Tuesday, November 22, 2011

Kids, Sports, and Concussion: A Guide for Coaches and Parents

Sidney Crosby, one of the most valuable players in the NHL and only 24 years of age, returned to the ice on Monday night after over spending 10 long months recovering from post-concussion symptoms after being hit in a game early in the year. The NFL started off the 2011-12 season with new regulations to protect against head injuries, limiting the amount of full-contact practice that a player can participate in. And in a close call in the 2011 Little League World Series, a teenage pitcher from Huntington Beach, California, was saved from what could have been a deadly line drive to the forehead by only the bill of his hat.

Concussions in sports have not only the potential to be career-ending, but also can have life-altering side effects. Youth sports are meant to be fun, and with the number of kids who play sports in the United States in the millions, knowing what to do in the event of a concussion and how to help prevent them is extremely vital to the safety of young athletes.

Below is an excerpt from the introduction to Kids, Sports, and Concussion: A Guide for Coaches and Parents by William Paul Meehan III, MD. Meehan is director of the Sports Concussion Clinic in the Division of Sports Medicine at Children's Hospital Boston, MA, and instructor of pediatrics and orthopedics at Harvard Medical School, Boston, MA.


We were in the heart of the rugby scrum. A 20-year-old lock playing for Boston College was struck in the head by the mighty kick of an opponent. As the ball was released, he staggered away toward the wrong end of the field before collapsing to the ground. He rose unsteadily, only to collapse again. Finally, he rose to his feet and began sprinting, in an attempt to rejoin the play. But he was running in the wrong direction, away from ball. He fell one last time, only to be helped off of the field by his teammates.

“What’s the matter with him,” hollered the coach.
“He’s all right,” came the reply. “He just got his bell rung.”
And that was how it was.
We got “shaken up” or “had our bells rung.” We simply “shook it off,” “toughed it out,” or “walked it off.” The word concussion was rarely used. When it was used, it was mostly for athletes who were knocked unconscious for longer than a few seconds. Many times, we returned to the game in which we were injured. Often, we returned while still experiencing headaches, ringing in the ears, and other symptoms.

So why all the concern nowadays? What was it that changed the way sport-related concussion is diagnosed and managed? Why is the media constantly reporting stories about concussion in young athletes?

Five main medical findings change the way we think about sport-related concussion:
1. Concussion results in measurable brain dysfunction, which lasts for several days, weeks, or even months in some athletes.
2. This brain dysfunction often persists, even after the athlete reports being symptom-free.
3. Athletes who sustain one concussion are at increased risk of sustaining more concussions in the future.
4. The effects of multiple concussions are cumulative.
5. There may be long-term effects, only revealed later in life, that result from sustaining multiple concussions earlier in an athlete’s career.

These recent medical findings have led to a relatively rapid change in the way doctors and other clinicians think about sport-related concussions and concussive brain injury in general. This rapid change in thinking has generated a lot of attention, not only in the medical literature but also in the popular media.

When many of us were growing up, a concussion was not thought to be a serious injury. Athletes often laughed and joked about it. Certainly few people believed that there were any long-term effects or brain dysfunction that could result from a concussion or even multiple concussions.

Kids, Sports, and Concussion: A Guide for Coaches and Parents
William Paul Meehan III, MD
Praeger, April 2011

These days, we know that a concussion results in a true, measurable, loss of brain function, that can persist, even after athletes feel that they are completely recovered. Furthermore, we know that sustaining multiple concussions over the course of one's career can lead to more permanent brain dysfunction, depression, and other problems. This sudden change in thinking has left many athletes, parents, coaches, and others confused. Kids, Sports, and Concussion will help clarify the medical and scientific data that has resulted in this change of thinking. In doing so, this book will answer the following questions:

• What is a concussion?
• How common is concussion?
• Can an athlete prevent a concussion?
• What is the best way to assess a concussion?
• What can be done to treat a concussion?
• When is it safe to return to playing after a concussion?
• What are the risks of suffering multiple concussions?

In addition, readers of this book will learn how they can respond to a concussed athlete, as well as what they should expect from medical personnel tending to a concussed athlete. For those readers interested in starting a comprehensive concussion management program in their area, this book contains some recommendations on how to proceed. Lastly, the book concludes with several athletes describing, in their own words, their experiences with concussions.

At the end of each chapter is a list of suggested readings for those readers who may wish to learn more about the topics covered within the chapter. Many of these readings are medical or scientific articles, often those referred to in the chapter. While these articles may use some medical and scientific jargon, I believe the overall principles can be appreciated, even without scientific or medical training.

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