Sports-Related Concussions: A Growing Concern
When Dr. Sandeep Kunwar met a famous pro football player who had recently retired from the San Francisco 49ers, he asked the Super Bowl-winning, Pro Football Hall of Fame member why he retired in the prime of his career.
"He responded that he had made a conscious decision to step down in order to avoid any further concussion injuries," recalls Dr. Kunwar, a neurosurgeon and medical co-director of the Taylor McAdam Bell Neuroscience Institute at Washington Hospital. "He recognized that there could be serious complications of repetitive concussions - including permanent brain changes that could drastically impact his health and quality of life, and that might even be life-threatening."
Since that time, awareness of dangerous sports-related traumatic head injuries including concussions has increased dramatically, especially among professional athletic organizations. More work in raising awareness and preventing such injuries is still needed, however, particularly among younger amateur athletes.
"I applaud the professional sports organizations for creating greater awareness of concussions, which are serious injuries that certainly deserve more attention," says Dr. Russell Nord, an orthopedic surgeon and medical director of the Washington Township Orthopedic Surgery and Sports Medicine Center.
"Professional football is doing a much better job of penalizing improper tackling technique that jeopardizes player safety," Dr. Nord notes. "This increased awareness is becoming more common in college, high school and community league sports as well. It's very important that we continue to promote concussion prevention in young athletes."
A study by the American Association of Neurological Surgeons (AANS) estimates there were nearly 447,000 sports-related head injuries treated in U.S. hospital emergency rooms in 2009, an increase of nearly 95,000 such injuries over the prior year. The AANS notes that the actual incidence of sports-related head injuries may be much higher since many of them are treated at physician's offices, urgent care clinics or at home. Concussions make up a sizable portion of those injuries.
While football may have gained the most attention in terms of concussions, they can happen in any sport or recreational activity. Football and ice hockey are the organized team sports with the most reported concussion injuries, but they are followed closely by baseball and softball, basketball and soccer. Individual sports, such as boxing, water sports (especially diving), wrestling, bicycling, snow skiing, and skateboarding have their concussion victims, too. Playground accidents - such as falling off a slide - also can be the cause of concussions. Even cheerleading has its risks for concussions.
"I once treated a school mascot for a concussion," says Dr. Nord. "It's important to recognize that it's not just football. You can get a concussion in any sporting activity. And it's not just a 'male' injury; females are also at risk for concussions."
In fact, a clinical report issued by the American Academy of Pediatrics states that girls are reported to have a higher rate of concussion than boys in similar sports. In girls' sports, the rate of concussion is highest in soccer and basketball.
"Girls and women have three times the risk of concussion than males in basketball and soccer," Dr. Kunwar says. "We're not sure of all the reasons why this is the case, but it may be partly because females generally have longer, thinner necks and weaker neck muscles than males. Having a thick, muscular neck makes you somewhat less likely to suffer a concussion."
What Is a Concussion?
"Generally speaking, a concussion is a traumatic injury to the brain that causes temporary loss of normal brain function," says Dr. Sandeep Gupta, a colleague of Dr. Nord's who is board-certified in both family medicine and sports medicine. "It can be caused by a direct blow to the head, face or neck that results in rapid onset of short-lived impairment of neurological function. It may or may not involve loss of consciousness. If the injured person does lose consciousness or has any serious symptoms, he or she should be evaluated by a physician who has experience in dealing with concussions."
Dr. Kunwar describes a concussion as a sheer-force injury.
"A concussion happens when the brain strikes the hard wall of the skull," he explains. "Different areas of the brain have different densities - some parts of the brain are softer and more prone to damage from the impact. I like to compare it to a hard plastic container filled with Jell-O, which represents softer areas of the brain. If you add marbles to the container, representing the denser areas of the brain, and then shake the container, it causes more damage to the Jell-O."
In addition to possible fainting or loss of consciousness, other symptoms of concussion might include:
* Headache or a sense of pressure in the head.
* Feeling in a "fog" or confused.
* Signs of memory loss or amnesia.
* Dizziness or trouble with balance.
* Slowed physical reaction times.
* Nausea or vomiting.
* Sleepiness, drowsiness or fatigue.
* Changes in vision or hearing, or sensitivity to light or sound.
* Slurred speech.
* Emotional reactions, such as irritability, depression or anxiety.
"Younger children who suffer a concussion may not be able to verbalize their symptoms as well as older children and adults do," Dr. Gupta adds. "If the impact to the head happens on the field, the player should be evaluated right away. If there are any symptoms of a concussion at all, the player should not go back into play in the same game."
Washington Hospital Treats Sports Injuries
Washington Hospital offers a full range of treatment and rehabilitation services for people that have suffered a sports injury. Visit www.whhs.com/services/sports to learn more.