Treatment of head injuries serious business
Dr. Adam Breiner, medical director of The NeuroEdge Brain Performance Center division of The Breiner Whole-Body Health Center in Fairfield, Conn., offered in a press release six things parents, teachers, and coaches need to know about concussions:
1. Concussions and traumatic brain injury occur when the brain suddenly shifts within the skull—usually as the result of a sudden blow, jolt, or change of direction (whiplash).
2. That damage can have long-term effects. Because children’s brains are still growing, they are especially vulnerable to concussions;
3. Multiple concussions are especially dangerous. If a child is concussed a second time while a previous brain injury is still healing, they may experience more serious symptoms, a longer recovery time, and even permanent cognitive and neurological damage.
4. The signs of concussion can range from mild to severe. The immediate effects of a concussion can be subtle or very noticeable.
5. The first and best line of defense is prevention. You can’t raise your child in a bubble, but you can take precautions to lower his risk of becoming concussed.
6. The standard wait-and-rest advice may not be good enough. If your child suffers a concussion or one is suspected, they should rest physically and mentally for a few days.
Concussions and the effects of Chronic traumatic encephalopathy (CTE) are an important topic of sports conversation these days.
University of Nevada Athletic Director Doug Knuth addressed head injuries when he spoke during a recent Rotary Club of Minden luncheon. Knuth said everything is being done to make sports safer — and he’s not alone in saying that.
“Has anyone ever had a concussion?,” Knuth asked the audience at the Carson Valley Inn. “It affects your focus, you get dizzy spells, you lose sleep; we have young men and women, a lot of times they can’t even go to class because they can’t focus or pay attention for too long. It’s not just football, but boys soccer has as many or maybe, percentage-wise, more concussions and women’s soccer has a lot of concussions. We had a concussion last year in volleyball.”
Ernie Monfiletto, who is entering his sixth season as head coach and 22nd season overall on the Douglas High School football coaching staff, is quick to point out that significant strides have been taken to help make the game safer, especially at the high school and youth levels.
“Back in the day, protocol was, ‘When you can stand up straight, you can play,’” he said. “But we’ve gone to great lengths as an (Northern Nevada Coaches) association to limit the amount of contact, which is 90 minutes per week, and you can’t have full contact more than two days in a row. We have the requirements on when you can go back to play; they must have five days without any symptoms and they have to pass a number of tests to prove that they are safe. We always have a trainer and a medical physician who make those decisions, so there’s a lot in place on behalf of kids.”
The University of Nevada follows the same protocol, Knuth said at the Rotary luncheon.
“If you do take a blow to the head and once someone does have concussion symptoms, we sit them out, and the return-to-play protocol is extremely conservative,” he said. “We sit them out, our doctors monitor them in every part of their life until they’re cleared to come back to practice and then eventually they’re able to come back and play. It takes weeks and sometimes months until someone gets their head clear again. This is serious stuff and we take it very seriously.”
Joe Girdner, who is in his first year as Douglas High’s principal, has seen many changes regarding the treatment of concussions. That dates back to when he played football at Douglas in the early 1990s and later as a strong safety at Modesto Junior College as well as the University of Mary in North Dakota. He has also been youth and high school coach.
“It’s changed a ton just the last couple of years, and from the time I played 25 years ago, it’s light years different,” Girdner said. “As a player, I don’t know if I ever had a concussion or recall any situation where I thought I might have had one. But high schools, colleges and all the way down to Pop Warner — and not only football, every youth sport — now coaches are required to get training on concussions.”
Since 2009, National Federation of High School rules publications have contained guidelines for management of a student who shows signs or symptoms consistent with a concussion. Under those guidelines, players must be immediately removed from competition and not allowed to return until cleared by a healthcare professional.
Nevada Revised Statute was adopted in 2011 to address head injuries statewide, from high school sports to the youth levels. At the high school level, the Nevada Interscholastic Activities Association (NIAA) and each of the state’s school boards are now required to have policy related to prevention and treatment of head injuries sustained by students.
Baseline testing is now mandatory at Nevada high schools and is conducted before each season to provide a measuring gauge for each athlete should a suspected concussion occur. At Douglas, cheerleaders have been added this year, according to Kate McCaffrey, who is entering her second year as the school’s athletic trainer.
“Baseline makes a difference,” McCaffrey said. “It tests their reaction time and their memory patterns, so it’s really a great tool to see how they’re doing.”
Head injuries can happen to anyone at any time, on or off the field of competition. McCaffrey said her one concussion was related to a bicycle accident before she even got to high school.
“Parents don’t often think about it, but biking is actually the most common cause of concussions for eighth grade and younger,” she said. “There is a lot more awareness now than there was in the past as far as what to watch for if something happens, and that’s a good thing.”
In July, the Miami Dolphins franchise announced it will fund baseline concussion testing for all student athletes enrolled in Miami-Dade public schools during the 2017 school year.
A study published in the medical journal JAMA on July 25 reported that CTE was found in 99 percent of brains from deceased NFL players that were donated to medical research.
Monfiletto believes that statistic doesn’t tell the entire story, however, in terms of comparing the NFL to high school football.
“One, that NFL population went without protocol. And number two, the families that submitted brains for research were all concerned about CTE, so it wasn’t a random sample,” Monfiletto said. “Those guys probably suffered repeated concussions without being treated properly, and that’s the reason why we have protocol today. And the number one cause of CTE, at least from what I understand, is repeated concussions and not giving the brain a chance to rest and heal.”
Football players, and athletes in general, have obviously grown in size with each decade. The average NFL offensive lineman of the 1940s averaged 6-foot-1, 221 pounds, according to report by Business Insider in 2011. By comparison, the average offensive lineman of the 1980s stood 6-4, 272. By 2011, the average was 6-5, 310.
Monfiletto pointed out that many of those NFL athletes may have played football since high school, or even longer, which means they have taken hits for 10 to 20 years.
“The game has progressed, people have gotten faster, stronger, bigger, and there was no protocol,” Monfiletto said. “And so the safety of those people who played, they suffered repeated concussions, and as a result of that, they have paid the price.”
He went on to point out the low percentage of football players who actually advance from high school and college to play NFL football.
“If you look at the high school game, 96 percent of all high school football players are not going to play college football,” Monfiletto said. “And so the risk of repeated concussions after their high school experience is minimal. So to compare the risk factor of those guys from the NFL to a kid playing high school football, it’s two different scenarios.”
There is no way to prevent all injuries, although measures have been put in place to help keep athletes as safe as possible.
“I’m not saying somebody can’t get hurt,” Monfiletto said. “But it is our responsibility as a coaching staff to provide the safest environment possible and to minimize the risk as much as we can.”
While Girdner feels fortunate to have never experienced a concussion first-hand, he has good cause to follow that conversation today.
“Now, with a son coming up, I am more aware,” he said. “It is concerning when you watch television and you see it on ESPN. I hope it doesn’t take away from football. It was a big part of my life growing up and a big part of who I am today.”