Contact sports and concussions. Peanut butter and jelly. It’s difficult to imagine one without the other.
Having your bell rung has long been considered part of the price you pay to play contact sports. It’s only recently that discussion about the long-term effect of repeated concussions has come to the attention of the public. In studying the brains of deceased NFL players, forensic specialists have made the alarming discovery that there is evidence of long-term damage to the brains – damage that is being attributed to the concussions suffered during their long playing careers. There has also been recent evidence that, at least for youth and adolescent players, brain rest leads to a quicker recovery.
The possibility of concussion starts at a young age with the inevitable collisions that occur during soccer, tackles during football, and slamming against the boards in hockey. It’s not necessary to have a head-to-head hit, or for the person to lose consciousness, for a concussion to occur. Worse, there is currently no standard medical test that can be done to verify a concussion.
Because there is no physical damage to the brain that can be observed by a CT scan or MRI, the diagnosis of concussion is based upon observation of specific signs and the reporting of specific symptoms by the player. Among those signs and symptoms are confusion, loss of memory, delay in answering simple questions, clumsiness, and the inability to maintain balance while standing with eyes closed. When any of these are present, the current recommendations are to take the player out of the game – also known as when in doubt, sit them out.
Once the player is out of the game, they are not to be left alone. Instead, they need to be observed until they are evaluated by a health expert. That evaluation will determine whether or not a concussion has been sustained, how severe the concussion may be, and what treatment is advised.
The current thinking, as formulated by the CDC in its Heads Up program and geared to adolescent athletes, calls for something known as Brain Rest. This entails taking a break from cognitive functioning – avoiding reading, watching television, playing video games, listening to modern music…basically anything that forms the world of the modern adolescent. As one person put it, “it’s like putting a Millennial into a deprivation tank.”
Studies have shown that the extent of the Brain Rest should be determined by the extent of the concussion. The average time for recovery of a concussion is about one to two weeks. During that time, a student should attend school for half day, be excused from tests, have modified homework (if any at all), and receive their assignments in writing rather than verbally. As the student is capable of more without a headache or extreme fatigue, more activity can be undertaken. An American Academy of Pediatrics (AAP) report recommended “a period of near full cognitive rest acutely after injury, approximately 3-5 days followed by a gradual return to sub-symptom levels of cognitive activity.”
For adults playing contact sports, football has the most data and debate at the moment. What about the players in the NFL? What about those playing in college? The studies indicate that the need for brain rest is greatest among adolescents and youth, and there are further studies that show that a second concussion is easier to suffer if the prior concussion is not yet healed. It’s also likely to do more damage when combined with the effects of the prior concussion.
We routinely see players sit out a game, yet come back to play the next weekend. How is it possible that all that damage has been suitably repaired? There are concussion protocols in place, but how do those relate to the schoolwork being done by scholar athletes? And how does the need for time for the brain to heal come into play for professional athletes in their daily lives?
It’s difficult to believe that every one of those players is good to go that quickly. It’s especially difficult to believe when you consider that most of these players have had multiple concussions over their playing careers. Of late, the NFL is not denying the role repeated concussions play in neurological damage to the players’ brains in the form of C.T.E. (Chronic Traumatic Encephalopathy).
In September, the N.F.L. filed documents in federal court, prepared by actuaries, estimating that 28 percent of the retired players eligible for payments under the settlement will develop long-term cognitive deficiencies, many of them at “notably younger ages” than the general population. In other words, they will suffer from early-onset dementia. With that, the connection between football and brain damage was validated.
For those retired from the N.F.L., the damage has been done. It’s up to the current players to decide what level of risk they are willing to take during the course of their careers. It’s also up to them to consider how much time is truly needed to recover from a concussion and what that will mean in terms of their playing time during a season.
For kids and adolescents, validating the connection between concussion and C.T.E., and knowing what action to take based on that connection are two different things. Does the knowledge that significant damage can occur later in life mean that kids should not play contact sports? Just how many concussions does it take to cause damage that will last a lifetime? How young is too young to play contact sports? And finally, is it necessary to change the way a sport is played so that kids can learn the skills and enjoy the game without the risk of brain trauma while their brains are still developing?
A first step would be for coaches and parents to be aware of the implication of concussions. One organization that is actively involved in making youth coaches aware of the implications of concussions is the NFHS (National Federation of State High School Association). They have a number of resources and educational materials available. A video course, “Concussion in Sports,” is available at no charge.
A critical step would be to be certain young players fully recover from any concussions they suffer. The current best way to do this? Practice brain rest for post-concussion care.
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