As a sports medicine physician with a special interest in sports-related concussions, I spend a lot of time educating parents, athletes, coaches, athletic trainers and other healthcare providers about sports-related concussions. Though the details of my presentations vary for different groups, the message is always the same: When in doubt, sit them out! And for the athletes: When in doubt, sit it out!
Current medical recommendations are that any athlete with a suspected concussion is to be immediately removed from play, and not allowed to return to play that same day. They are then not allowed to return to play until they have recovered from the injury and have been cleared by a medical professional.
I have first-hand experience treating thousands of young athletes with concussions during my career. In a recent study of 185 athletes with concussions seen recently in my practice, we found that four in every ten returned to play or continued to play on the day of their injury. These patients reported more symptoms and worse symptoms than those who were immediately removed from play. This is an alarming finding when the recommendations are that an athlete be immediately removed from play.
Athlete Mentality – The same drive and commitment that makes someone a great athlete, often is a barrier to reporting an injury. The culture of sports for players to be tough and push through pain places young athletes in danger, especially when dealing with a brain injury. In some cases, the athlete may justify that it is OK to continue, saying, “it’s not that bad,” or he or she may hide symptoms thinking, “I don’t want to get benched” or “I don’t want to let my team down.” Athletes who are playing at more competitive levels and have more at stake during a season or even a game have a higher risk of these behaviors. Athletes often will tell their coaches and parents, “I’m fine” so they may continue to play, even when they know they are injured. I encourage athletes to immediately report any injury or symptoms and for parents, coaches and teammates to work together and speak up to protect others. There is no reason for this to be a decision made alone.
Lack of Standardized Education – Through legislation and media, many people have learned about best practices for concussion recognition and management, however, some still do not know how to recognize or respond to a suspected concussion. For example, education and management requirements in Texas House Bill 2038 only apply to University Interscholastic League (UIL) schools. Therefore, coaches in recreational and club organizations or parochial and private schools may not have required concussion education. Many of these do not have concussion protocols in place.
Lack of Awareness – Parents and young athletes may have been exposed to some education about the dangers of concussions, but many have not learned how to recognize the signs and symptoms. Unfortunately, some misunderstandings about the facts may also cause concussions to go unnoticed. For instance, some don’t realize that most concussions occur without a loss of consciousness and some occur without direct impact to the head.
We have so much to learn about concussion management, but we must continue to take action on what we already know. Here are the key messages for everyone involved in youth sports:
Young athletes take longer to recover than college and professional athletes. Returning to sports too early places the athlete at risk for more significant injuries.
Following rules and learning proper technique have been shown to reduce the risk of head injuries in sports.
Immediate removal from play has been shown to minimize symptoms and shorten recovery for many athletes who do sustain a concussion.
Learning the signs and symptoms of concussions is the responsibility of everyone involved in youth sports from league administrators to the athletes themselves.
Shane M. Miller, M.D. is board certified in pediatrics and sports medicine. He is a sports medicine physician at the Center for Excellence in Sports Medicine at Texas Scottish Rite Hospital for Children. Dr. Miller is a member of the American Academy of Pediatrics Council on Sports Medicine and Fitness. He also holds an appointment as Associate Professor of Orthopedics and Pediatrics at the University of Texas Southwestern Medical School. He sees patients for sports injuries including bone and joint, muscle and ligament injuries as well as sports concussions at our North Campus, now in Plano.