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Last updated January 1, 2014

Contact Sports and Concussions

Keep up the contact, but take every concussion seriously

Interview with Michael Collins MD, Today Show, MSNBC, 03/04/2003

Each year more than a million high school athletes are involved in contact sports. And out of that group, an estimated 63,000 concussions will occur. It's an area of sports medicine that's been largely ignored, until recently. Dr. Michael Collins is assistant director of the sports concussion program at the University of Pittsburgh Medical Center. He's also co-author of a recently published study in the Journal of Neurosurgery titled: "Recovery from Mild Concussion in High School Athletes." He discusses the impact of concussions in kids on "Today." Read some of his thoughts below.

Why Study High School Athletes And Concussion?
Because it hasn't been done before and they're the athletes at greatest risk because the largest group of athletes are high school athletes. The coverage for high school athletes is not as extensive as it is for college and professional athletes. As a clinician, this is what I do all day every day is see athletes with concussions, the worst cases I see are in high school athletes. So, for every Troy Aikman, Steve Young, Merill Hodge or Eric Lindros there are thousands of high school athletes who have the same problems with far less fanfare.

One Of The Big Problems Is That Many Of The Mild Concussions Go Unreported And Undiagnosed. Why Is That?
In the mild concussion by definition, you're not going to have much of the loss of conciousness. And often times these symptoms are subtle and also the athlete needs to report the injury himself. But athletes are taught to play through injury, so they often go under the radar when something is wrong. Why? Well, first they want to play. Second, they may not be aware that these subtle signs may be signs of a head injury. We know that the brain is vulnerable to second trauma when you're still recovering from a first concussion. I often see athletes with multiple mild concussions who do go under the radar, that's when the cumulative effects of injury become very pronounced.

Symptoms of a concussion:

  • headache
  • nausea
  • balance problems or dizziness
  • double or fuzzy vision
  • sensitivity to light or noise
  • feeling sluggish
  • feeling "foggy"
  • change in sleep pattern
  • concentration or memory problems

So What Are The Headlines From This Study?
The take home point is that every concussion needs to be taken seriously. The traditional way of dealing with athletes with concussions is that if they're fine they get put back on the field within minutes following a mild concussion or a mild injury. We all know the 'how many fingers am I holding', 'who's the president', etc. and that predicates getting back into the game. We wanted to test the assumption that a mild concussion is really mild. So, we looked at 64 high school athletes diagnosed with 'bell-ringers' or mild concussion, meaning there was no loss of consciousness and their on-field symptoms disappeared within 15 minutes.

Traditional guidelines and parameters regarding return to play suggest that an athlete can return to play within 15 minutes if their symptoms disappear within that time. So, we tested that hypothesis. And we found that these mild concussions have consequences in terms of brain function that we need to take very seriously.

Did You Notice Any Difference In Either Recovery Time Or Symptoms?
Yes. You've just hit on a very important issue. We found that the athletes reported feeling fine by day four, post injury as a group. Whereas the deficits on impact lasted until at least day seven. So, if we're relying on the self report of the athlete, it may be a slippery slope.

Were There Any Differences Between Female And Male Athletes?
In this study the samples weren't large enough to compare that. We are studying that issue right now. There are some hypothesis out there about that.

If The Athlete Is Placed Back In The Game Before The Brain Has Completely Healed, Specifically What Kind Of Damage Could We Be Talking About?
There are really several different levels. The very rare event, but possible, is what we call second impact syndrome. It's very rare but when it does happen, it's extremely catastrophic. There's been approximately 30-35 high school athletes who have died second to having two concussions in a short period of time. In each of those cases, the athlete had had a mild concussion and was still symptomatic from that injury, but whether they reported it or not, went back to play.

The more likely occurrence is that they become more vulnerable. Less of a blow is going to cause them to have a concussion. The brain is not ready to handle a second blow while it's recovering from the first blow. The symptoms may also be a lot more severe. Then it's much harder to hit the reset button on those athletes. They start going down that road of commutative effects to injury and that's when you can't get them back.

The Reality Is, Most Of These Kids, Will Not Go On To Professional Athletics. They Will Need To Be Sharp For Whatever They May Do In Their Lives.
Exactly. High School kids need their brains for far more important things down the road. They have a lifetime of thinking ahead of them.

Based On This Study, Should Parents And Students Be Concerned About High School Contact Sports?
Absolutely not. That is not the message here at all. We are pro sport. We want kids to be competitive and we want them to be itching to get back on the field. We want kids to be playing sports. But the best prevention for concussion problems is managing it properly when you have one. If you allow the brain to recover following a concussion, 99 percent of the time everything will be fine and there will be full recovery. This is the message we want to send. Let's just manage this injury sensibly.

What Should Parents Know?
What a parent needs to be aware of, is we need to take every concussion seriously. I think a common misconception is that you need to have a loss of consciousness to have a concussion. That's not true and parents need to know that. But many other symptoms are also important. Memory loss, balance issues, personality changes, difficulties in the classroom, continued headache, not feeling right, feeling foggy, having sleep problems. These are all signs that the brain has not recovered from injury. An athlete exhibiting any of those symptoms should not return to play until all of their symptoms are gone both at rest and exertion. And that's what parents should know.

The Reality Is As Long As There Are Contact Sports, There Will Be Concussions, Right?
Force equals mass times acceleration. And athletes are heavier and faster than they've ever been. This is a problem that's not going away.

A guest on "Today," Dr. Michael Collins is assistant director of the sports concussion program at the University of Pittsburgh Medical Center. He's also co-author of a recently published study in the Journal of Neurosurgery titled: "Recovery from Mild Concussion in High School Athletes."

Related Journal Abstracts

Relationship between concussion and neuropsychological performance in college football players.

Cumulative effects of concussion in high school athletes.




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