Proper Steps Important In Return From Concussions

Concussions are often an “unseen” injury: you may not have a lump on your forehead and you may not be bleeding—but the damage is there.

In the short term concussions—traumatic brain injuries that change the way the brain functions that are often caused by a blow to the head—can cause headaches and nausea. If untreated or ignored, especially in younger athletes, the long-term damage can be far worse.

In recent years, numerous studies and a flurry of media coverage have drawn attention to sports-related concussions and changed the way athletes, coaches and medical professionals think about them.

In May the Minnesota legislature passed a law that requires high school and youth coaches to take concussion-awareness tests, and for players to receive medical clearance before returning to play after such an injury. The law went into effect mid-August for high school athletics and Sept. 1 for youth programs.

With 20 years of coaching experience, football coach Tim Murtha said the test was mainly review for him, however, he still found it helpful.

“Even if it didn’t teach you anything new," he said, "it reminded you of how important this is."

Sitting it out

One of the main points of the concussion legislation in Minnesota was the requirement to keep athletes off the field until they recover from a concussion. Heather Bergeson, a sports medicine physician at the TRIA Orthopedic Center in Minneapolis, said that’s important because it puts the decision into a medical professional’s hands rather than a volunteer youth league or high school coach.

Once the symptoms of concussion are gone, Bergeson recommended that athletes slowly return to play, doing light workouts before going back to practice and gameplay. That process could take at least a week—or more.

In addition, the law takes the pressure off young athletes who might feel obligated to get back in the game, even if they have lingering effects, Bergeson said.

Coach Murtha said it’s natural for teenagers to want to get back into the game before they’re ready.

“They work really hard to earn the right to play, so they’re fiercely determined to be out there, so sometimes you do have to hide the helmet,” he said. “Somebody on the sideline’s got to be old enough and wise enough to tell a kid not to go back in.”

At Tartan, the school’s trainer or a student's doctor has final say on when a student can start playing again, he said—not the coaches.

 “We always leave this issue in the hands of a medical professional,” he said. “A concussion’s a serious thing, but that second concussion is really what’s seriously dangerous.”

The Centers for Disease Control and Prevention created the “Heads Up” campaign to create awareness of concussions in youth and high school sports. The campaign’s website reminds athletes, “It’s better to miss one game than the whole season.”
          
Media attention

The topic of sports concussions started gaining steam in 2009, when autopsies of several deceased former National Football League players revealed they suffered from brain damage caused by repetitive trauma—a condition known as chronic traumatic encephalopathy (CTE).

Researchers found that out of seven players who died by the age of 50, six of them suffered from CTE. The condition can cause problems with memory loss, concentration and coordination, according MayoClinic.com.

The NFL findings, along with a 2008 U.S. Army study that found that soldiers who suffered concussions are more likely to develop post-traumatic stress disorder, caused a “wave of awareness,” said David King, executive director of the Brain Injury Association of Minnesota.

Since then sports concussions at every age level and sport have received some attention.

Bergeson said although there is much more attention being paid to sports concussions, there is much more to understand.

One thing that medical professionals do know, Bergeson said, is that younger athletes tend to take longer to recover from concussions than adults. This is likely because their brains are still developing, she said.

And while the medical profession is still somewhat in the dark about the long-term effects of concussions, it’s important to take a conservative approach to treatment, she said.

“This law is a good framework to approach this systematically,” Bergeson said. “I think it’s a good thing for kids and their health.”
          
Everyone is different

Bergeson explained that concussions are caused when the brain is moved inside the skull, either from a direct or indirect blow.

There are numerous symptoms of concussions, Bergeson said, and people often display them in different ways. Some might feel nauseous, while others may suffer memory loss.

The Tartan football team usually doesn’t tackle to the ground during practice to prevent concussions and other injuries, Coach Murtha said.

“A lot of that is heads bouncing off the ground,” he said. “Those are things that can contribute to concussions—are the helmet to ground contact as well as the helmet to helmet contact.”

Working as an athletic trainer for the University of Minnesota football team more than a decade ago, Brent Millikin, president of the Minnesota Athletic Trainers’ Association, recalled one player who couldn’t remember what stadium he was in or what team he was playing against after sustaining a major hit.

In that instance, it was obvious that the player had suffered a major head injury. Other times, it’s not so clear.

“There are some challenges” to identifying concussions, Millikin said. “It’s not like an ankle sprain.”

Even during those times, if a player had a concussion Saturday, but felt better Sunday, he’d often be back on the field Monday, Millikin said.
          
“We know we need to be more conservative now,” he said.

This story is part of a three-part series examining the new state law on sports-related concussions in Minnesota youth sports. The series was reported by John Hageman, Patty Busse, and edited by Regional Sports Coordinator Mark Remme.

YESTERDAY (Part I): The origins of the new Minnesota concussions law
TODAY (Part II): Why proper recovery steps are important to an athlete’s long-term health
TOMORROW (PART III): How one young woman’s testimony helped get the law passed, and how it affects youth sports