As a sports medicine physician, I have seen and been asked about many “hot topics” through the years. None, however, have caught the attention of so many people as that of concussions. From parents of Pop Warner football players all the way up to our own US Congress, a nation continues to be perplexed on what to do with the alleged “rising incidence” of concussions. The NFL even deemed 2010 as the “Year of Concussion Awareness”. For many non-sports enthusiasts, the answer seems simple - get rid of football. In fact, this was the suggestion of a medical ethicist at a conversational forum about concussions. Her contention was that physicians take the Hippocratic Oath to always do what is best for our patients, and how could we ethically allow our patients to partake in an activity that could result in such potentially devastating consequences? While I can see her point, the same argument would then have to be made for every patient who plays any contact sport, rides in a car, or dares to walk on icy pavement. It would also have to include any child who plays at a park, in their backyard or on playground equipment. It is impossible to eliminate concussions from real life. They can happen to anyone, at any time and anywhere. One very astute coach made the observation that everyone is worried about allowing kids to play football, while many parents let their children ride bikes without helmets. He has a valid point. Football gets the most attention due to the sheer numbers of participants. Studies actually show that many other sports have equal or greater percentages of concussions. These include soccer and ice hockey to name a few. But the argument isn’t who is winning the race in terms of the number of concussions. The argument should be how and why we should maintain youth participation in sports while still protecting them from head injury.
With over 38 million young boys and girls participating in youth sports in the US, sports have the opportunity to play in integral part in the development of our children. The benefits of participating in a sport abound. With our rising obesity epidemic, athletic activities help to instill healthy habits for life in our next generation. Sports are also the perfect forum for young people to learn life skills such as teamwork, leadership, resiliency, time-management, respect for authority and application of rules. Sports teach about the fact that hard work and extra effort can reap results, even for those who may not have been blessed with amazing natural abilities. They also help young people to understand about winning and losing gracefully, Additionally, sports involvement can help young people with socialization and acceptance of others as well as assist with stress relief. Some studies report that sports have the potential to keep at-risk kids from joining gangs and that sports also can help to keep kids in school and to achieve better grades. So with all of these positives, how could an ethical physician suggest that contact sports be abolished?
Rather than eliminate sports off the map, we all need to do our part to EDUCATE. Parents, coaches and players need to understand that they have a part in concussion prevention and treatment. Safety in all activities should be a number one priority. The proper equipment for the sport should be used at all practices and games. It should be well-maintained and fit correctly. Coaches and officials need to ensure that safety rules are enforced to help in prevention of injuries. If that is not occurring, it needs to be reported. All coaches, parents, officials and players also need to be provided with education on the signs and symptoms of concussion. The CDC has free materials and on-line training courses to assist with this process. While no one expects these groups to become experts in concussion management, they can stick with the mantra; “when in doubt, sit them out” as it is better to miss one game than a whole season. Once a concussion is suspected, it is paramount to see a physician who is trained in managing concussions and deals with them on a regular basis. The bottomline is that no athlete should be allowed to return to play the same day as a concussion and/or if they are still experiencing any symptoms. The early success of the nation’s educational efforts is seen in the fact that more concussions are now being reported. For the record, the incidence has likely not increased, just the reporting.
Lately when I’m asked if concussions are something to fear, I respond that they are not to be feared, just respected. One cannot ignore symptoms and try to play through it or they risk long-term injury and/or more devastating consequences. Those patients with recurrent concussions need to weigh the risk versus benefits of continuing their sport, as no magic number exists to tell us when one has had too many concussions. The good news is that the medical field will continue to advance with regards to concussion management and prevention. Until then, nothing takes the place of education and good old common sense.
Carrie A. Jaworski, MD
Primary Care Sports Medicine Physician
NorthShore University Health System
Former Head Team Physician for Northwestern University