Spotlight on Head Injuries Persists as NFL Settles Suit

footballToday, the NFL agreed to pay $765 million to settle a lawsuit brought by thousands of former players who have been affected by the long-terms effects of head trauma. Millions of football players in leagues across the country, from Pop Warner to the NFL, are at risk of suffering similar injuries as they practice for the upcoming season, reinforcing the need for physicians to keep up-to-date on proper procedures in case a concussion is suspected.

Those who care for athletes of all levels should stay current with guidelines for concussion management, educate their athletes and coaches on the potential dangers of concussions and develop a concussion safety plan with their school or sports organization, according to an article published in the 2013 Rush Orthopedics Journal.

A concussion, typically caused by a direct blow to the head, is a common sports injury, particularly in high-contact sports such as football, hockey, soccer and basketball. The injury can have severe short- and long-term effects, causing memory problems for up to a week and increasing the danger of developing dementia, Parkinson’s disease and depression if multiple concussions are suffered. Children and younger athletes are particularly susceptible, taking up to twice as long to recover than older athletes.

A physician experienced in the management of concussion should guide the treatment, management and eventual clearance to return to play.

“Clinicians should only clear an athlete to return to competition when the athlete is symptom-free both at rest and while exercising, off medication, has a normal neurologic examination and any testing has returned to baseline levels that were recorded prior to the injury,” said Dr. Kathleen Weber, the article’s lead author, a sports medicine physician at Rush and a team physician for the Chicago Bulls.

On-field and sideline evaluations

Although many athletes will complain immediately of some concussive symptoms, others may not. It is always better to take additional time, use caution and observe the athlete on the sideline because concussive symptoms can develop over time. An initial assessment of an athlete suspected of having a concussion should follow a standard protocol:

  • An on-field evaluation should begin with an assessment of consciousness, breathing and circulation.
  • Once on the sideline, the athlete should be evaluated for the presence of concussion-related symptoms such as headache, dizziness, light-headedness and nausea. In addition, the athlete should be questioned regarding the events prior to and following the injury to check for possible memory loss.
  • Athletes who are not experiencing symptoms but are otherwise suspected of having a concussion should undergo testing prior to going back into play, progressively introducing physical activity to the athlete and evaluating if he or she develops symptoms of a concussion. Such activities include pushups, sit-ups, jogging and short sprints to more sport-specific activities.
  • If an athlete is still experiencing symptoms or does not pass the battery of sideline tests, or both, he or she should be not be allowed to return to play in that competition.

“Some athletes may not recognize symptoms of concussion or want to volunteer that they are having symptoms out of fear that they will not be able to play, so it is important that physicians be educated on the signs and symptoms of a concussion,” Weber said.

As many as 3.8 million concussions occur yearly in the United States. Almost 9 percent of all athletic injuries at the high school level are concussions, and the rates of concussion among high school girls are higher than among boys in the same sports. During the last decade, emergency room visits have increased 60 percent for sports and recreation-related traumatic brain injury in children and adolescents. Most of these visits are related to football, basketball, soccer and playground activities.

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