male gender has a stronger neck which helps avoid some of these concussions," he said. "In female sports, when you're going backwards and fall and hit the ground, and your head snaps, you're essentially do the same thing as a guy playing football."
The early season humidity kept the sports medicine team busy!
