In the last few years, Erik Lanese, athletic trainer at Holy Cross High School in Waterbury, Connecticut, has seen a dramatic increase in the number of diagnosed concussions. The key word is “diagnosed.” Lanese, like many others who deal with head injuries, doesn’t believe more concussions are happening, but that the condition is better recognized.
“Years ago, we graded them from one to five. There is no more of that. It is black and white: a concussion or not,” said Lanese, who has been at Holy Cross for 19 years. “And if it falls under a concussion, we have a specific protocol for return to play. Kids have to be asymptomatic for 10 days before they can return.”
Concussions have been in the news in recent years as many states, including Connecticut, have passed legislation regarding awareness and documentation among youth sports. Plus, the movie “Concussion,” which opened Dec. 27, has put the issue in the limelight. The film, which stars Will Smith, is based on the true story of a pathologist who exposed the effects of repetitive head injuries among National Football League players.
The film addresses a specific condition called chronic traumatic encephalopathy, a progressive, degenerative disease of the brain found in athletes and others with a history of repetitive brain trauma. CTE has been known to affect boxers since the 1920s, but it was identified in the autopsies of professional football players in 2005.
A concussion is a mild traumatic brain injury that affects how the brain functions. It is caused by a bump, blow or jolt to the head or body that causes the head and brain to move back and forth rapidly. The sudden movement can cause the brain to bounce or twist inside the skull, stretching and damaging brain cells.
Dr. David Wang, medical director of Hartford, Connecticut-based Connecticut Children’s Medical Center’s elite sports group, cautioned about drawing a link between minor concussions, which most people recover from easily, and a serious disease like CTE that has no cure.
“My issue with the movie is the topic versus the title,” Wang said. “This idea that everybody who has a concussion therefore is going to get CTE is not true.”
Sarah Bullard, a neuropsychologist in the Center for Concussion Care at Gaylord Hospital in Wallingford, Connecticut, agreed. “For the average person, you will never meet someone with CTE,” said Bullard, who is also co-director of Gaylord’s Center for Brain Health. “Ninety percent of kids and adults will get better in a week from a concussion, and we see the ones who are not getting better.”
Concussion symptoms typically include headaches; dizziness; fogginess; feeling fatigued, irritable and unbalanced; blurred vision; changes in personality; and misaligned eyes, said Dr. Neil Culligan, a physician with Associated Neurologists, which has offices in Danbury, Waterbury, Southbury and New Milford, Connecticut.
“The two most important things are to not engage in any activity that has a possible risk of injury and to rest. If you get a second hit while you are still recovering, you can have much worse symptoms. While recovering, your reaction isn’t normal and your balance isn’t normal,” said Culligan, who is also director of his practice’s Western Connecticut Concussion Center.
“You want to limit cognitive activity for at least a few days as there is some swelling of the brain and if you stimulate it too much, it needs more oxygen and can cause more headaches.”
In the last five years, medical professionals and lay people have come a long way in their understanding of concussions, Bullard said.
“The way I was raised, you would get up and shake it off and get back in the game, but now we have realized that is the worst thing you can do,” she said. “Things are happening on a cellular level for 24 to 48 hours after the hit. When in doubt, sit it out and rest.”
In 2010, Connecticut State Legislature passed a law requiring high school coaches complete courses in concussion awareness. Legislation passed last year focused on increased education, reducing concussions and mandating schools report concussions to the Department of Education. Schools must also have a protocol for when athletes can return to competition, which can include medical clearance by a neurologist.
Most student athletes are back to all of their normal activities four weeks after an average sports concussion, Culligan said.
“But every concussion is different. Before we would not have even seen these kids, and they would have just gone back into the game,” he said. “The athletes are bigger and faster and better trained than they were in the past because many kids train in a single sport year-round, which means the forces and impacts have gone up. But if these kids are treated correctly, they will do fine.”
Culligan said he sees concussions across all sports. “Football has the highest number, but hockey has the highest incidence. I have seen them in runners hit by a lacrosse ball, and a runner who ducked under a branch and missed,” he said. “With the concerns over obesity, we want people to exercise and with good coaches, it’s safe.”
The next push is expanding concussion awareness to athletes below the high school level. Many youth programs require their coaches to be certified through the Heads Up Football program, an initiative from USA Football that teaches safe tackling skills and concussion education and response. There are also limits on the number of contact hours kids can play.
“There are all those club and extra sports. Kids training as professional figure skaters or boxing or MMA (mixed martial arts) shouldn’t be treated differently than kids playing in high school sports teams,” Wang said. “In Pop Warner, you have parents who are working full-time and they are running out to volunteer coach, and it’s harder to identify those coaches.”
Young children take longer to recover from concussions, Wang said. “Older adolescents to college age, most clear up within seven days. But with younger kids, they take a little longer and two to three weeks is not unusual,” he said.
Getting youth athletes to admit they’ve been hurt is another challenge, Wang said. “They don’t want to lose their position or let anyone down. And think about the messages we give our children in sports, `Push through the pain, work harder, get stronger,”‘ he said. “They need to learn the difference between good pain, such as sore muscles, and bad pain, like bone pain.”
Despite the risks, Wang and others tout the benefits of playing sports.
“They create collegiality and hard work and perseverance,” he said. “But should you avoid contact sports? That is a personal decision and if there is a lot of love for that sport, I am not willing to say, `Don’t do that.’ I have seen it taken away and kids go into a depression and fail out of school.”
However, if a child “has paid a high price” and missed several months of school due to concussions, the decision is more clear cut, Wang said. “Parents want it to be a number, but it’s multifactorial, including how easily they occur,” he said.
Lanese agreed that the “good outweighs the bad,” when it comes to sports. “Part of playing sports is understanding there is some danger, whether it is breaking a bone or twisting an ankle. Is it fair to say, `I don’t think my kid should play a sport because of getting a concussion?’ I don’t think we are there yet. I think what we are doing now is prudent.”