Preventing Concussions from Turning Catastrophic

September 22, 2013

The most common discussion right now in sports is surrounding concussions. Last month, the National Football League settled with former players relating to a lawsuit filed regarding concussions. Not a day goes by that Twitter is not filled with headlines from concussions at the youth, high school, college and professional levels. Many states have taken some sort of step, they believe, through legislation but critics say that legislation does not go far enough. In many states, that is true as some of the most vulnerable athletes are left with no legal protection. In many states, the concussion legislation only covers high school athletes. Illinois is one such state that while legislation is in place, it goes nowhere near far enough. In Illinois, the only ones truly protected are those who compete for IHSA schools as the law mandates such schools to have policies in place in accordance with IHSA rules. But what about those schools who are not members of the IHSA? What about middle schools, junior highs, and elementary schools? What about club sports?

Let’s look a little closer and we’ll often find that legislation only mandates education. But what education is sufficient? What is overkill? And does the education work?

Here today I want to consider a multi-level approach to concussions. We cannot forget any of these levels because each piece is an important piece.

I’ve said it before and I’ll say it again. Concussions themselves do not worry me so much. They happen and they will happen regardless of what we do. The biggest concern to me is the lack of recognition and the lack of awareness after the fact. We must improve this aspect.

Education

Education is at the forefront of everything we do in the concussion world. Parents, athletes, coaches, school administrators, and healthcare providers must be educated in concussion recognition and concussion management. But does the current education go far enough? I don’t believe it does. Too often do I continue to hear things such as “I don’t have a headache” or “I didn’t lose consciousness” as reasons for why people believe they cannot have suffered a concussion. There are about 25 concussion symptoms; headache is not the only one. So when you report several symptoms, but no headache, you are likely concussed! And a small percentage of concussions result in loss of consciousness. It’s important to note if LOC did occur, but the severity of the injury is not linked to that potential event.

Student-athletes and parents must be educated on the signs and symptoms of a concussion. It’s important that the parents be able to recognize these problems with their son or daughter and equally important for the athlete to report problems to their parents, coaches, and or healthcare provider. Additionally, it is crucial that the athletes report problems that their teammates are experiencing. When you see your teammate “not acting right” then you need to say something!

Coaches also must be educated in the recognition of concussions. At the high school and youth level, there is not always a healthcare provider available. The coaches must take on these responsibilities and if there is any question, hold the athlete out until they are seen by a healthcare provider. Additionally, coaches must be educated in proper techniques whether that be tackling in football, heading a soccer ball, or stunting in cheerleading. Coaches should regularly undergo education in safety topics.

School administrators also must be educated so that cognitive impairments are identified and can be corrected. Concussions don’t only affect the physical activities such as sports, but can have significant problems in an academic setting. Concussion management must be included at the schools too.

Healthcare Providers

The National Athletic Trainers’ Association now says that approximately 60% of high schools nationwide have access to an athletic trainer. Athletic trainers are healthcare providers specifically trained in athletic injuries and one such injury is concussion. Athletic trainers have long been on the forefront of concussion recognition and concussion management.60% of high schools may have access to an athletic trainer, but what does that really mean? If it’s like at my current school, it means there is a healthcare provider there occasionally. But what about all the other occasions? If it’s the case of many schools, the athletic trainer is often there for football games only or maybe varsity events. But what about that freshmen soccer game? What about that cheerleading practice? There are many incidences where athletic trainers are not present, but the school “has access.”

On this blog, I have long said “Every Athlete Deserves an Athletic Trainer.” The time has come that schools MUST have athletic trainers. These individuals must be certified by the Board of Certification and licensed by their respective state. An inability to hire a full-time athletic trainer is an inability to provide adequate athletic opportunities to a school’s students.

In addition to a certified athletic trainer, schools must have a team physician who is also trained in concussion management. The athletic trainer and physician must work together for all injuries for the safety of the student-athlete.

Protocols and Procedures

The last piece of the puzzle is having proper protocols in place. We cannot allow a student-athlete to simply return because they “feel better.” There is a lot of controversy with regards to things like neurocognitive testing, baseline testing, and return to play protocols. But utilizing the available resources the healthcare providers should be able to develop protocols that are sound. In our company, we do utilize ImPACT but that’s just one tool in the big picture. You must also have progressive return to play protocols so that you gradually increase activity before allowing one to return fully to sports.

As you can see, there are multiple avenues that must be undertaken in order to properly manage concussions. It is this management that can be life or death so it is vital that we get it right. Do the right thing, and take the steps necessary. Educate, hire proper healthcare professionals, and have protocols in place.

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