Heading injuries off at the pass

Health: Concussion's threat at last is being taken to heart.

June 18, 2000|By Nancy Menefee Jackson | Nancy Menefee Jackson,Special to the Sun

When John Doby was hit in the head playing lacrosse last fall, he stayed in the game.

"I was kind of disoriented," the 20-year-old Villa Julie College student says, "but I shook it off and kept on playing ."

On the ride home, his ears were ringing, and the next day he threw up. Doby had a concussion, but he was lucky: Continuing to play with his injury could have had more serious -- even deadly -- results.

A study by the University of California, Los Angeles, Medical Center last month found that even mild head injuries can cause changes to the brain's metabolism that make people more vulnerable to severe injury from a second blow.

"Even though a person may appear normal, alert and able to talk, what occurs inside the person's brain is anything but normal," says David Hovda, director of the UCLA Brain Injury Research Center.

In the past, head injuries on the playing field were usually considered serious only when an athlete lost consciousness or suffered memory loss. Players who "got their bell rung" would sit out a few plays and then return to the game.

Now, neurologists and sports medicine specialists say that there is no such thing as a "mild" concussion and that all head injuries should be treated with caution.

Veteran quarterback Steve Young announced his retirement this week in part because repeated concussions put him at too great a risk for permanent injury if he continued to play.

About 300,000 athletes are diagnosed with concussion every year, and about a third of them happen on the football field, according to the American Academy of Neurology. But soccer, hockey, baseball, skiing and lacrosse -- in short, almost all sports-- also put athletes at risk.

Shaking the brain

Concussion occurs when the brain is shaken inside the skull. According to American Academy of Neurology, concussion does not require a direct blow to the head and can occur with or without loss of consciousness.

Particularly alarming is second-

impact syndrome, which can occur when a player has suffered a concussion and then gets hit again before symptoms from the first injury have disappeared.

After the first hit, says Dr. Richard Hinton, who specializes in children's sports medicine at Union Memorial Hospital, "the brain area that's injured doesn't use the blood supply and glucose as efficiently. Even a very mild [second] trauma can cause a change in blood supply in the brain -- the blood supply shuts down and the kids die. It's very sudden. That's the big worry about returning to play."

In one case recorded by the Centers for Disease Control in Atlanta, a 19-year-old football player reported a headache to family members after an August 1993 practice. During practice the next day, he made a tackle and soon after collapsed. He died three days later.

Between 1992 and 1995, 17 cases of second-impact syndrome were reported. Researchers aren't sure how often it happens, but a study of data from Colorado, Missouri, Oklahoma and Utah between 1990 and 1993 found that for every 100,000 sports-related brain injuries, 2.6 of them ended in hospitalization or death.

Concussion often goes undiagnosed because there isn't always visible trauma or clear symptoms, and sometimes athletes don't admit to symptoms for fear of being taken out of the game.

To complicate matters, coaches and parents do not receive adequate training to recognize subtle signs of concussion, according to Dr. Jay Rosenberg, chairman of the public education committee of the American Academy of Neurology's Education and Research Foundation.

Rosenberg and others believe coaches should be required to learn how to assess head trauma in their players.

Fred Foster, North Harford High School's football coach, has lobbied for a trainer to be on the sidelines of every game, and for the past two years, Union Memorial Hospital Sports Medicine Center has supplied him with one for free.

"A kid is going to get a dinger and then come off and out for a couple of plays," Foster says. "A trainer will evaluate him. The trainer will make the call whether the kid goes back in, and we don't overrule the trainer."

Youth coaches -- many of whom are volunteers with no training regarding injuries -- have little support except to hope that a spectator has medical training.

Levels of trauma

Rosenberg co-wrote a set of national guidelines that divided concussions into three categories.

A grade-one concussion involves symptoms that resolve within 15 minutes. An athlete can be returned to play, but even then, he cautions, "the younger you are, the more conservative you play it. When we say return to play after a grade-one concussion, in a kid you might be out for a week."

Grade-two concussions are characterized by symptoms that have not resolved within 15 minutes. Symptoms may include headache, dizziness, nausea, sensitivity to light and disorientation.

In those cases, players should not play for one to two weeks from the time they are symptom-free.

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