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Legislation and education could reduce long-term effects of concussions
 



The high risk of concussions in high school football players has led the Tennessee legislature to pass a new law that places the long-term health of the athlete first.

Dr. Leon Scott, M.D.
The law will especially help coaches, trainers and referees better understand the symptoms of a concussion and more universally enforce return-to-play protocol.

Awaiting an expected signature by Gov. Haslam, once approved, the law will go into effect on Jan. 1, 2014.

If passed, all coaches, athletic trainers and referees will be required to go through an annual training program that identifies the normal signs of a concussion as well as symptoms that might indicate more severe damage to the brain.

The legislation arose from an effort to create consistency between high schools, club teams and travel teams about how to react to a potential concussion.

Ultimately, we want to avoid missing severe head injuries or a concussion, which is a functional injury to the brain that occurs after you are hit either in the head, neck or body in a way that causes the brain to rotate, stressing the brain cells.

Symptoms
You can’t see a concussion, but the symptoms are its hallmarks: confusion, dizziness, nausea and the headache. Over time, you might notice irritability and difficulty with concentration.

Treatment
Once a concussion has been diagnosed, the latest research recommends rest. Up to 85 percent of concussions resolve within 21 days with adequate rest alone. The problem, however, has always been determining how much rest is adequate.
Often times, you would be recommended to rest until all symptoms are gone. If that takes a while, some symptoms that seem classic for concussion, including change in mood and irritability, might arise that are more related to the isolation from friends and activities rather than from the concussion.

The Journal of Pediatrics found that one week of rest improved symptoms for all individuals who had not previously rested. Data out of Harvard is trying to pinpoint exactly how much rest is beneficial. What researchers are finding is that full academic and physical rest with gradual introduction of light and minimal risk activity can improve recovery, but they can’t yet quantify where that sweet spot is.

At some point you have to start getting back into activities. I recommend low level exertion exercise including stretching and light aerobic activity as tolerated after two weeks in many cases if symptoms are still progressing. After a monitored period of rest, moderate movement is now being shown to help you recover from symptoms more quickly.

Recovery
To recover from a concussion, you need energy to heal the brain cells. If you don’t do anything for a period of time greater than two weeks, your untrained muscles can sap the energy away. Losing all conditioning will put you at greater risk of concussion symptoms continuing. You will not hurt your brain cells anymore in low risk situations. You are truly training your brain. When symptoms recur, that is a sign you need to step back. But it doesn’t mean you have done more damage and there is no evidence that the concussion will prolong any further with intermittent episodes of worsened symptoms.

Prevention Currently, new helmet and mouth guard technology is not doing much to prevent concussions, although they are crucial for protecting against other types of head, face and dental injuries.  However, one little known fact is that concussions can be prevented. We can’t prevent 100 percent of them, but there are some new strengthening protocols put together from collaborative efforts by doctors in Colorado, Ohio and Tennessee that are preventing concussions. There are fewer concussions per season among teams using these training tools than those that aren’t. 

That is one of the special things about Williamson Medical Center. The medical team has access to these protocols and teaches them during our sports checkups. People typically don’t perceive value in sports physicals, but this is an example of how we can greatly increase the value. 

Everyone who trains young athletes should work collaboratively with physicians who can educate them on neck and shoulder strengthening exercises. Athletic trainers in the school can also implement these exercises. We can give a prescription to your coach or trainer to implement these programs in schools.

We are already exercising. We might as well do it proactively.

Leon Scott, M.D. is a graduate of the sports medicine fellowship from Harvard-Boston Children’s Hospital. He is also a board-certified pediatrician credentialed at Williamson Medical Center and was one of the physicians treating the injured at the 2013 Boston Marathon. Learn more about his practice at www.gosporti.com.
 

Posted on: 9/5/2013

 
 

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