Sports Concussions: Where are we headed? Michael C. Koester, MD, ATC January 4th, 2010 Chair, NFHS Sports Medicine Advisory Committee Director, Slocum Sports Concussion Program Slocum Center for Orthopedics and Sports Medicine Eugene, OR
Disclosures
I am a paid consultant for the Oregon Center for Applied Science, Inc. (ORCAS). They are developing concussion education programs for youth programs and high schools.
I have no financial relationship with the developers/owners of ImPACT, Inc., CRI, or CogSport
What is a Concussion?
A concussion is a mild traumatic brain injury that interferes with normal function of the brain Evolving knowledge
“dings” and “bell ringers” are serious brain injuries Do not have to have loss of conciousness
Young athletes are at increased risk for serious problems
The Problems in the Medical Field
There is much variation in the knowledge of health care providers managing concussed athletes
Physicians (MD/DO) Physician assistants Nurse practitioners Chiropractors Athletic trainers School nurses
New and emerging research and technologies will lead to a continuing evolution of care
Problems for AthletesPost-Concussion Syndrome
85-90% of concussed young athletes will recover within 1 to 2 weeks The remainder may have symptoms lasting from weeks to months interfering with school and daily life Subtle deficits may persist a lifetime
Problems for Administrators: “At Burg, Simpson, Eldredge, Hersh, & Jardine, P.C., our brain injury lawyers represent brain injury victims caused during high school sports in Colorado, Wyoming and nationwide. We have the resources and experience with complex brain injury lawsuits to fully assess your injuries and take your case to a jury. If you or your loved one has suffered a brain injury while playing high school sports, please email or call us today.”
Extent of the Problem
Professional athletes get a great deal of attention
1600 NFL players
Much more common in high school than any other level- due to large number of participants HS Sports Participants
Football- 1.14 million Boys Soccer- 384,000 Girls Soccer- 345,000 Boys Hoops- 545,000 Girls Hoops- 444,000
NFHS 2008-09
Extent of the Problem
19.3% of all FB injuries in 2009!!!
Likely at least 100,000 concussions in HS athletes yearly based on CDC estimates
Not Just a Football Problem Injury rate per 100,000 player games in high school athletes
Football Girls soccer Boys soccer Girls basketball Wrestling Boys basketball Softball Data from HS RIO JAT, 2007
47 36 22 21 18 7 7
What has happened to make this such a big deal?
Increasing awareness and incidence
Number of high profile athletes over the past 20 years Steve Young, Troy Aikman, Eric Lindros, etc Bigger and faster kids, increased opportunities
What has happened to make this such a big deal?
High profile cases
Second Impact Syndrome
Death or devastating brain damage when having a second injury when not healed from the first
Long-term effects
Possible long-term effects- dementia, depression
Chronic Traumatic
CTE- progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma
Tau protein
Examples
Normal brain 45 yo former NFL player 73 yo boxer
Chronic Traumatic Encephalopathy
18 yo HS athlete
2 documented concussions in football
Multi-sport athlete
Early CTE changes on autopsy
Isolated case or harbinger of huge ramifications for contact sports?
NFL making changes
Commissioner before Congressional Subcommittee in Oct NFL’s response since that time:
Resignation of concussion committee co-chairs Hiring of “independent” neurologists to make RTP decision No RTP same game in most cases
NCAA Follows NFL lead
December 2009
NCAA now making changes in response to what NFL has done
No return to play same day of concussion
Sea Change?
November 2009
2 Super Bowl QBs report that they cannot play in upcoming games due to persistent headaches and/or not feeling that they had recovered from most recent concussion. How important is that upcoming HS game this week??
What has the NFHS SMAC done?
Rulebook
Language change
Suggested management
Concussion Brochure
Education!!
No RTP same day- Fall 2008
Dissemination of information Where does that information come from?
2010 – 2011 NFHS Rule Book Changes on Concussion
Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional. (Please see NFHS Suggested Guidelines for Management of Concussion).
Approved by NFHS Sports Medicine Advisory Committee – October 2009 Approved by the NFHS Board of Directors – October 2009
Concussion Management- The Basics
Coach Education
Awareness and Recognition When in doubt, sit ‘em out!!
Policies
No return to activity on the same day of a concussion No return to activity if having symptoms of a concussion
Staying Ahead of the Issue
Need to take initiative State SMACs (form one if you don’t have one!!)
Education for coaches No same day return to play
State laws in WA and OR in 2009
What’s happening in your state? Keep your ear to the ground
The Oregon Experience- 2008
Any athlete…with a concussion…shall not be permitted to return… on that same day. No return until… “no longer experiencing post-concussive symptoms, and a medical release form signed by an appropriate healthcare professional”
The Oregon Experience- 2009
Oregon BIA sponsors “Helmet Law” in honor of young Second Impact Syndrome victim
Mandatory football coach education Mandatory helmet “re-conditioning” yearly Mandatory helmet retirement after 10 years
OSAA finds out just before the first public hearing Testimony by OSAA execs and SMAC Chair
Result is a significantly better law
“Max’s Law”- The final product
Mandatory coach education Player must be removed from play if “exhibits signs, symptoms, or behaviors consistent with a concussion” Cannot return to play that day Cannot return to play until asymptomatic and cleared to return by a “health care professional”
Washington- “Zach’s Law”
Zach Lystedt- suffered devastating brain injury playing with concussion symptoms Similar to Oregon Law with additions:
Applies to youth sports Parents and athlete read and sign information sheet which details signs, symptoms, and effects of a concussion
Outstanding press state-wide and nationally FB player from Spokane died in September
Beyond Education and Policy
Rules making and enforcement
Leading with helmet Rough play Limiting contact in practice?
Can we prevent concussions? Should there be a “mandatory retirement” rule? What if they just say, “I’m fine?”
Neuropsychologic Testing
Computerized programs
Easily accessed Can be done quickly with immediate results Can obtain “baseline” data on all athletes Can assess reaction times and processing speed
Prevention
“Concussion prevention” has become the “holy grail” for sports equipment marketers
Soccer head gear Girl’s Lacrosse head gear/ helmets
Pole vaulting helmet
New football helmets, soccer head pads, mouth guards- NO PROVEN PROTECTION FROM CONCUSSION!! Multiple flaws in a study looking at “Riddell Revolution” helmet
Neurosurgery, 2006
Conclusions
Educate
Everyone dealing with young athletes must be aware of the signs, symptoms, and ramifications of concussions
Mandate or Legislate?
Concussion management policies must be in place at every level If you don’t do it, someone will do it for you
THANK YOU!!!!!!
Thad Stanford, MD, JD- Salem Bill Bowers- Executive Director, OADA Tom Welter- Executive Director, OSAA Mickey Collins, PhD- Pittsburgh Ron Savage, EdD- New Jersey Brian Rieger, PhD- New York Ann Glang, PhD- Eugene
Feel free to contact me with any questions:
[email protected]
