Care, caution remain best approach for concussion
By Kristen Shilton Thu, 07/19/2012 - 3:01pm
Of all the issues facing youth sports today, few have earned as many headlines as head injuries.
Dr. Margot Putukian, director of athletic medicine and head team physician for Princeton University, can see why.
“This is a topic that’s really important and one the medical community can’t ignore,” she said. “We haven’t solved it. Everyone wants answers, but we aren’t quite there yet.”
Putukian spoke about concussion and head injuries in sport Thursday during the NFL/USA Football Youth Summit in Canton, Ohio. About 150 youth and high school coaches gathered at Kent State Stark campus to share best practices, ways to help players reach their potential and health and safeties issues as well as promote cooperation between coaches and youth commissioners from all 50 states and Washington, D.C.
But despite the bulk of concussion blame falling on football, Putukian, a member of the NFL’s Head, Neck and Spine committee, emphasized all sports need to be more aware of head injuries and how to treat them.
“This isn’t just a problem with football. Concussions are an issue in a lot of different places,” she said. “There have been a lot of changes in football over the last couple of years, but concussions are a very subjective diagnosis. We don’t have the ability to put someone in an (MRI) scanner and tell them if they have a concussion or not. Fortunately, there is a lot of research going on. Unfortunately, we don’t have all the answers yet.”
And therein lies the biggest struggle in concussion diagnosis and treatment – how can you tell if a player’s brain has been hurt if there are no physical signs? Putukian advised the coaches in attendance on how to be aware of the signs and symptoms.
“The hallmark of a concussion is confusion,” she said. “There are also headaches, nausea and vomiting as well as difficulty processing information. It’s the ‘deer in headlights’ look. If you have an athlete who got a concussion (some time ago), they’ll complain about not being able to sleep. They feel hung over. As (a coach) you have to know your athletes, and if you are seeing a change in their personality, it can be a sign of concussion.”
A common belief about concussions is that they damage the brain itself, but it’s a functional, not structural, problem that occurs. Putukian explained how the biomedical and cognitive parts of the brain become mismatched.
It’s the software, not the hardware, that’s the issue.
“The key elements to concussion treatment are really recognizing the signs, being wary of kids who get a high hit in the head or body and then listening to your gut,” she said. “Concussions account for 6 percent of all injuries at the college level and more so at the high school level. And the younger the athlete, the more susceptible they are.”
As frustrating as concussions can be for coaches, parents and athletes, Putukian stressed that strides continue to be made.
She warned against quick-fixes or products that promise to reduce concussion, but by implementing practices with less hitting, continuing to educate, improving equipment quality and putting rule changes into action, the risks can be decreased.
“What we don’t know is how to answer the question ‘how many (concussions) is too many?’ before you end a young athlete’s career,” she said. “Sometimes it’s after two. Sometimes it’s after 12. We need to work with coaches to make sure youngsters are managed appropriately.
“It’s important we don’t encourage kids to play through injuries. You wouldn’t send a kid back in on an ankle injury. You can’t do it with brain injuries either.”
That’s a message that resonates with Ralph Clinton of the North Metro Football League in Atlanta.
“It was a great session. I have my coaches’ meeting next Saturday, and this information will be a part of it,” Clinton said. “We will pass out similar information to the parents at registration, information packets provided by the CDC.
“We’ve adopted the rule that if a player shows signs of concussion, they get taken out until cleared by a medical professional. Because of this, we’ve also purchased insurance to help people pay to see a medical professional. This is not something you can cut corners on.”
