Johna Register-Mihalik, concussion expert, talks about the changes in the recognition and reporting of concussions in the last decade. Video by Travis Long tlong@newsobserver.com
Johna Register-Mihalik, concussion expert, talks about the changes in the recognition and reporting of concussions in the last decade. Video by Travis Long tlong@newsobserver.com

High School Sports

FAQ: What you need to know about concussions

By Gary Schwab

gschwab@charlotteobserver.com

October 17, 2015 2:00 PM

Key issues you need to be aware of for concussion safety, according to Dr. Robert Cantu, a leading U.S. expert on head injuries, in his book, “Concussions and Our Kids”

▪ It’s never safe to play with a concussion.

▪ The best therapy is rest. When a concussion is properly managed, the patient will get better.

▪ If a concussion is not properly managed, the patient risks prolonging the symptoms or developing long-term problems like headaches, dizziness or insomnia.

▪ And, in rare cases, a patient who returns too soon and gets hit again could suffer a condition called second-impact syndrome and die.

“We do want people to play the sport,” Cantu says. “We want them to do it as safely as possible.”

Here is information that can help you recognize and manage concussions:

Q: When should players come out of a game if they’ve been hit in the head?

A: If in doubt, sit them out. The Centers for Disease Control and Prevention says: If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try to judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says it’s OK to return to play.

Q: Does a player have to black out to have a concussion?

A: No. Athletes, parents and coaches sometimes don’t recognize a problem because some still believe a player must lose consciousness to get a concussion. “A concussion is caused by a bump, blow or jolt to the head or body that causes the head and brain to move quickly back and forth. Even a ‘ding,’ ‘getting your bell rung,’ or what seems to be a mild bump or blow to the head can be serious,” according to the CDC.

Q: Do most athletes report their concussions?

A 2014 study said that 69 percent of athletes who suffered a concussion did not report it and continued to play. That can be because they don’t understand what just happened. Or, they don’t want to lose their spot in the lineup or leave the game and let their teammates down.

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Coaches, athletic trainers and organizations can make it clear through awareness campaigns and frank discussion that reporting an injury is an expectation, not a sign of weakness as some still think. Players should not try to play through the pain of a head injury. Help athletes understand that by reporting and possibly sitting out a game or two, they could be saving their season, their career or their life.

Dr. Kevin Guskiewicz, co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, says concussion numbers are up, but kids are safer today than ever because of increased awareness. “It looks as if we’ve seen an increase in concussion incidents, but I think that’s because we’re just capturing more through reporting.”

Q: What are warning signs that a player might have a concussion?

A: They include: Headaches, nausea, dizziness, confusion, being bothered by light or noise and feeling groggy or lethargic, according to the CDC.

Q: What signs might I see that a player has a concussion?

A: They include: Losing consciousness for even a brief time, being unable to recall events before or after an incident, appearing dazed, moving clumsily, answering slowly or being moody and behaving differently, according to the CDC.

Q: When should I take a player to the the emergency room, or call 911?

A: According to the CDC, seek help if a person displays any of these symptoms: One pupil larger than the other, drowsiness or falling asleep, a headache that gets worse and doesn’t go away, numbness or decreased coordination, repeated vomiting or nausea, slurred speech, convulsions or seizures, increasing confusion or agitation, unusual behavior, losing consciousness or difficulty recognizing people or places. If there’s doubt, get medical help immediately.

Q: When can an athlete return to play after a concussion?

A: Get a doctor’s advice and clearance. Wait until you’re 100 percent of who you always are, says Dr. David Wiercisiewski, a concussion expert with Carolina Neurosurgery & Spine Associates. If you come back too soon and have another head injury, the result might be far worse. “If I ask a kid if they have a headache, they might say no on the chance they will be released to play,” he says. Instead, he asks: Do you feel you’re 100 percent of who you always are? “You can tell when they pause ...”

Q: In soccer, do headers cause most concussions?

A: Studies show heading the ball accounts for about 30 percent of soccer concussions. It happens mostly when players collide with another player while attempting a header or hit their head on the ground after a collision.

Former U.S. World Cup and Olympics stars Cindy Parlow Cone and Brandi Chastain are working with the Concussion Legacy Foundation and the Santa Clara Institute of Sports Law and Ethics to promote a campaign to eliminate heading the ball in soccer until age 14. That would stop years of additional head impact and delay the tactic until players have finished most of their growth and are better coordinated. The Concussion Legacy Foundation estimates that delaying the introduction of headers would prevent more than 30,000 concussions for middle-school-aged players annually.

Developing better spatial awareness of where other players are through drills and improving peripheral vision can also help players avoid injury when doing headers, experts say.

Q: How much should players practice headers?

A: “The likelihood of getting a concussion if you’re taught the proper technique of heading is significantly reduced, but it’s still going to happen. It’s not a good idea, even with proper techniques, to relentlessly head a ball,” says national concussion expert Dr. Robert Cantu, co-director of the Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine. He suggests limiting headers in practice.

Q: What else in soccer causes head injuries?

A: Rough play. Enforcing the rules and reducing person-to-person contact would have the most impact in reducing soccer concussions and other injuries, according to a study led by Dr. Dawn Comstock, of the Colorado School of Public Health. “Anybody who watched the women’s World Cup and compared it to a decade ago, the level of aggressive athlete-to-athlete contact is way up,” Comstock said. The study, published in July in JAMA Pediatrics, found that player contact was responsible for 69 percent of boys’ and 51 percent of girls’ soccer concussions. She said parents and coaches in youth sports should ensure that officials are properly trained and enforce the rules.

Q: Where can an athlete, coach or parent get useful information about concussions?

A: Experts recommend HeadsUp on the Centers For Disease Control and Prevention website. There you can find tips about recognizing and treating concussions, online concussion training videos, facts sheets to print out and keep with you at games and a downloadable app to help you know what to do if you suspect a concussion has occurred.

Q: Does my school have an obligation to recognize and treat concussions?

A: All states now have a concussion-in-sports law. North Carolina adopted a law in 2011 requiring students participating in interscholastic activities who exhibit signs of a concussion be removed from the activity and not return to play the same day. They must be cleared by a medical professional with training in concussion management before returning on a subsequent day.

Q: What can I do to prepare a child for the potential of having to sit out because of a head injury?

A: Get a child involved in multiple activities, not just one. “If one sport gets taken away even for two weeks, there can be a loss of identity,” says sports psychologist Dr. Desaree Festa. “Having a backup activity helps them get through an injury or a concussion.”

Q: Are sports too dangerous for my child?

A: “We need kids to play sports because it’s such a good way to incorporate physical activity,” says Dr. Dawn Comstock of the Colorado School of Public Health. Comstock recently led a study on soccer injuries. “The long-term negative health consequences of inactivity – obesity, heart disease, diabetes – are much more certain and concerning than the very low likelihood that any child will sustain a serious sports related injury.”

Q: I’m a coach but have never been trained about what to look for. What can I do?

A: The CDC has facts and tips to help you, plus a free 30-minute online training course.

“When a coach knows what to look for and what the consequences are, they are much more willing to make changes to how they coach and how much contact the players are exposed to unnecessarily,” says Laura Richins, Porter-Gaud High School trainer.

Q: How do Charlotte youth leagues promote concussion awareness?

A: Charlotte-Mecklenburg Schools has partnered with Carolinas HealthCare System for five years to provide a certified trainer at all high schools. The trainer administers baseline testing, attends games and works with doctors to help students who have had a concussion return safely to the classroom and the playing field. “Having a trainer at school every day, they get to know the kids and if they’re trying to hide (a concussion),” says Leigh Ann Caldwell, manager for sports medicine for Carolinas HealthCare. Before the partnership, not all schools had trainers.

Two of the area’s largest soccer clubs offer baseline testing (to compare to test results after a child might have had a concussion) and are affiliated with local hospitals: Charlotte United partners with Carolinas HealthCare System, and Charlotte Soccer Academy teams with Novant Health Sports Medicine to provide concussion information and testing.

Youth soccer leagues vary in concussion awareness, from posting information on websites to sharing information with coaches. As a parent, you can ask your coach about his or her philosophy as well as raise immediate concerns at the field if you think your child might have suffered a concussion.

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