In recent years, the issue of concussions has come to the fore in media coverage of American sports. Though the early media focus was on professional football, the issue is being highlighted at nearly every level of sport now.
According to the Centers for Disease Control and Prevention, U.S. emergency departments annually treat an average of 173,285 sports- and recreation-related traumatic brain injuries among children and adolescents. Such emergency visits have increased 60% over the past decade; in 2009 alone, there were 248,418 such cases.
Among the pioneers of reporting in this field, Alan Schwarz of the New York Times highlighted the history of concussions and their consequences in the National Football League. Former NFL players now continue to pursue legal action and raise awareness of the issue. The National Hockey League has more recently experienced its own crisis of conscience, as Sidney Crosby, one of the league?s best players, went down for the better part of a year, beginning in 2010.
The stories of other prominent players continue to draw attention to concussions and their impacts. In Major League Baseball, concussions are known to have helped end the careers of Mike Matheny (now the manager of the St. Louis Cardinals) and Corey Koskie, and they cost Minnesota Twins star Justin Morneau the better part of a season of play. During the National Basketball Association 2012 Finals, Oklahoma City star James Harden received a concussion just before the beginning of the playoffs, as his team was contending for a league championship.
Moreover, the attention paid to concussions has led to rules changes within professional leagues, as Major League Baseball has instituted a disabled list for players with concussions, and the NFL has banned certain types of hits as well as aggressively prosecuted the usage of ?bounty pools,? where players receive bonuses for injuring players on the opposing team.
This recent attention at the top levels of sport has also helped spotlight the fact that concussion risk starts at the youth level in all these sports and more, including soccer, boxing, gymnastics, horseback riding, skiing, and cycling. The long-term effects of head injury are only partially understood and are still being studied across all sports and development levels. The Boston University Center for Traumatic Enchephalopathy continues to examine the brains of deceased athletes in order to research and compile case studies on the long-term effects of concussions; the Center also continues to conduct other inquiries and publish academic studies in this evolving field.
Below are studies and articles that bring a research perspective to questions around concussions in sports:
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?Sports-Related Head Injury?
American Association of Neurological Surgeons, Patient Information Report, December 2011.
Excerpt: ?A traumatic brain injury (TBI) is defined as a blow or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in mental state or consciousness, while severe cases may result in extended periods of unconsciousness, coma or even death.?
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?Epidemiology of Concussions among United States High school Athletes in 20 Sports?
Marar, M; McIlvain, NM; Fields, SK; Comstock, RD. American Journal of Sports Medicine, 2012.
Excerpt: ?During the study period, 1936 concussions were reported during 7,780,064 athlete-exposures (AEs) for an overall injury rate of 2.5 per 10,000 AEs. The injury rate was higher in competition (6.4) than practice (1.1) ? The majority of concussions resulted from participation in football (47.1%, n = 912), followed by girls? soccer (8.2%, n = 159), boys? wrestling (5.8%, n = 112), and girls? basketball (5.5%, n = 107). Football had the highest concussion rate (6.4), followed by boys? ice hockey (5.4) and boys? lacrosse (4.0)?. In gender-comparable sports, girls had a higher concussion rate (1.7) than boys (1.0)?. The most common mechanisms of injury were player-player contact (70.3%) and player-playing surface contact (17.2%). In more than 40% of athletes in sports other than girls? swimming and girls? track, concussion symptoms resolved in 3 days or less. Athletes most commonly returned to play in 1 to 3 weeks (55.3%), with 22.8% returning in less than 1 week and 2.0% returning in less than 1 day?. Although interest in sports-related concussions is usually focused on full-contact sports like football and ice hockey, concussions occur across a wide variety of high school sports. Concussion rates vary by sport, gender, and type of exposure. An understanding of concussion rates, patterns of injury, and risk factors can drive targeted preventive measures and help reduce the risk for concussion among high school athletes in all sports.?
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?Functionally-Detected Cognitive Impairment in High School Football Players Without Clinically Diagnosed Concussion?
Talavage, TM, et al. Journal of Neurotrama, 2011.
Findings: Overall, the data suggest ?the presence of a previously unknown, but suspected ? group of athletes exhibiting neurocognitive deficits that persist over time, but which does not present observable symptoms.? The study?s authors say the findings indicate current on-field tests for concussions may not be sufficient in determining full risks to the brain.?
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?Clinical Report?Sport-Related Concussion in Children and Adolescents?
Halstead, Mark E; Walter, Kevin D. American Academy of Pediatrics, 2010.
Excerpt: ?Sport-related concussion is a ?hot topic? in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the de?nition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury? This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes. ?
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?Response to Acute Concussive Injury in Soccer Players: Is Gender a Modifying Factor??
Zuckerman, SL, et al. Journal of Neurosurgery Pediatrics, October 2012.
Abstract: ?Several studies have suggested a gender difference in response to sports-related concussion (SRC). The Concussion in Sport group did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. In the present study the authors endeavored to assess acute neurocognitive and symptom responses to an SRC in equivalent cohorts of male and female soccer players. The authors hypothesized that female athletes would experience greater levels of acute symptoms and neurocognitive impairment than males?. The results failed to replicate prior findings of gender specific baseline neurocognitive differences in verbal and visual memory. The findings also indicated no differential gender based acute response to concussion (symptoms or neurocognitive scores) among high school soccer players. The implications of these findings for the inclusion of gender as a modifying factor in this tightly matched cohort are addressed.?
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?Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ?19 Years?United States, 2001-2009?
Gilchrist, Julie, et al. CDC Morbidity and Mortality Weekly Report, 2011.
Excerpt: ?From 2001 to 2009, the number of annual TBI-related ED visits [Traumatic Brain Injury-related Emergency Department visits] increased significantly, from 153,375 to 248,418, with the highest rates among males aged 10?19 years. By increasing awareness of TBI risks from sports and recreation, employing proper technique and protective equipment, and quickly responding to injuries, the incidence, severity, and long-term negative health effects of TBIs among children and adolescents can be reduced.?
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?Assessment and Management of Sport-Related Concussions in United States High Schools?
Meehan, William P, et al. American Journal of Sports Medicine, 2011.
Excerpt: ?Concussions account for nearly 15% of all sport-related injuries in high school athletes. The timing of return to play after a sport-related concussion is similar regardless of whether the decision to return the athlete to play is made by a physician or an AT. When a medical doctor is involved, most concussions are assessed by primary care physicians as opposed to subspecialists. Computed tomography is obtained during the assessment of 1 of every 5 concussions occurring in high school athletes.?
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?Consensus Statement on Concussion in Sport?
McCrory, P, et al. Journal of Clinical Neuroscience, 2009.
Excerpt: ?This document is developed for use by physicians, therapists, certi?ed athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play (RTP) decisions remain in the realm of clinical judgment on an individualized basis.?
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?Catastrophic Sports Injury Research Twenty-Ninth Annual Report Fall 1982 ? Spring 2011? (PDF)
Mueller, Frederick O; Cantu, Robert C. Department of Exercise & Sport Science, University of North Carolina, 2011.
Description: ?The National Center for Catastrophic Sport Injury Research collects and disseminates death and permanent disability sports injury data that involve brain and/or spinal cord injuries. The research is funded by a grant from the National Collegiate Athletic Association, the American Football Coaches Association, and the National Federation of State High School Associations. This research has been conducted at the University of North Carolina at Chapel Hill since 1965. Each year three annual reports are compiled.?
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?Management of the Athlete with Concussion?
Su, John K; Ramirez, Joel F. The Permanente Journal, 2012.
Excerpt: ?The approach to and management of the athlete with concussion can be a challenging endeavor to physicians who care for athletes who have suffered a head injury?this group includes family physicians, pediatricians, internists, emergency medicine physicians, primary sports medicine physicians, orthopedic surgeons, neurologists, and neurosurgeons. Sometimes questions regarding the need for neurologic, psychological, or radiographic imaging can make the decision for return to play unclear. New legislation will undoubtedly increase physician visits for these athletes to return to play. Thus, the goal of this article is to review the latest guidelines regarding concussion management to help all physicians who care for athletes do so appropriately.?
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?Hockey Concussion: Is It Child Abuse??
Hemond, Chris. Canadian Medical Association Journal, 2012.
Excerpt: ?If not a stampede, it appears there is at least a slow shuffle of Canadian youngsters out of contact hockey as a result of widespread publicity about the parade of National Hockey League (NHL) superstars onto injured reserve lists. Meanwhile, one critic says Hockey Canada?s failure to implement even more stringent anti-concussion measures constitutes nothing short of ?child abuse.??
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?Effect of Bodychecking on Rate of Injuries Among Minor Hockey Players?
Cusimano, Michael D, et al. Open Medicine, 2011.
Excerpt: ?Bodychecking is a leading cause of injury among minor hockey players. Its value has been the subject of heated debate since Hockey Canada introduced bodychecking for competitive players as young as 9 years in the 1998/1999 season?. In this study, the odds of injury increased with decreasing age of exposure to bodychecking. These findings add to the growing evidence that bodychecking holds greater risk than benefit for youth and support widespread calls to ban this practice.?
Tags: sports, children, youth, safety, research roundup
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