Concussions and Kids: Traumatic Brain Injury Can Sideline Young Athletes

Thousands of Tulsa-area students will begin their football career this fall, and thousands more will return for another season on the gridiron. Boys from 5 to 18 are snapping on their helmets and hitting the turf. Countless other student athletes will run onto the soccer pitch, the tennis court, the hockey field, the volleyball court or enter the ring for competition this school year, and they are all at risk of sustaining an injury that causes comprehensive damage and possible death.

On July 1, Senate Bill 1700 went into effect in Oklahoma. This new law requires a student with a possible Traumatic Brain Injury (TBI) to be removed from a game and evaluated by a doctor. The student must be cleared by the physician before he or she can resume play. Enacting this bill into law suggests that concussions are a significant problem in high school athletics and that adults need standards to prevent and treat these athletes.

Myriad reasons explain why an injured student may return to a game instead of seeking treatment. He believes he owes it to his team. Maybe she doesn’t understand the injury and “feels fine.” Sometimes a coach doesn’t recognize the symptoms or perhaps the parent is unaware of the dramatic long-term effects caused by Traumatic Brain Injury. Observers might say, “He had his bell rung,” or “shake it off.” And while that may at times be appropriate, that attitude overlooks symptoms that could indicate a student should not return to competition.

Wendy Jones, a married mother of two recounts a concussion she sustained as a child. “I received a concussion riding my Pink Panther bike from [a friend’s] residence to my house back in 1983. My book-bag got tangled in my front wheel, flipped over the handlebars, and smacked my forehead on the road. My dad… refused to take me to the hospitable. A few days later my eyes swelled and made me look cross-eyed. I still did not see a doctor. I did at least get to stay home from school a few days. Pink Panther never recovered!”

And while Wendy laughs as she tells the story, her experience reflects an outmoded attitude that has begun to change with research and technology. Dr. Lamont Cavanagh, director of Sports Medicine at OU, points to former NFL stars Steve Young and Troy Aikman as well as boxing legend Muhamed Ali as high profile athletes whose TBIs have led to increased awareness and education.

According to the Sports Concussion Institute, “a concussion is the result of a blow to the head or neck, which causes the brain to be rocked back and forth inside of the skull…” Another analogy from Dr. Robert Mongrain from the Berkshire Dental group in Tulsa likens the brain and skull to ice in a glass of water. Knocking, tipping or upsetting the glass causes the ice to collide with the glass. When this happens to the brain inside the skull, according to Dr. Mongrain, “it damages the computer that is the brain.”

The problem with diagnosing and treating concussions is that there is no immediately apparent “brain bleeding or bruising,” but according to Dr. Cavanagh, “there is real brain dysfunction taking place.”
Doctors continue to study what happens during a brain injury and Dr. Cavanagh says what they do know is that when the brain smashes into the skull, “it causes damage to the nerve cell, which in turn causes a cascade of chemical reactions in the cell and neurons. There is an increased demand for energy and a reflexive (opposing) decrease in energy supply to the brain.”

Symptoms of concussion include being dazed or confused, forgetful, unsure of the game being played, clumsiness, loss of consciousness, mood changes or memory loss. Someone with a possible concussion will have headache, dizziness, double vision, sensitivity to light or noise, or concentration problems.
The new legislation is in place to protect students who are injured during a game. But both Dr. Cavanagh and Dr. Mongrain urge parents to remove their kids from any game if they suspect the child may have a concussion. Parents can also take cues from their children. Debbie Morgan knew they needed to head to the hospital when her son asked, after a blow to the head in karate, “When did we get on this roller coaster?”

In fact, the best method of diagnosing concussion is clinical rather than technological. Dr. Cavanagh says coaches and trainers have increased education about head trauma cues and implement this information on the sideline. Computer-based technologies exist, but students actively playing do not have access to them, and some of the new testing offers incomplete data at this point.
Analysis of TBIs in young athletes reveals a grim reality: “Students who have ever had a concussion are at an increased risk for another,” according the CDC. Moreover, “the effects of concussions are cumulative.”

While a large portion of TBIs that occur each year are mild, 52,000 people die each year from TBI and 275,000 are hospitalized as a result of brain injury. Of course, high school athletics cannot take the blame for every single one, but, “in organized high school sports, concussions occur more often in competitive sports, with football accounting for more than 60 percent.” Significantly, brain injuries cause more deaths than any other sports injury, “accounting for 65-95 percent.”

While football holds the dubious honor of causing the most concussions, it is clear that football is not the only sport with a high risk of injury. Parents attest to TBIs sustained by their children while surfing, biking, playing soccer or tennis, riding horses — the list goes on. Risk of injury is inherent in most every sport. Males with TBI from sports likely sustained them playing football while females in sports most likely sustain concussions playing soccer.

The Sports Concussion Institute warns parents on its website that repeated injury is likely and can be devastating. If an athlete who has suffered a concussion returns to play before fully healed, the brain is more vulnerable to permanent injury if another concussion occurs. The research shows that once an athlete has one TBI, his odds of sustaining another are higher. Therefore, his odds of permanent damage to the brain are higher. Dr. Cavanagh calls this “second impact syndrome,” and he says that the second impact can be seemingly inconsequential, not a blow that would under normal circumstances would cause a concussion. Brains that have been concussed are vulnerable to further injury when not fully healed.

The short- and long-term effects of repeated TBI, like TBI themselves, range from mild to severe. Head injury affects thinking, sensation, language and emotions, which encapsulates nearly every aspect of what it is to be human. Repeated sufferers are at risk of epilepsy, increased risk of Alzheimer’s, Parkinson’s and other brain disorders. In fact, the CDC cautions that “repeated mild TBIs occurring within a short period of time (hours, days, weeks) can be catastrophic or fatal.”

If we can’t stop our kids from competing and we can’t stop them from getting hurt, Dr. Mongrain urges parents to be educated about concussions and their prevention. In addition to his dental practice, he works with brainpads (brainpads.com) to provide one preventive measure. According to Dr. Mongrain, brainpads are “dual arch, prefab mouth guards that position the jaw down and forward to protect the brain from blows to the jaw.”

“A strike to the jaw sends the jawbone slamming into the skull like a hammer, bone on bone,” Dr. Mongrain said. The brainpad positions the jaw so that when it is jarred, the mouth absorbs the contact, or force, rather than the brain.” In other words, the guard “lowers the amount of impact energy to the base of the skull.”

Dr. Mongrain also stresses that football coaches teach and train the youngest players appropriate blocking and tackling technique. When a child learns that “good tackling can also be safe,” then that child has one more line of defense against TBI.

The problem is, many parents and some volunteer coaches do not have access to knowledge about proper technique. Indian Nations Football Conference holds training classes for volunteer coaches and Dr. Mongrain urges parents, particularly dads, to attend. In this way, parents can reinforce good technique rather than coaching against the coach.

“Proper technique,” is a refrain echoed by Dr. Cavanagh. While parents may not be able to keep their kids from playing sports, when they “learn not to hit with the head, to keep the head out of it,” the risk of TBI decreases.

But, Dr. Cavanagh cautions that a fully helmeted and mouth-guarded child is not immune to injury.
Elizabeth Martin, a Tulsa mom and teacher, says both her kids sustained head injuries while bike riding in helmets. “My son had to have internal and external stitches over his eyebrow. My daughter had a skull fracture on her forehead. Both injuries are still visible.”

For Ana Helmerich, a graduate of Holland Hall School, sustaining five concussions over her high school sports career has landed her with the likes of former pro athletes. Her doctor has advised her to stop competing all together. The only activity she has been cleared for is running.
Her first concussion came from a mishap with a wave on the ocean, a patch of coral and her head. Her recovery from that first incident left her shaken. “I remember that I couldn’t read or pronounce my words correctly and I was really frightened by that.”

Four more concussions followed, sustained in soccer, basketball and tennis. Again, recovery continued to be a problem.

“It was scary because I had memory loss. I got really behind in school.” One of her coaches describes her as a “natural athlete, who can compete in pretty much any sport.” And yet, Ana can no longer participate. She says, “As sad as that is, I’m ok with it. I don’t want to injure my brain more than I already have.”

While Ana did not plan to play sports in college, an athlete who counts on being highly recruited by colleges and then scouted by top pro teams may find himself with no future in sports if the decision is made to keep competing after injury. Also, Ana shows a knowledge that many don’t have — that concussions and traumatic brain injuries are serious and can lead to lasting neurological damage.
Recovering from a concussion sounds easy. The only prescription doctors have for concussions is rest. It can take seven days or more for the symptoms of brain injury to subside. Doctors urge patients to take their time, even if they think they feel better, or “back to normal.” What’s more, it takes longer for a high school-aged brain to heal than for a college-aged brain.

The CDC offers additional thoughts on recovering, aside from not rushing back to activity:
• Avoid further possible damage.
• Ask a doctor if it’s safe to ride in a car, to drive, to bike or to use heavy equipment.
• Take only drugs approved by a physician.
• Don’t drink alcohol.
• Write things down if memory loss seems to be a problem.
• Know that it may be necessary to relearn skills.

Every doctor who deals with concussions on a regular basis will tell patients that follow-up is key to recovery. Dr. Cavanagh suggests that if your child is treated for TBI at Urgent Care or in Emergency, then be sure to seek out follow-up from a primary care physician. Another avenue to pursue is to have a sports doctor or concussion specialist in mind if your child participates in a sport that carries risk. Primary care doctors can suggest experts who can see your child if the unexpected happens. When the brain has an opportunity to heal, the injured person has an excellent chance of making a full recovery.
High school sports offer team building, community involvement, healthy activity, a social environment and fun. Coupled with these positives is the risk of injury. Kids get hurt playing sports. It’s a fact. Parents, coaches and students have resources to prevent and treat head injuries quickly and safely so that students can return to sports as soon as they are healthy. When coaches, trainers and parents view the student athlete as a child rather than a short-term asset, students with injuries to the head have the chance to recover.

For additional information see:
• Cdc.com (Centers for Disease Control and Prevention)
• Brainpads.com
• Concussiontreatment.com (Sports Concussion Institute)
• Ok.gov/health
• Inyouthsports.com (Indian Nations Football Conference)
• OU Physician’s Sports Medicine a1111 S. St. Louis Ave, Tulsa, OK 74120, (918) 619-4400