Post by Coach Campbell on Jun 20, 2012 18:01:19 GMT
Football Tackles Concussion Risk
What's being done to protect football players -- from the NFL to high school -- from concussions and their effects.
The issue gained national attention in 2009. Increasing attention has been focused on the damage football players' brains may sustain as a result of concussions associated with the repeated tackles they endure.
Football and Concussions What should be done when a football player (or any other athlete) has a suspected concussion? Read expert advice on immediate treatment and when the player can return to training and competition.
Football Concussions: What to Do
Fast-forward to February 2011. That's when the NFL announced new guidelines that will be used, starting in the 2011 season, to determine whether an athlete who's taken a powerful hit and sustained a concussion will be benched or sent back into the game.
The guidelines, developed by the NFL's Head, Neck, and Spine Committee, combine a symptom checklist, evaluation of the player's attention and memory, neurologic examination, and a balance assessment -- and it can be used on the sidelines.
It's the first time the NFL has spelled out what is to be done when a possible concussion has happened.
"It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play," says Margot Putukian, MD, the head team physician at Princeton University and chair of the Return-to-Play subcommittee of the NFL's Head, Neck, and Spine Committee.
When Concussion Strikes
In a concussion, the brain is shaken so forcefully that it hits the inside of the skull, causing brain injury.
Symptoms of a concussion can include loss of consciousness or drowsiness, confusion, headache, nausea or vomiting, blurred vision, and loss of memory of events surrounding the injury.
If a player is left unconscious for more than a few minutes, the concussion is clearly serious. But sometimes even seemingly mild concussions can do damage. "A minor hit on the field can take a long time to recover," says Mark Lovell, PhD, founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program.
There is no magic number of concussions that constitutes "too many."
"It's not as simple as how many concussions someone's had -- it's total brain trauma," says Robert Cantu, MD, co-director of Boston University's Center for the Study of Traumatic Encephalopathy and clinical professor of neurosurgery at Boston University School of Medicine.
"Linemen who've had almost no concussions have the majority of cases of chronic traumatic encephalopathy, because on every play they get their brains rattled, trying to block with their head," says Cantu, who is also the co-director of the Neurological Sports Injury Center at Boston's Brigham and Women's Hospital.
Research Shows Risks
An evolving body of research has linked athletes' repeated concussions to long-term brain damage, including a condition known as chronic traumatic encephalopathy (CTE), a degenerative brain disease that mimics dementia.
CTE symptoms have been reported in a number of former NFL players, many of whom are much younger than the typical Alzheimer's patient. In June 2010, scientists at the Brain Injury Research Institute of West Virginia University announced that Chris Henry, the Cincinnati Bengals receiver who died after falling or jumping out of a pick-up truck the previous December, had developed CTE. Just 26, Henry was the first player to have died with trauma-induced brain damage while still active in the NFL, according to media reports.
Dave Duerson, a former safety for the Chicago Bears who committed suicide at age 50 in February 2011, had a "moderately advanced case" of CTE, according to Boston University's Center for the Study of Traumatic Encephalopathy. Researchers at the Center made that diagnosis in May 2011.
Hitting Young Players Hard
Concussion is not just an issue for the NFL. High school athletes who have suffered as few as two concussions may already have the signs of "post-concussion syndrome," according to a study published in the journal Neurosurgery in January.
The study found that, even though they had sustained no concussions within the past four months, young athletes with a long-term history of at least two concussions were more likely to have:
Cognitive symptoms, such as memory problems or feeling mentally "foggy."
Physical symptoms, including headaches, problems with balance, or feeling dizzy.
Sleep symptoms -- specifically, sleeping either more or less than they normally would.
And a study from the National Center for Injury Prevention found that 47% of high school football players say they suffer a concussion each season, with 35% of those reporting multiple concussions in a season.
But most sports-related concussions -- about 85% -- go undiagnosed, according to the American College of Sports Medicine.
Even when they are diagnosed, more often than not, concussions in football and other sports may not be managed optimally.
For example, the American Academy of Neurology's guidelines state that no athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion. After a concussion, a doctor with proper training should be consulted prior to clearing the athlete for return to participation.
It's not clear if that's happening. A previous study -- done before the American Academy of Neurology revised its guidelines -- shows that at 100 U.S. high schools studied for three years, nearly 41% of athletes with concussions were back on the field too soon.
Long-Term Impact
It's clear that concussions can have devastating long-term impact on NFL players -- though that's not always the case.
Many former players, still young, report persistent headaches, fatigue, difficulty paying attention, memory problems, mood swings, and personality changes.
A preliminary study commissioned by the NFL showed a higher rate of dementia among retired players than in the general population -- about six times as high in players over 50 compared to other men in the same age group. This study cannot prove cause and effect, however.
Much less is known about how repeat concussions affect high school and college athletes over the long term.
"The long-term effects of a few concussions on the young athlete is an incomplete book," Lovell says. "We're just starting to scratch the surface. We're starting to study kids as young as 5 and follow them throughout their lives, but that takes years to do; 90% of what we know about concussion, we've learned in the last five years."
The little information available is troubling. Boston University's Center for the Study of Traumatic Encephalopathy (CSTE), which studies long-term brain damage from injuries such as concussions, has now identified three young players -- aged 17, 18, and 21 -- who had abnormal proteins in their brains at the time that they died.
What those proteins may have done to them, and why they were there, is not clear. The players hadn't shown any symptoms, "but were on their way, had they lived, to develop CTE later in life from the head trauma they had sustained," Cantu says.
"You don't have to play for a number of years in the NFL to have brain trauma that can cause long-term damage. You can pick up enough of that trauma just playing in high school and college," Cantu says.
Dangers to Young Brains
A major problem for young athletes is that high school and even some college programs lack the resources necessary to protect their players from concussion.
"At the professional and, to a lesser extent, the collegiate level, everybody's trying to protect these athletes from getting hurt. But at the lower level, it's not managed as well," says Anthony Alessi, MD, co-chair of the American Academy of Neurology's sports neurology section.
"There's not usually a doctor on the sidelines at a high school football game to evaluate an athlete after a concussion," Lovell says. "And most high school football teams don't have athletic trainers."
Schools often cite cost as the problem.
"Many high schools say they can't afford to have an athletic trainer. I say that means you can't afford to have a program," Alessi says. "The presence of a certified athletic trainer makes your program safer by every measure, and if you can't afford to make the program safe, then you should be closing it up. Where we're getting into trouble is with programs where there are no trainers and no medical personnel who understand what happens to the brain in a concussion."
What's being done to protect football players -- from the NFL to high school -- from concussions and their effects.
The issue gained national attention in 2009. Increasing attention has been focused on the damage football players' brains may sustain as a result of concussions associated with the repeated tackles they endure.
Football and Concussions What should be done when a football player (or any other athlete) has a suspected concussion? Read expert advice on immediate treatment and when the player can return to training and competition.
Football Concussions: What to Do
Fast-forward to February 2011. That's when the NFL announced new guidelines that will be used, starting in the 2011 season, to determine whether an athlete who's taken a powerful hit and sustained a concussion will be benched or sent back into the game.
The guidelines, developed by the NFL's Head, Neck, and Spine Committee, combine a symptom checklist, evaluation of the player's attention and memory, neurologic examination, and a balance assessment -- and it can be used on the sidelines.
It's the first time the NFL has spelled out what is to be done when a possible concussion has happened.
"It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play," says Margot Putukian, MD, the head team physician at Princeton University and chair of the Return-to-Play subcommittee of the NFL's Head, Neck, and Spine Committee.
When Concussion Strikes
In a concussion, the brain is shaken so forcefully that it hits the inside of the skull, causing brain injury.
Symptoms of a concussion can include loss of consciousness or drowsiness, confusion, headache, nausea or vomiting, blurred vision, and loss of memory of events surrounding the injury.
If a player is left unconscious for more than a few minutes, the concussion is clearly serious. But sometimes even seemingly mild concussions can do damage. "A minor hit on the field can take a long time to recover," says Mark Lovell, PhD, founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program.
There is no magic number of concussions that constitutes "too many."
"It's not as simple as how many concussions someone's had -- it's total brain trauma," says Robert Cantu, MD, co-director of Boston University's Center for the Study of Traumatic Encephalopathy and clinical professor of neurosurgery at Boston University School of Medicine.
"Linemen who've had almost no concussions have the majority of cases of chronic traumatic encephalopathy, because on every play they get their brains rattled, trying to block with their head," says Cantu, who is also the co-director of the Neurological Sports Injury Center at Boston's Brigham and Women's Hospital.
Research Shows Risks
An evolving body of research has linked athletes' repeated concussions to long-term brain damage, including a condition known as chronic traumatic encephalopathy (CTE), a degenerative brain disease that mimics dementia.
CTE symptoms have been reported in a number of former NFL players, many of whom are much younger than the typical Alzheimer's patient. In June 2010, scientists at the Brain Injury Research Institute of West Virginia University announced that Chris Henry, the Cincinnati Bengals receiver who died after falling or jumping out of a pick-up truck the previous December, had developed CTE. Just 26, Henry was the first player to have died with trauma-induced brain damage while still active in the NFL, according to media reports.
Dave Duerson, a former safety for the Chicago Bears who committed suicide at age 50 in February 2011, had a "moderately advanced case" of CTE, according to Boston University's Center for the Study of Traumatic Encephalopathy. Researchers at the Center made that diagnosis in May 2011.
Hitting Young Players Hard
Concussion is not just an issue for the NFL. High school athletes who have suffered as few as two concussions may already have the signs of "post-concussion syndrome," according to a study published in the journal Neurosurgery in January.
The study found that, even though they had sustained no concussions within the past four months, young athletes with a long-term history of at least two concussions were more likely to have:
Cognitive symptoms, such as memory problems or feeling mentally "foggy."
Physical symptoms, including headaches, problems with balance, or feeling dizzy.
Sleep symptoms -- specifically, sleeping either more or less than they normally would.
And a study from the National Center for Injury Prevention found that 47% of high school football players say they suffer a concussion each season, with 35% of those reporting multiple concussions in a season.
But most sports-related concussions -- about 85% -- go undiagnosed, according to the American College of Sports Medicine.
Even when they are diagnosed, more often than not, concussions in football and other sports may not be managed optimally.
For example, the American Academy of Neurology's guidelines state that no athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion. After a concussion, a doctor with proper training should be consulted prior to clearing the athlete for return to participation.
It's not clear if that's happening. A previous study -- done before the American Academy of Neurology revised its guidelines -- shows that at 100 U.S. high schools studied for three years, nearly 41% of athletes with concussions were back on the field too soon.
Long-Term Impact
It's clear that concussions can have devastating long-term impact on NFL players -- though that's not always the case.
Many former players, still young, report persistent headaches, fatigue, difficulty paying attention, memory problems, mood swings, and personality changes.
A preliminary study commissioned by the NFL showed a higher rate of dementia among retired players than in the general population -- about six times as high in players over 50 compared to other men in the same age group. This study cannot prove cause and effect, however.
Much less is known about how repeat concussions affect high school and college athletes over the long term.
"The long-term effects of a few concussions on the young athlete is an incomplete book," Lovell says. "We're just starting to scratch the surface. We're starting to study kids as young as 5 and follow them throughout their lives, but that takes years to do; 90% of what we know about concussion, we've learned in the last five years."
The little information available is troubling. Boston University's Center for the Study of Traumatic Encephalopathy (CSTE), which studies long-term brain damage from injuries such as concussions, has now identified three young players -- aged 17, 18, and 21 -- who had abnormal proteins in their brains at the time that they died.
What those proteins may have done to them, and why they were there, is not clear. The players hadn't shown any symptoms, "but were on their way, had they lived, to develop CTE later in life from the head trauma they had sustained," Cantu says.
"You don't have to play for a number of years in the NFL to have brain trauma that can cause long-term damage. You can pick up enough of that trauma just playing in high school and college," Cantu says.
Dangers to Young Brains
A major problem for young athletes is that high school and even some college programs lack the resources necessary to protect their players from concussion.
"At the professional and, to a lesser extent, the collegiate level, everybody's trying to protect these athletes from getting hurt. But at the lower level, it's not managed as well," says Anthony Alessi, MD, co-chair of the American Academy of Neurology's sports neurology section.
"There's not usually a doctor on the sidelines at a high school football game to evaluate an athlete after a concussion," Lovell says. "And most high school football teams don't have athletic trainers."
Schools often cite cost as the problem.
"Many high schools say they can't afford to have an athletic trainer. I say that means you can't afford to have a program," Alessi says. "The presence of a certified athletic trainer makes your program safer by every measure, and if you can't afford to make the program safe, then you should be closing it up. Where we're getting into trouble is with programs where there are no trainers and no medical personnel who understand what happens to the brain in a concussion."
