Concussions: a Hidden Epidemic

Many athletes know what it is like to get hit in the head during a sports game, feel dazed, shrug it off, and get back in the game. Unfortunately, studies show that many of those hits actually result in concussions, a type of mild traumatic brain injury that can have short or long term consequences on academic performance, emotional health, and behavior. Although it is still unclear exactly what occurs in the brain during a concussion, it is important to take steps to prevent them and to recognize the signs of a concussion, especially in young people who are particularly vulnerable to their long-term health consequences.

Approximately 1.6-3.8 million concussions occur during competitive sports each year in the USA. A study sponsored by the Centers for Disease Control and Prevention (CDC) found that most concussions in youth 5-18 years old occur in contact sports, including football, basketball, and soccer. As many as half go unrecognized by coaches and players. Concussions are more likely to be detected among girls than boys, possibly because girls are generally more likely to report their injuries.

The most common physical symptoms of a concussion include headache, nausea, vomiting, balance problems, changes in vision, fatigue, and sensitivity to light or noise. Mental changes after a concussion can include feeling mentally “foggy” or “slow,” difficulty concentrating or holding a conversation, confusion, or memory loss. Some children and teens may find it more difficult to learn in school than they did before their head injury, which can translate to a decline in academic performance. Nervousness, sadness, or irritability are also common symptoms of a concussion, and can be accompanied by changes in sleep habits.

Any child or teen who experiences a change in mental function after a blow to the head should be evaluated by a medical professional, whether or not the child lost consciousness after the injury. A medical doctor will evaluate the child for neurological and vision problems, examine the child’s head, and determine whether the child needs further testing.

The New York State Concussion Law was designed by health professionals and policy makers to protect youth athletes from concussions and to minimize their health effects. According to the Law, youth diagnosed with a concussion must be removed from play immediately and not allowed to return to sports until they are cleared in writing by a licensed healthcare provider. The first step toward clearance is for youth to get plenty of physical and mental rest, generally 7-10 days or more, until they are symptom-free for 24 hours without using medication. After that, the child or teen’s pediatrician will coach him or her through the Return to Play Guidelines, a five step protocol designed by international health and sports experts, which allows athletes to participate in progressively more vigorous exercise until they are able to return to sports without restrictions. The steps in the Return to Play Guidelines are listed below:

1. Light aerobic activity (e.g. 5-10 minutes of walking; no jumping, running, or weight lifting)
2. Activities that increase heart rate and incorporation of gentle head and body movements (e.g. moderate intensity jogging or weight lifting)
3. Heavy, non-contact physical activity (e.g. sprinting/running, high-intensity stationary cycling, regular weightlifting routine)
4. Reintegration of the athlete into practice sessions, even full contact if appropriate for the sport
5. Full return to play without medical restrictions

Working with a medical professional can speed an athlete’s recovery and prevent him or her from sustaining worse injuries in the future. Children and teens who have recently had a concussion are four times more likely to experience a second and more severe concussion, even with a softer blow to the head. Youth who have multiple concussions can develop disruptive or even disabling complications later in life, such as depression and difficulty understanding or remembering information, so preventing concussions is a valuable investment for health.

It is important to note that no protective sports gear, even properly fitting helmets, is 100% effective at preventing concussions. Following the rules of the sport and avoiding unnecessary hits to the head are the best ways athletes and coaches can avoid concussions. For more information about preventing and treating concussions, speak with a doctor, and share this information with youth you know, to help them stay healthy!

References:

1. Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, and Hinton RY. Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study. Am J Sports Med 2011; 39: 958.
2. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train 2007; 42(4):495-503.
3. Iverson GL, Gaetz M, Lovell MR, and Collins MW. Cumulative effects of concussion in amateur athletes. Brain Inj 2004; 18(5): 433.
4. Dick RW. Is there a gender difference in concussion incidence and outcomes? Br J Sports Med 2009; 43(suppl 1):i46-i50.
5. Zemeck RL, Farion KJ, Sampson M, and McGahern C. Prognosticators of persistent symptoms following pediatric concussion: a systematic review. JAMA Pediatrics 2013 March; 167 (3): 259-65.

Beatrix Traa is from Washington, DC, and a second year medical student at the University of Rochester School of Medicine and Odothonlogy. She is planning to pursue a career in Pediatric and She is the president of the Rochester University’s chapter of the Latino Medical Student Association, a national organization whose mission is to educate and advocate for the health needs of the Latino community. LMSA members, including herself, contribute to CNY Latino and are raising awareness regarding the many health issues affecting the Latinos of Central NY and beyond.