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Concussions in Young Athletes: Slower Recovery Suggests Different Treatment (By Dr. James Harding, Vail, CO Dentist)
Concussions in Young Athletes:
Slower Recovery Suggests Different Treatment
Until recently, most studies on concussions have been conducted on male football players from the NFL and colleges. But over the past couple of years, there is a growing emphasis on how concussions affect younger athletes who account for 3 to 5 million injuries a year, many of which go unreported. Concussions suffered by younger athletes often result from a non-contact sport such as skiing, snowboarding, soccer, lacrosse, hockey, and basketball. Increasingly these athletes are just as likely to be female.
In November of 2008 the 3rd International Conference on Concussion in Sport took place in Zurich and for the first time there were specific statements made referring to pediatric issues and concerns with traumatic brain injuries. Based largely on that report and continued research on how younger athletes should be diagnosed and treated differently the American Academy of Pediatrics will introduce revised guidelines on concussions later this summer.
Why should pediatric concussions be treated differently?
• Younger athletes recover more slowly.
Concussions affect people differently and studies show younger athletes seem to recover more slowly from these mild traumatic brain injuries than older athletes (Collins et al. 2006 Journal of Neurosurgery). It means questions about when an athlete can return to a sport need to be considered carefully. The push to return to full activity too soon can result in additional concussions and possible long-term brain damage.
• Concussions are hard to diagnose without medical training.
Professional and college athletic programs have a medical team on the sideline at every game while younger athletes who are injured rely on the care of coaches and parents who may lack medical knowledge. For example, a common fallacy is that concussions involve loss of consciousness when in fact less than 10% actually do. If the athlete doesn’t lose consciousness, they may end up back on the playing without being properly examined by a physician or neurophysiologist who understands concussions. The challenge of diagnosing a concussion is further complicated in the young developing brain. As the injury is more of a metabolic issue than a structural one, even a CT or MRI cannot rule out a concussion.
Symptoms
Symptoms of a concussion fall into four categories:
1. Physical: (headache, fatigue, dizziness, nausea)
2. Cognitive: (difficulty remembering or concentrating, feeling slowed down or foggy)
3. Emotional: (irritable or more emotional than normal)
4. Sleep Disturbances: (drowsy, sleeping more or less than usual)
Treatment
While there is still no simple formula for treating concussions, one thing is agreed: young athletes must be handled very cautiously, especially if there is any history of multiple concussions or mild traumatic brain injuries. The fear of long-term affects and even death from Second Impact Syndrome is very real and taken much more seriously now than even a few years ago. It has been shown that repeat concussions occur 92% of the time within ten days of the original incident (Guskiewicz, McCrea et al. 2003 JAMA).
Most healthcare professionals have adopted protocols for diagnosing and treating concussions. In one protocol, the Acute Concussion Evaluation (ACE), a five-minute questionnaire is given to the patient and the parents to assess the presence or absence of 22 symptoms in the four important categories of somatic, cognitive, emotion and sleep. Since younger athletes are not always as accurate in reporting symptoms, friends, teachers and coaches may also be interviewed as they often pick up subtle differences in the athlete after a concussion.
When it comes to letting concussions heal in younger athletes, we are no longer are we looking solely at physical exertion. The child must rest the body and the brain. They need to sleep well and avoid activities that produce a return of symptoms, which may even be brought on by extended periods of reading or concentration at school.
All athletes, parents, coaches, teachers need to be education about concussions and fortunately this information is becoming more readily available. One excellent resource on traumatic brain injuries is the Center for Disease Control (www.http:cdc.gov/concussion).
The bottom line is younger athletes might take longer to fully recover from a mild traumatic brain injury and we should proceed more cautiously when treating these individuals. The athlete should never return to their sport the same day if there is any concern of a concussion.
Dr. Jim Harding recently returned from the 28th annual Academy for Sports Dentistry Symposium in Washington, D.C. An official medical provider to the US Ski and Snowboard teams and the team dentist for Ski and Snowboard Club Vail, he is currently conducting groundbreaking research on performance enhancing sports mouth guards. (www.jameshardingdds.com.)
Slower Recovery Suggests Different Treatment
Until recently, most studies on concussions have been conducted on male football players from the NFL and colleges. But over the past couple of years, there is a growing emphasis on how concussions affect younger athletes who account for 3 to 5 million injuries a year, many of which go unreported. Concussions suffered by younger athletes often result from a non-contact sport such as skiing, snowboarding, soccer, lacrosse, hockey, and basketball. Increasingly these athletes are just as likely to be female.
In November of 2008 the 3rd International Conference on Concussion in Sport took place in Zurich and for the first time there were specific statements made referring to pediatric issues and concerns with traumatic brain injuries. Based largely on that report and continued research on how younger athletes should be diagnosed and treated differently the American Academy of Pediatrics will introduce revised guidelines on concussions later this summer.
Why should pediatric concussions be treated differently?
• Younger athletes recover more slowly.
Concussions affect people differently and studies show younger athletes seem to recover more slowly from these mild traumatic brain injuries than older athletes (Collins et al. 2006 Journal of Neurosurgery). It means questions about when an athlete can return to a sport need to be considered carefully. The push to return to full activity too soon can result in additional concussions and possible long-term brain damage.
• Concussions are hard to diagnose without medical training.
Professional and college athletic programs have a medical team on the sideline at every game while younger athletes who are injured rely on the care of coaches and parents who may lack medical knowledge. For example, a common fallacy is that concussions involve loss of consciousness when in fact less than 10% actually do. If the athlete doesn’t lose consciousness, they may end up back on the playing without being properly examined by a physician or neurophysiologist who understands concussions. The challenge of diagnosing a concussion is further complicated in the young developing brain. As the injury is more of a metabolic issue than a structural one, even a CT or MRI cannot rule out a concussion.
Symptoms
Symptoms of a concussion fall into four categories:
1. Physical: (headache, fatigue, dizziness, nausea)
2. Cognitive: (difficulty remembering or concentrating, feeling slowed down or foggy)
3. Emotional: (irritable or more emotional than normal)
4. Sleep Disturbances: (drowsy, sleeping more or less than usual)
Treatment
While there is still no simple formula for treating concussions, one thing is agreed: young athletes must be handled very cautiously, especially if there is any history of multiple concussions or mild traumatic brain injuries. The fear of long-term affects and even death from Second Impact Syndrome is very real and taken much more seriously now than even a few years ago. It has been shown that repeat concussions occur 92% of the time within ten days of the original incident (Guskiewicz, McCrea et al. 2003 JAMA).
Most healthcare professionals have adopted protocols for diagnosing and treating concussions. In one protocol, the Acute Concussion Evaluation (ACE), a five-minute questionnaire is given to the patient and the parents to assess the presence or absence of 22 symptoms in the four important categories of somatic, cognitive, emotion and sleep. Since younger athletes are not always as accurate in reporting symptoms, friends, teachers and coaches may also be interviewed as they often pick up subtle differences in the athlete after a concussion.
When it comes to letting concussions heal in younger athletes, we are no longer are we looking solely at physical exertion. The child must rest the body and the brain. They need to sleep well and avoid activities that produce a return of symptoms, which may even be brought on by extended periods of reading or concentration at school.
All athletes, parents, coaches, teachers need to be education about concussions and fortunately this information is becoming more readily available. One excellent resource on traumatic brain injuries is the Center for Disease Control (www.http:cdc.gov/concussion).
The bottom line is younger athletes might take longer to fully recover from a mild traumatic brain injury and we should proceed more cautiously when treating these individuals. The athlete should never return to their sport the same day if there is any concern of a concussion.
Dr. Jim Harding recently returned from the 28th annual Academy for Sports Dentistry Symposium in Washington, D.C. An official medical provider to the US Ski and Snowboard teams and the team dentist for Ski and Snowboard Club Vail, he is currently conducting groundbreaking research on performance enhancing sports mouth guards. (www.jameshardingdds.com.)
