Don’t Put Me in, Coach

On a recent Friday afternoon, I was watching a college basketball game on television. Seconds after the players returned to the court from a time-out, one player collided with another, knocking him backward. The opponent landed on his back, hitting his head so hard it bounced up and hit the floor again.

Lying somewhat still, he held his head as though trying to make it stop moving. Moments later, he was assisted to his feet, insisting he was fine, but the referee sent him to the bench for evaluation—despite resistance from the player and his coach. The coach continued to pressure the referee, who firmly stood his ground. Zoom in: Player sitting on the bench, undergoing a neurologic evaluation. Even through the TV, it was evident the player was unable to hold his gaze through the visual field process. Score two points for the referee!

In another game, on a different day with different teams, a similar event occurred: A player fell, banged his head, and was obviously stunned. Yet he was allowed to return to play. His mother came out of the stands protesting, insisting her son was hurt. The referee and coach dismissed her objections, and she was ushered back to her seat by security. Technical fouls for the coach and referee!

While not every bump, blow, or jolt to the head will result in a traumatic brain injury (TBI), nonetheless, TBI has become a serious public health issue, contributing to one-third (30.5%) of all injury-related deaths.¹ An estimated 1.7 million TBIs occur annually; between 2001 and 2005, nearly 208,000 emergency department visits for concussions and other TBIs related to sports and recreational activities were reported per year.^1,2

Recently, we have begun to recognize that even the seemingly “benign” head injuries athletes sustain during play are not without some complications—short term as well as long term. In the past two or three years, researchers have started to focus on and explore the effects of “subconcussive” blows to the head, with unanticipated results.

In a 2010 study of high school football players, researchers from Purdue University identified a previously unknown category of athletes who, despite having no clinically observable signs of concussion, showed measurable impairment of neurocognitive function (primarily visual working memory) on neurocognitive tests, as well as altered activation in neurophysiologic function on MRI.³ As a result of this and additional studies, repeated minor “bumps” are now viewed through a different lens—even the mild ones can take their toll, impeding language processing or motor skills.

The May 2012 suicide of Junior Seau, a former professional football player who sustained repeated blows to the head during his career, was a further wake-up call. It has become increasingly clear that the blows to the head sustained by players in a variety of sports and recreational activities require more serious attention—and we need to address it earlier in an athlete’s career (amateur or professional), not once the irreparable damage is done.

The first law to address concussion management in youth athletics was passed in Washington State in May 2009. By 2012, 42 additional states and the District of Columbia had passed similar laws.⁴ The intent of these “Return to Play” laws is to reduce the impact of youth sports and recreation–related concussions, and their tenets can extend to our college and professional athletes.

The long-term effects of repeated blows to the head have only begun to surface. We need to be diligent in recognizing and preventing TBI in all athletes, because doing so can prevent further brain injury or even death. Arm yourself with information; the CDC Web site is an excellent resource (www.cdc.gov/concussion/sports/index.html).

Finally, a message to all coaches and parents, athletes, and health care professionals: Getting your “bell rung” in a sports event should not be taken lightly. It must be recognized as the serious and potentially dangerous occurrence it is. So, don’t put him in, coach—he may not be ready to play!

Share your thoughts and experiences with me at NPEditor@frontlinemedcom.com.                      

References
1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, GA: CDC, National Center for Injury Prevention and Control; 2010. www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf.

2. Gilchrist J, Thomas KE, Xu L, et al. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤ 19 years—United States, 2001–2009. MMWR Morbid Mortal Wkly Rep. 2011;60: 1337-1342.

3. Talavage T, Nauman E, Breedlove E, et al. Functionally detected cognitive impairment in high school football players without clinically diagnosed concussion. J Neurotrauma. 2010; Oct 1 [Epub ahead of print].

4. CDC National Center for Injury Prevention and Control. Implementing Return to Play: Learning from the Experiences of Early Implementers. www.cdc.gov/concussion/pdf/RTP_ Implementation-a.pdf.

On a recent Friday afternoon, I was watching a college basketball game on television. Seconds after the players returned to the court from a time-out, one player collided with another, knocking him backward. The opponent landed on his back, hitting his head so hard it bounced up and hit the floor again.

Lying somewhat still, he held his head as though trying to make it stop moving. Moments later, he was assisted to his feet, insisting he was fine, but the referee sent him to the bench for evaluation—despite resistance from the player and his coach. The coach continued to pressure the referee, who firmly stood his ground. Zoom in: Player sitting on the bench, undergoing a neurologic evaluation. Even through the TV, it was evident the player was unable to hold his gaze through the visual field process. Score two points for the referee!

In another game, on a different day with different teams, a similar event occurred: A player fell, banged his head, and was obviously stunned. Yet he was allowed to return to play. His mother came out of the stands protesting, insisting her son was hurt. The referee and coach dismissed her objections, and she was ushered back to her seat by security. Technical fouls for the coach and referee!

While not every bump, blow, or jolt to the head will result in a traumatic brain injury (TBI), nonetheless, TBI has become a serious public health issue, contributing to one-third (30.5%) of all injury-related deaths.¹ An estimated 1.7 million TBIs occur annually; between 2001 and 2005, nearly 208,000 emergency department visits for concussions and other TBIs related to sports and recreational activities were reported per year.^1,2

Recently, we have begun to recognize that even the seemingly “benign” head injuries athletes sustain during play are not without some complications—short term as well as long term. In the past two or three years, researchers have started to focus on and explore the effects of “subconcussive” blows to the head, with unanticipated results.

In a 2010 study of high school football players, researchers from Purdue University identified a previously unknown category of athletes who, despite having no clinically observable signs of concussion, showed measurable impairment of neurocognitive function (primarily visual working memory) on neurocognitive tests, as well as altered activation in neurophysiologic function on MRI.³ As a result of this and additional studies, repeated minor “bumps” are now viewed through a different lens—even the mild ones can take their toll, impeding language processing or motor skills.

The May 2012 suicide of Junior Seau, a former professional football player who sustained repeated blows to the head during his career, was a further wake-up call. It has become increasingly clear that the blows to the head sustained by players in a variety of sports and recreational activities require more serious attention—and we need to address it earlier in an athlete’s career (amateur or professional), not once the irreparable damage is done.

The first law to address concussion management in youth athletics was passed in Washington State in May 2009. By 2012, 42 additional states and the District of Columbia had passed similar laws.⁴ The intent of these “Return to Play” laws is to reduce the impact of youth sports and recreation–related concussions, and their tenets can extend to our college and professional athletes.

The long-term effects of repeated blows to the head have only begun to surface. We need to be diligent in recognizing and preventing TBI in all athletes, because doing so can prevent further brain injury or even death. Arm yourself with information; the CDC Web site is an excellent resource (www.cdc.gov/concussion/sports/index.html).

Finally, a message to all coaches and parents, athletes, and health care professionals: Getting your “bell rung” in a sports event should not be taken lightly. It must be recognized as the serious and potentially dangerous occurrence it is. So, don’t put him in, coach—he may not be ready to play!

Share your thoughts and experiences with me at NPEditor@frontlinemedcom.com.                      

References
1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, GA: CDC, National Center for Injury Prevention and Control; 2010. www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf.

2. Gilchrist J, Thomas KE, Xu L, et al. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤ 19 years—United States, 2001–2009. MMWR Morbid Mortal Wkly Rep. 2011;60: 1337-1342.

3. Talavage T, Nauman E, Breedlove E, et al. Functionally detected cognitive impairment in high school football players without clinically diagnosed concussion. J Neurotrauma. 2010; Oct 1 [Epub ahead of print].

4. CDC National Center for Injury Prevention and Control. Implementing Return to Play: Learning from the Experiences of Early Implementers. www.cdc.gov/concussion/pdf/RTP_ Implementation-a.pdf.

On a recent Friday afternoon, I was watching a college basketball game on television. Seconds after the players returned to the court from a time-out, one player collided with another, knocking him backward. The opponent landed on his back, hitting his head so hard it bounced up and hit the floor again.

Lying somewhat still, he held his head as though trying to make it stop moving. Moments later, he was assisted to his feet, insisting he was fine, but the referee sent him to the bench for evaluation—despite resistance from the player and his coach. The coach continued to pressure the referee, who firmly stood his ground. Zoom in: Player sitting on the bench, undergoing a neurologic evaluation. Even through the TV, it was evident the player was unable to hold his gaze through the visual field process. Score two points for the referee!

In another game, on a different day with different teams, a similar event occurred: A player fell, banged his head, and was obviously stunned. Yet he was allowed to return to play. His mother came out of the stands protesting, insisting her son was hurt. The referee and coach dismissed her objections, and she was ushered back to her seat by security. Technical fouls for the coach and referee!

While not every bump, blow, or jolt to the head will result in a traumatic brain injury (TBI), nonetheless, TBI has become a serious public health issue, contributing to one-third (30.5%) of all injury-related deaths.¹ An estimated 1.7 million TBIs occur annually; between 2001 and 2005, nearly 208,000 emergency department visits for concussions and other TBIs related to sports and recreational activities were reported per year.^1,2

Recently, we have begun to recognize that even the seemingly “benign” head injuries athletes sustain during play are not without some complications—short term as well as long term. In the past two or three years, researchers have started to focus on and explore the effects of “subconcussive” blows to the head, with unanticipated results.

In a 2010 study of high school football players, researchers from Purdue University identified a previously unknown category of athletes who, despite having no clinically observable signs of concussion, showed measurable impairment of neurocognitive function (primarily visual working memory) on neurocognitive tests, as well as altered activation in neurophysiologic function on MRI.³ As a result of this and additional studies, repeated minor “bumps” are now viewed through a different lens—even the mild ones can take their toll, impeding language processing or motor skills.

The May 2012 suicide of Junior Seau, a former professional football player who sustained repeated blows to the head during his career, was a further wake-up call. It has become increasingly clear that the blows to the head sustained by players in a variety of sports and recreational activities require more serious attention—and we need to address it earlier in an athlete’s career (amateur or professional), not once the irreparable damage is done.

The first law to address concussion management in youth athletics was passed in Washington State in May 2009. By 2012, 42 additional states and the District of Columbia had passed similar laws.⁴ The intent of these “Return to Play” laws is to reduce the impact of youth sports and recreation–related concussions, and their tenets can extend to our college and professional athletes.

The long-term effects of repeated blows to the head have only begun to surface. We need to be diligent in recognizing and preventing TBI in all athletes, because doing so can prevent further brain injury or even death. Arm yourself with information; the CDC Web site is an excellent resource (www.cdc.gov/concussion/sports/index.html).

Finally, a message to all coaches and parents, athletes, and health care professionals: Getting your “bell rung” in a sports event should not be taken lightly. It must be recognized as the serious and potentially dangerous occurrence it is. So, don’t put him in, coach—he may not be ready to play!

Share your thoughts and experiences with me at NPEditor@frontlinemedcom.com.                      

References
1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, GA: CDC, National Center for Injury Prevention and Control; 2010. www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf.

2. Gilchrist J, Thomas KE, Xu L, et al. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤ 19 years—United States, 2001–2009. MMWR Morbid Mortal Wkly Rep. 2011;60: 1337-1342.

3. Talavage T, Nauman E, Breedlove E, et al. Functionally detected cognitive impairment in high school football players without clinically diagnosed concussion. J Neurotrauma. 2010; Oct 1 [Epub ahead of print].

4. CDC National Center for Injury Prevention and Control. Implementing Return to Play: Learning from the Experiences of Early Implementers. www.cdc.gov/concussion/pdf/RTP_ Implementation-a.pdf.