Understanding of concussions is undergoing a paradigm shift

Research shows that among boys soprts, only football has more concussions than lacrosse

for girls, the injury is less common than in basketball and soccer

March 15, 2012|By Dr. Andrew Tucker, Special to The Baltimore Sun

I heard the oldies station playing the Bob Dylan tune "The Times They Are a-Changin'," and the famous line could well apply to the seismic cultural change surrounding sports concussions.

Not so long ago, the injury was hardly a headliner. A "ding" was almost considered a rite of passage and badge of honor for athletes playing contact sports.

Today, concussions are front-page news, the focus of millions of dollars' worth of research and legislative action across the country. The injury is now a priority for all involved with youth and scholastic sports.

What is a concussion? There is no universally accepted definition. I have an old New England Journal of Medicine review article (but much younger than the Dylan song) that defines a concussion as a loss of consciousness — in other words, getting knocked out.

Today we define the injury as "a trauma-induced change in neurologic (brain) function." The most common symptoms and signs are headache, light sensitivity, dizziness, fatigue and problems with focus, concentration, memory and sleep. Interestingly, loss of consciousness occurs in only 10 percent of sports concussions.

The study of concussions in youth sports and lacrosse has been a focus of researchers at Medstar Health Research Institute. Recent contributions by Andrew Lincoln and Dr. Richard Hinton and others have contributed greatly to our understanding of this injury. Partnering with Fairfax County, Va.,) high schools, the researchers found boys lacrosse accounted for the second-highest number of concussions among all sports, second only to football.

For girls, concussions in lacrosse are less common than in basketball and soccer. The researchers used game video analysis to study high school girls lacrosse head injuries and demonstrated that injuries typically occur in the area in front of the goal, with stick-to-head contact being the most common cause of injury.

Early recognition of a head injury is critical to treating it properly. For the athlete who suffers a concussion, a second brain injury that occurs before recovery is complete can be life-threatening in rare cases; this is known as second-impact syndrome.

More commonly, an athlete who continues to play with a concussion is at higher risk for recurrent injury and a much longer and difficult recovery. This has ramifications for return to sports and school performance. Proper initial treatment should emphasize rest, both physical and mental, to allow the brain to recover. Gradual resumption of schoolwork and physical activity should be guided by clinicians with experience in caring for the injury.

Failure by athletes to report symptoms of the injury, either for fear of being held out of play or a simple lack of understanding, appears to be less common today compared with five to 10 years ago. Educating sports medicine providers, parents, coaches and athletes is having a positive impact on injury recognition and treatment. Many states, including Maryland, have laws providing for concussion education for all involved in youth and scholastic sports, and mandatory removal of any athlete suspected of suffering a concussion. We have much work to do, but we have come a long way. The times are a-changin', and for the better.

Dr. Tucker is the medical director of MedStar Union Memorial Sports Medicine and head physician of the Ravens. He is a nationally recognized expert on sports concussions.

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