March is Brain Injury Awareness Month, and this year’s focus is on concussion in sports. Concussion is often called the “silent injury,” because its effects cannot be seen. The casual observer cannot tell that a sullen, withdrawn teen was once a vibrant and smiling girl prior to her concussion while playing soccer. You don’t know that the young man next door now struggles with basic schoolwork after multiple concussions during last football season.
For many years concussions were described as “dings” or “bell-ringers” and usually thought to be minor injuries. In fact, a concussion is a traumatic brain injury that interferes with the brain’s normal function. Sadly, a small number of high school athletes die each year from catastrophic brain injuries. Thousands of additional athletes suffer nonfatal, but potentially disabling, brain injuries. These injuries garner very little attention, but may have dramatic long-term consequences.
The U.S. Centers for Disease Control and Prevention estimate that 300,000 sports concussions occur among children and adolescents each year in the United States. Using the most conservative estimates, approximately 1,000 high school athletes in Oregon suffer at least one concussion each school year. While most of these youngsters recover within a few weeks, many suffer from memory problems, chronic headaches, difficulty concentrating and depression for months or even years.
The past decade has seen a revolution in the management of sports-related concussion. What was once considered a relatively benign condition is now recognized as a critical medical issue with distressing and potentially permanent consequences.
We have learned that adolescents recover more slowly and are more prone to further injury than college and professional athletes. We now know that an athlete doesn’t have to be rendered unconscious to have suffered a concussion. In fact, only about 5 percent of all concussed athletes are “knocked out” at the time of injury. Research also indicates that young athletes who have a history of a previous concussion take longer to get better and may be three to six times more likely to sustain an additional concussion.
Perhaps even more surprisingly, recent studies confirm that concussions are not just “football injuries.” New evidence suggests that girls playing soccer are not only more susceptible to concussions than their male counterparts, they also take longer to recover normal brain function after the injury. High school girls playing soccer sustain concussions at a rate 60 percent higher than boys. In basketball, the concussion rate for girls is 300 percent that of the boys.
As our knowledge of concussions has evolved, so has our approach to diagnosing and managing injured athletes. Key to this understanding is that athletes who are still having symptoms from a concussion (headache, confusion, difficulty concentrating, etc.) should never return to physical activity until those symptoms have resolved and they have been cleared by a physician. If they do return to sports while still experiencing concussion symptoms, they are at risk for a more severe concussion, or even a potentially fatal condition called Second Impact Syndrome.
To safeguard high school athletes, the Oregon School Activities Association became the nation’s first state athletic governing body to mandate a “no same day return to play” policy for concussed athletes. The OSAA has also supplied coaches and athletic directors with educational materials on the signs and symptoms of concussion. Unfortunately, our ability to protect high school athletes does not extend to the thousands of athletes in youth and club sports. Parents and coaches in youth and club leagues must be aware of the signs and symptoms of concussion and insist that educational programs, rules and protocols regarding proper concussion management are instituted.
In response to these concerns, we have formed the Oregon Concussion Awareness and Management Program. This program has focused upon educating physicians, coaches, administrators, athletes, parents and others on the signs and symptoms of concussion, as well as management strategies, safe return to play, and prevention. The program also has helped make computerized neurocognitive testing available at a discounted rate to all high schools across the state. While the program was created to address concussions in high school athletes, we stand ready to expand our efforts to encompass all young athletes within our state.
The goals that program has set can be reached only through the cooperation of all the parties involved: parents, athletes, coaches, athletic trainers, physicians, teachers and others. Unfortunately, educating this broad group of participants across our large state brings many logistical and financial barriers. While the dedicated efforts of a handful of individuals have already shown tangible results, we will require the help of many more. Only through grants, state funding, private contributions and sponsorship will we be able to make youth, club and high school sports safer throughout Oregon.
