The concussion epidemic

By Archie Dickinson, MD

I have a dilemma. My eight-year-old son simply loves football. He has played for the local Pop Warner team every year since he was five. He lives, eats and breathes football. As a parent, I would like to support and nourish this passion except for one simple fact - I'm afraid of concussions and possible long-term damage to his brain.

There has been an explosion in research regarding concussions over the past five years, largely due to the efforts of the National Football League. We know much more about the identification and management of concussions than we ever have. No longer does an athlete get his “bell rung,” take a few plays off and return to finish the game. We also know much more about the long-term effects of repeated concussions, which is what really frightens me.

First, let’s review a few basics. What is a concussion? Your brain is basically three pounds of Jell-O floating inside a hard, bony case. When the skull is struck or suddenly decelerates, such as after a body check or tackle, the brain strikes the hard bony surface. This bruises the brain and causes it to temporarily malfunction.

The malfunctioning brain leads to the tell-tale symptoms of a concussion. These include headache, temporary loss of consciousness, confusion or feeling “in a fog,” amnesia surrounding the event, dizziness or “seeing stars,” nausea or vomiting, slurred speech and fatigue.

Other symptoms may be delayed in onset by hours or even days after an injury. These include difficulty concentrating, irritability or personality changes, sensitivity to light or noise, sleep disturbance, depression and disorders of taste and smell. It is critical to identify these so the athlete can be removed from play immediately to avoid further, possibly catastrophic, damage. An athlete with any of these symptoms should be removed from further competition until they are assessed by a health care provider.

Why are children and adolescents at particular risk of concussion? They may be less aware of the symptoms of concussion and therefore be less likely to report them. In addition, there is research that suggests the developing brain is particularly sensitive to the effects of concussion. Children's brains take longer to heal than adults and they also may be at higher risks of post-concussion syndrome with repeated injuries.

How can you prevent concussions? Unfortunately, there is precious little we can offer to prevent concussions. Despite all of the protective equipment, there is no evidence that helmets, mouth guards or any other technology significantly reduces the risk of concussion. Changes to rules that eliminate high-risk hits have helped to a certain extent in the NHL and NFL. But, the fact remains that the risk of concussion will always be there, especially in sports where the goal is to knock your opponent down on every play.

For these reasons, a Sports Concussion Program was created at Dartmouth-Hitchcock and the Children’s Hospital at Dartmouth-Hitchcock to help assess and manage athletes who are suspected of having a concussion. The program is designed for athletes who have had a concussion and want a defined assessment and management plan for return to sports. Two stages are offered in this program including baseline testing and post-concussion management.

In the end, you can't change anatomy and concussions will always be a risk in sports. Through education and rule changes we can ameliorate these risks but not eliminate them. We need to ensure those supervising our children are well versed in the symptoms and signs of a concussion and when in doubt, take them out until they can see a health care provider.

The real question is, should I let my son play football at all, knowing the risk? Right now, I don't have the answer.

Dr. Archie Dickinson, MD works as a family medicine practitioner at Dartmouth-Hitchcock Merrimack. For more information about the Sports Concussion Program at Dartmouth-Hitchcock, and the Children’s Hospital at Dartmouth-Hitchcock, go to Dartmouth-Hitchcock.org or ChadKids.org.