Bigger and Better but at what cost?

We are told that football is more than what we know it here in New England down in the Southern states. After watching this video, it certainly shed some light on that fact for me even more. As the video states, many high school football programs are run just like a collegiate program. They are super stars and the pressure is immense. http://www.pbs.org/wgbh/pages/frontline/football-high/?utm_campaign=viewpage&utm_medium=grid&utm_source=grid

Although this specifically is about football, we all know youth sports has exploded and it is certainly not what it was years ago. And that pertains to all sports- both female and male sports. I know it is long but anyone in sports- coach, parent, athlete, athletic director, support staff, athletic trainer, EMT, the list goes on and on- should watch this. We live in a state where athletic trainers are in many if not most schools in some sort of manner.  We are lucky as many states and rural towns don’t and student athletes suffer the consequences- in fact Arkansas has athletic trainers in only 15% of it's high schools. 

I can remember doing a field hockey camp- it was between 5 and 7 pm and it was high school girls. We were in day 2 of a heat streak and the temperature was still approximately 95 degrees at 6pm and very humid and I made the decision that goalies were not to wear pads and that they had to alter the game to field play only with open net. This was a JV league and it was only 1/2 field. I had a parent who became irrate at my decision and told me that my decision was foolish and that her daughter had to learn how to play in those conditions. To this day, I certainly do not regret that decision. I only hope Mom looked back and realized what the consequences could have been.

I unfortunately have had to experience an athlete with heat stroke here at BSU, a very scary condition, one I will never forget.

I was also lucky enough to work in two very successful high school football programs with outstanding coaches- Mansfield High School and Foxboro High School- both having a lot of respect for me and taking into consideration my recommendations. As a matter of fact- at Foxboro the team would not practice unless an athletic trainer or medical staff such as an EMT was present at the school.

Like I said, it is long. Take a few  minutes and watch bits of it over the next few days- and more importantly- pass it along to those who need to know!

Now that you have an idea of some of the basic terms associated with concussions, we will talk a bit about what the signs and symptoms are and the evaluation process.

Signs and symptoms of a concussion are much more complex than just a headache. We now know that concussions effect various parts of the brain which in turn leads to various signs and symptoms depending on the part of the brain that is damaged. Signs and symptoms vary and include physical symptoms, cognitive symptoms, emotional and sleep symptoms. I think one of the most recent symptoms we hear of lately in the news certainly is the emotional symptoms both short term and long term- long after an athlete is on the field or court where they are sustaining concussions.

Physical Signs and Symptoms
Headache
Fatigue
Dizziness
Photophobia (sensitive to light)
Sensitivity to noise
Nausea
Balance problems
Loss of consciousness
Vision difficulty

Cognitive Signs and Symptoms
Difficulty remembering
Difficulty concentrating
Feeling slow
Feeling foggy
Slowed reaction time
Altered attention
Amnesia- both short and long term

Emotional Signs and Symptoms
Behavioral changes
Irritability
Sadness
Depressed
Feeling emotional
Anxiety
Nervous

Sleep Signs and Symptoms
Drowsiness
Sleep more than usual
Sleep less than usual
Difficulty falling asleep

These symptoms although we often think of how it effects someone on the field, certainly impact their everyday life both in the short term and long term aspects of their life which is part of the reason concussion management has changed over the years.

Concussion testing now begins even before an acute concussion or a season begins for some athletes. Using ImPact testing which is a neurocognitive test, we can get a personal baseline for athletes identified as being a higher risk for concussion and will be tested prior to first contest (blog to come explaining ImPact testing). Currently those sports tested include field hockey, football, men and women soccer, men and women basketball, diving, wrestling, baseball, lacrosse, and softball. Those who are not tested using a baseline test can still use ImPact testing if a concussion is sustained, their scores will be compared to "norms" which have been established.

If an concussion is suspected, an onfield assessment will be performed. An important note is that if a concussion is suspected, the athlete WILL NOT BE ALLOWED to return to sport that day. Further neurological, neurocognitive and neuromotor/neurocognitive testing will be performed as well as a signs and symptoms inventory will be noted. ImPact Testing will be completed on all athletes (including those who did not have baseline completed) within 48 hours of initial concussion or reporting of concussion signs and symptoms. Referral will be made if deemed necessary. Instructions while symptomatic includes no athletic involvement inluding recreationally, rest, limited scholastic work, limited computer/games. Frequent neurologic exam, neurocognitive exams, and neuromotor/neurocognitive evaluations will be completed to determine the athletes progress or lack of progress. Ideally, daily check ups will be completed. Once an athlete is deemed cleared via evaluation, testing and/or a doctor, a progressive return to play guideline will be used to introduce physical activity safely to ensure no symptoms return which can often happen. The term "cleared" does not mean the athlete is able to jump right into a practice or game- it means they begin a progressive return to full activity. More on the return to play guidelines in the next blog.

Hopefully this gives you a bit more of an understanding of signs and symptoms and evaluations. Please note also that any loss of consciousness, spinal injury, progressive symptoms,  drastic deterioration of mental status, focal neurologic defect, complex signs/symptoms and assessements will be referred to a doctor.

We all have the best of intentions and when I created this blog, I certainly had high expectations of what I wanted BSU to gain from it. Well work life happens and I got distracted and neglected the site. I apologize. My intentions were to continually educate our staff, administrators, coaches, students and athletes using the newest, fastest, "easiest" ways, through social media and blogs. I got away from this this past year but as I leave BSU, I want to certainly get this back on track. I take pride when coaches and administrators say they learned something from this, it is what I created it for.

As with every season, this year was no different and we were as usual faced with very difficult injuries. Concussions are certainly one that we face often and the complexity not only of what concussions actually cause but also how we handle them has become more complex. Is this bad? No, certainly science and research has taught us a lot and we in society are seeing more and more of this in the news. Is this difficult to understand and adjust to- ABSOLUTELY! Understandably so.

As research and science learns more and more about concussions, so doesn't the way we as athletic trainers/health care professionals treat concussions. Changes especially have been quite dramatic in the last couple years. Here in the BSU Sports Medicine-Athletic Training department we take great pride in that we are on top of the current research, take guidelines set forth by the NCAA, NATA and the latest research very seriously for the well being of our student athletes, not only today and tomorrow but for the rest of their lives.

Gone are the days of "just got his bell rung", sit it out a few minutes and get back in, and rest today- you'll be ready tomorrow. Gone are the days of everyone thinking a concussion is a "bruised brain" and a few days of healing and you'll be back to normal. Is it easy to foget that of what many have been taught all through their days of sports? NO, certainly not easy at all. At the ripe old age of 35, even I have really had to adjust in how to handle situations.

So I want to start with a few things to teach you, after all it is true that we can teach an "old" dog new tricks! I will put out a few definitions, let you digest the information and in the next few weeks, add some more information to it to help you understand concussions and we deal with them.

CONCUSSION: A complex pathophysiological process affecting the brain, induced by traumatic

biomechanical forces.

·  Direct blow or impulsive forces transmitted to the head

·  Typically results in rapid onset of neurological impairments

·  Functional injury: Not a structural injury

·  May or may not include loss of consciousness (LOC)

·  Not identifiable on standard imaging (CT, MRI)

MILD TRAUMATIC BRAIN INJURY (mTBI): 

· All concussions are a form of mTBI

· Not all mTBI's are concussions

· The terms concussion and mTBI should not be used interchangeably

POST CONCUSSION SYNDROME:

· A set of symptoms which may last days, months,  or years following a concussion

SECOND IMPACT SYNDROME:

· Rare condition when an athlete sustains a second head injury before the symptoms of the first injury have resolved. Second Impact Syndrome is often fatal.