By Dr. Stan Sack
That time has come again. It’s the time to remove and stash that rainbow of pro football jerseys that populates Duval Street from Labor Day to That Big Sunday in February. Yes, football season is officially over — but unofficially, it lives on, especially down here, where pickup games are pretty easy to orchestrate year-round. And year-round, there are always other sports to take over.
What this also means is that it’s never “off-season” to talk about head injury. This is especially true since in recent years, how we manage head injury, especially concussion, has changed a lot. Those who follow the goings-on in the NFL may notice what appears to be an emerging culture of safety. Let’s spend a little time seeing how some of these changes translate to school sports.
First off, there are so many terms tossed around, you’d think that the medical community is running a flea-flicker offense. What IS a concussion? It’s best described as an injury to the brain that temporarily interrupts it from working correctly. Although many concussions are from a direct blow to the head, they sometimes occur after trauma to other parts of the body. In any case, obvious signs of head injury may be absent. Also, the player does not need to become unconscious or “black out” to have a concussion; even mild symptoms such as headache, difficulty concentrating or cranky mood can mean trouble.
The “old ways” of managing concussion seemed pretty simple. Kids who showed significant symptoms were usually taken out of the game and given quick medical attention. Those who didn’t were rested for a while — as little as 15 minutes, according to one 2001 guideline — and went back into the game.
The sicker concussion victims were rested and monitored either at home or in the hospital, often with tests to rule out a more serious problem. If it was a first concussion, players were returned to sports, usually after a week with no symptoms.
Nowadays, this thinking generally doesn’t cut it. The reason? It appears that brain cells are damaged a little more than originally thought, even with mild concussions. They need time to heal, which takes oxygen and nutrition. And the thinking now is that brain activity can slow this healing process.
For this reason, sports medicine now advocates a “graduated return to play.” What this means is that we rest the brain. To say that means “no thinking” is maybe a little simplistic, but there is a grain of truth in that statement. Children are now encouraged to engage in schoolwork and other heady activities initially on a limited basis, and to pay attention to their symptoms when they do: even a headache is a reason to scale back. And this might mean no video games or texting to start out!
Similarly, the return to sports is gradual. It may mean just light cardiovascular activity at first, such as walking; then, running; then, maybe some non-contact drills. You get the idea. In most cases, it’s actually the schools that have “run with the ball” and developed return-to-sports policies. Health care providers are intimately involved in the process as well; occasionally a specialist is called in to help with the game plan.
Situations and providers differ so much that there is no more a road map to recovery from head injury than there is a road map to the Super Bowl. Your child’s “team” (not THAT one; rather, her provider, trainer, coach and teachers) will always be the best resource in terms of how to manage concussion.
You don’t have to bar-hop to realize how important sports are. For kids, as for all of us, it’s an opportunity for physical activity, camaraderie, and self-esteem (not to mention fun). The newer developments in the science of head injury management are designed to keep everyone in the game for life — and that’s a good thing.
