Written by Scott R. Laker, MD
Fall is officially here, school has started, sports are in full swing, and the CU Sports Medicine team is here to help keep our athletes healthy and safe this season. With all the news of the National Football Leagues’ concussion settlement, it’s important to understand exactly how these injuries affect our youth athletes.
Concussions are one of the most common injuries to occur in contact and collision sports but can be dangerous if not identified and managed appropriately, especially considering the developing young brain. The highest rates of concussion occur in sports like football where there is the potential for collision on every play, but they occur in all sports.
All concussions are brain injuries and all brain injuries are serious. Concussions occur when someone is hit either directly in the head or neck, or if there is enough force involved to cause a problem in the brain’s functioning. Internally, there is a rapid change in how the brain cell’s function and the balances of electrolytes on the inside and outside of the brain cell. These abnormalities resolve spontaneously over time but no one has clearly identified a “quick fix” to make the symptoms go away more quickly.
The symptoms typically start within seconds to minutes of the collision but can worsen over the course of hours to days. Most athletes notice headache, memory problems, concentration issues, sensitivity to light and noise. Only about 10% of concussions will cause any loss of consciousness, so it is important to be on the look out for athletes that are behaving differently after a hit during a game or practice.
On the sideline or in the first days after the injury, we recommend that athletes be evaluated urgently in an Emergency Department if there is a decrease in level of consciousness, prolonged initial loss of consciousness, worsening headache, or multiple episodes of vomiting. These symptoms can indicate that the injury is more severe and potentially dangerous and should be evaluated by a professional.
Interestingly, young women may suffer concussions more frequently than young men in similar sports. For example, the rates in girls’ soccer are reported to be three times as common as in boys’ soccer. No one has clearly identified why this occurs but some thoughts include differences in head and neck geometry, differences in style of play, possible and differences between the developing adolescent male and female brains. There are several ongoing studies trying to identify these differencesso that sports medicine doctors can give the best advice possible to our patients and their families.
Most athletes recover over the course of 7-10 days after suffering a concussion. Current recommendations are to strictly keep the athlete away from collision and contact activity and to have them rest and recover. Athletes that exercise too hard during their symptoms may be at risk to prolong their eventual recovery.
Almost all people that suffer a concussion will resolve completely, though a small minority may be left with longer-term problems like headache disorders, concentration issues, or memory challenges. Most experts currently recommend that athletes with prolonged recoveries (longer than two weeks) or severe symptoms be seen by a specialist to help coordinate return to school and sports.
The State of Colorado follows the Jake Snakenberg Youth Concussion Act, named in honor of a young man who died from second impact syndrome while playing high school football. The law requires that athletes be removed from play immediately in the event of a suspected concussion and that they not be returned to practice or play until evaluated and cleared by a licensed medical professional.
It also provides for concussion education of athletes involved in organized sports from the ages of 11- 18. As of this writing, 47 states have similar concussion laws to prevent unnecessary injury to our young athletes.
We do know that athletes that return to their sport before being completely recovered are at risk for “second-impact syndrome”. This is an extremely rare situation in which the brain tissue rapidly swells beyond the ability for the skull to accommodate it, and nearly always results in death or severe disability.
Despite the rarity of the condition, most sports medicine doctors agree that these cases may have been preventable by removing the athlete at the first sign of a concussion and not returning them until they have been evaluated and cleared by a medical provider or their athletic trainer.
We have very limited information on the long-term consequences of concussion in youth athletes. The majority of our knowledge comes from professional athletes. Over the next decade, the research on concussion is likely to help us guide decisions for Colorado’s future youth athletes.
Overall, the best way to manage a concussion is to identify it early, remove the athlete from the risks of repeat injury, and to seek medical care and obtain good information regarding return to sports from a provider with experience in managing this common sports injury.
Scott Laker, M.D.
Assistant Professor, Physical Medicine and Rehabilitation
Medical Director Lone Tree Health Center