Being Smart About Concussions

Public awareness on the seriousness of sports concussions has exploded in recent years, most notably following the suicides of prominent ex-American football players for the purposes of allowing their brains to be studied for damage related to their playing days.  This has cast a harsh light on a very serious problem in sports.  At IWS, we love sports – we watch, we play and our kids play.  While parents can rightfully appreciate the enormous benefits of playing sports: the camaraderie; the ability to work as a member of a team; and, of course, the substantial health benefits (at the same time as all countries including China are facing a booming obesity problem particularly among kids), we also need to recognize that sports do involve a level of risk.   While parents quickly understand that sprains and bruises are simply part of the game, many are not aware of how commonly brain injuries will occur and that proper assessment and treatment of sports concussions is essential to reduce long term effects.

Concussions can occur in any sport – indeed there are an estimated 4 million concussions per year in the U.S. alone from sports and recreation.  Recreational activities with the most concussions include bike riding and skate boarding.   In team sports, while they are most prevalent in American football, surprisingly girls’ soccer sees the second most brain injuries followed by lacrosse; boys soccer, girls field hockey and basketball.  Even cheerleaders are at risk.  But let’s keep it in perspective:   About 5% of student athletes in a given year will suffer a concussion and if correctly diagnosed and treated, the chances of serious and long lasted consequences are dramatically reduced.

So what is a concussion? A concussion is essentially a state of impaired brain function with either physical or chemical disruption in nerve connections, typically caused by trauma to the brain. Classically, we associate a direct blow to the head as the cause; but, in reality, any force on the body that initiates rapid head movement can cause brain trauma.  Many practitioners now define it as mild traumatic brain injury.  But don’t be fooled by the word “mild”: all levels of concussion are serious and can lead to cognitive, emotional, and physical changes.

The scary fact about concussions is that they cannot be diagnosed by X-Ray, CT or MRI imaging.  And once you have one, you are 4 times more likely to experience a second one.   This is when parents start to look for and understand the meaning of “sports medicine.”  Sports medicine is a field of study focusing on the diagnosis and treatment of injuries that result from sports: anything from nagging foot pain from running to a sore elbow from tennis to yes, the headaches your 14 year old girl is experiencing after her soccer match.  SAS is fortunate to have the services of Caleb Lott and Joe Panchella, two certified athletic trainers that work with SAS as part of the IWS athletic training program.   Joe and Caleb earned their master’s degree in athletic training from the University of South Carolina and in their work with the University football team, local high schools and the USC Sports Medicine center, played a critical role in diagnosing and treating young athletes that suffered a sports concussion.

“The most important first step in managing a sports concussion is recognizing its occurrence” says Joe Panchella, the AT assigned to SAS Pudong.  “Since most times an athlete won’t lose consciousness” adds Caleb (assigned to SAS Puxi) “you need to be aware of the key signs and symptoms.”  Caleb and Joe along with the IWS sports medicine physician team are working with CISSAC to develop and implement a city wide sports concussion awareness and treatment plan.  Ironically, after outlining the plan in mid-August, a high school volleyball player suffered a concussion the next day.

Caleb got the call from the hotline that was set up and walked the athlete through an assessment testing his memory and a number of physical and emotional signs.  The verdict: clear case of sports concussion.

Once signs of a concussion have been recognized, the athlete MUST be removed from play immediately.  In the days following, a team effort between athletic trainers, coaches, parents and teachers is essential to monitor the student’s condition and take the necessary steps to manage after-effects of the injury.  While in some cases athletes will have complete relief of symptoms after a day or two, many others will experience headaches, fatigue, concentration difficulty, etc. that will last for weeks and even months.  In all cases of concussion, the immediate treatment is not as simple as restricting return to playing sports; it involves resting their brains (“cognitive rest”) in all aspects of life.   This may mean missing school or attending on a shortened schedule; reducing or delaying tests and homework; and cutting back or avoiding leisure reading, video games, TV, and computer time.  Recovery during this period is monitored by intermittent examination and quantitative measuring tools, such as ImPACT testing, which provides a measure of recovery for cognition, memory, reaction time, etc.   An athlete should only be considered for a return to play after his/her symptoms are completely gone and there is no return of symptoms during a stepwise ease into sports activity, usually over 5-7 days.

Many schools require physician approval before permitting a student athlete to return to play.  For clearance, it is essential that parents seek a sports medicine specialist.  A general practitioner or other physician with training in sports medicine is often times preferable to a neurologist – particularly here in China – with no experience or knowledge of sports medicine. At IWS, our sports medicine team consists of a physiatrist; primary care sports specialist; and orthopedist with enormous experience in caring for professional and amateur athletes.  They work closely with Caleb and Joe to monitor the athlete’s recovery and make sure they are really ready before returning to play.  Dr. Jones understands the stakes:   “I played Aussie Football and I never wanted to sit out, so my biggest challenge is getting these kids to see that it is in their and their team’s best interests to only go back to play when they are physically ready.”

Playing sports is an essential part of a well-rounded education and helps build outstanding habits that will last forever.  Being smart about head injuries, however, is not only good sense but the responsibility of every player, coach and parent.