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The OADA Newsletter - Winter 09-10
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Sports Concussions Continue to Make Headlines
Michael C. Koester, MD, ATC, FAAP
NFHS Sports Medicine Advisory Committee
Over the past year, I have used this column to inform you about the efforts of the OSAA and Oregon Concussion and Awareness Management Program (OCAMP). I am proud to say that the OSAA and OCAMP, with the help of the OADA, have been “ahead of the curve” on concussion education and management. Thus, we are now in the position to be seen as leaders in our approach to the sports concussion problem.
As I am sure you have noticed, sports concussions continue to receive a great deal of attention in the media. From “60 Minutes” to “The New Yorker” the effects of concussions on high school and professional football players have been well detailed. In addition, NFL Commissioner Roger Goodell, along with representatives from the NCAA and NFHS, has gone before a congressional sub-committee to discuss the “concussion epidemic.” The NFL has responded to this increased scrutiny in a number of ways, the most substantial of which has been disallowing an athlete to return to play on the same day he has suffered a concussion- a policy the OSAA has had in place since 2008 (and became a state law in 2009).
As the attention has often focused upon professional athletes I would like to use this opportunity to address a number of questions which often arise in regard to concussed high school athletes. Please feel free to copy and distribute this list to coaches, teachers, parents and athletes.
Sports Concussion Frequently Asked Questions
What is a concussion?
A concussion is a brain injury which results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. An athlete does not have to lose consciousness (“knocked-out”) to suffer a concussion.
What should I do if I think an athlete has had a concussion?
If an athlete is suspected of having a concussion, he or she must be immediately removed from play, be it a game or practice. Continuing to participate in physical activity after a concussion can lead to worsening concussion symptoms, increased risk for further injury, and even death. Parents and coaches are not expected to be able to “diagnose” a concussion, as that is the job of a medical professional. However, you must be aware of the signs and symptoms of a concussion and if you are suspicious, then your child must stop playing:
When in doubt, sit them out!
All athletes who sustain a concussion need to be evaluated by a health care professional who is familiar with sports concussions. Parents should be notified and they should then call the child’s physician and explain what has happened and follow the physician’s instructions. If the child is vomiting, has a severe headache, is having difficulty staying awake or answering simple questions he or she should be taken to the emergency department immediately.
When can an athlete return to play following a concussion?
After suffering a concussion, no athlete should return to play or practice on that same day. Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury. Studies have shown us that the young brain does not recover quickly enough for an athlete to return to activity in such a short time.
Concerns over athletes returning to play too quickly led state lawmakers in both Oregon and Washington to pass laws stating that no player shall return to play following a concussion on that same day and the athlete must be cleared by an appropriate health care professional before they are allowed to return to play in games or practices. The laws also mandate that coaches receive education on recognizing the signs and symptoms of concussion.
Once an athlete no longer has symptoms of a concussion and is cleared to return to play by health care professional knowledgeable in the care of sports concussions he or she should proceed with activity in a step-wise fashion to allow the brain to re-adjust to exertion. On average the athlete will complete a new step each day. The return to play schedule should proceed as below following medical clearance:
Step 1: Light exercise, including walking or riding an exercise bike. No weight-lifting.
Step 2: Running in the gym or on the field. No helmet or other equipment.
Step 3: Non-contact training drills in full equipment. Weight-training can begin.
Step 4: Full contact practice or training.
Step 5: Game play.
If symptoms occur at any step, the athlete should cease activity and be re-evaluated by their health care provider.
How can a concussion affect schoolwork?
Following a concussion, many athletes will have difficulty in school. These problems may last from days to months and often involve difficulties with short and long-term memory, concentration, and organization.
In many cases it is best to lessen the athlete’s class load early on after the injury. This may include staying home from school for a few days, followed by a lightened schedule for a few days, or perhaps a longer period of time, if needed. Decreasing the stress on the brain early on after a concussion may lessen symptoms and shorten the recovery time.
What can schools do?
• Everyone involved with athletics must learn to recognize the “Signs and Symptoms” of concussion as listed above.
• Instruct athletes to tell the coaching staff if he or she experiences such symptoms.
• Emphasize to administrators, coaches, teachers, and other parents your concerns and expectations about concussion and safe play.
• Instruct athletes to tell their coaches if they suspect that a teammate has a concussion.
• Monitor sports equipment for safety, fit, and maintenance.
• Ask teachers to monitor any decrease in grades or changes in behavior that could indicate concussion.
• Report concussions that occurred during the school year to appropriate school staff. This will help in monitoring injured athletes as they move to the next season’s sports.
Why is it so important that an athlete not return to play until they have completely recovered from a concussion?
Athletes who are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from the concussion and return to play decisions are carefully made. No athlete should return-to-sport or other at-risk participation when symptoms of concussion are present and recovery is ongoing.
Is a “CAT scan” or MRI needed to diagnose a concussion?
Diagnostic testing, which includes CT (“CAT”) and MRI scans, are rarely needed following a concussion. While these are helpful in identifying life-threatening brain injuries (e.g. skull fracture, bleeding, swelling), they are typically normal, even in athletes who have sustained a severe concussion. A concussion is diagnosed based upon the athlete’s story of the injury and the health care provider’s physical examination.
What is the best treatment to help a child recover more quickly from a concussion?
The best treatment for a concussion is rest. There are no medications that can speed the recovery from a concussion. Exposure to loud noises, bright lights, computers, video games, television and phones (including text messaging) all may worsen the symptoms of a concussion. The concussed athlete should be allowed to rest as much as possible in the days following a concussion. As the symptoms lessen, they may have increased access to computer, phone, video games, etc., but the access must be lessened if symptoms worsen.
How long do the symptoms of a concussion usually last?
The symptoms of a concussion will usually go away within 1 weeks of the initial injury. You should anticipate that an athlete will likely be out of sports for about 2 weeks following a concussion. However, in some cases symptoms may last for several weeks, or even months. Symptoms such as headache, memory problems, poor concentration, and mood changes can interfere with school, work, and social interactions. The potential for such long-term symptoms indicates the need for careful management of all concussions.
How many concussions can an athlete have before he or she should stop playing sports?
There is no “magic number” of concussions that determine when an athlete should “retire” from contact or collision sports. The circumstances surrounding each individual injury, such as how the injury happened and length of symptoms following the concussion, are very important and must be considered when assessing an athlete’s risk for further and potentially more serious concussions. The decision to “retire” from sports is a decision best reached following a complete evaluation by the child’s primary care provider and consultation with a physician or neuropsychologist who specializes in treating sports concussion.
I’ve read recently that concussions may cause long-term brain damage in professional football players. Is this a risk for high school athletes who have had a concussion?
The issue of “chronic encephalopathy” in several former NFL players has received a great deal of media attention lately. Very little is known about what may be causing dramatic abnormalities in the brains of these unfortunate retired football players. At this time we have very little knowledge of the long-term effects of concussions which happen during high school athletics.
In the cases of the retired NFL players, it appears that most had long careers in the NFL after playing in high school and college. In most cases, they played football for over 20 years and suffered multiple concussions in addition to hundreds of other blows to their heads. Alcohol and steroid use may also be contributing factors in these cases. Obviously, the average high school athlete does not come close to suffering the total number or shear force of head trauma seen by professional football players. However, the fact that we know very little about the long-term effects of concussions in young athletes is further reason to very carefully manage each concussion.
Some of this information has been adapted from the CDC’s “Heads Up: Concussion in High School Sports” materials by the NFHS’s Sports Medicine Advisory Committee. Please go to www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm for more information.
If you have any further questions regarding concussions in high school athletes or want to know how to find a concussion specialist in your area please contact Michael C. Koester, MD, ATC at michael.koester@slocumcenter.com.
Dr. Koester is a sports medicine specialist at the Slocum Center for Orthopedics and Sports Medicine in Eugene. He is the Chair of both the OSAA Medical Aspects of Sports Committee and the NFHS Sports Medicine Advisory Committee.
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Happy New Year! I hope you had some time to rest, relax and RECHARGE over the holiday break! For me, it takes just a few days away to feel refreshed and of course, begin those New Year’s Resolutions that always seem to fade like the January sunshine! 
The Y2K issue many of us remember back in 2000 is now 10 years removed. It appears the world is still functioning and if anything technology has become an even bigger part of our life. The problem in 2010 is not if technology can function, but rather how well each of us adapt to the ever changing discoveries and inventions that seem to make that laptop you received from your district in September on the verge of being obsolete by spring break. 2009 was a special year for the OADA. Allow me to review some important happenings:
The Oregon Athletic Directors Association (OADA) will induct five former high school athletic directors into the OADA Hall of Fame on April 17, 2010 at Sunriver Resort south of Bend, at the 41st annual OADA State Conference. This will be the second class of inductees.
Mike Maghan, athletic director at McNary High School in Keizer was one of the selected recipients of the NIAAA Distinguished Service Award presented during the National Conference in Grapevine, Texas in December. 
Kevin Bryant, CMAA, the former athletic director at Tigard High School was one of eight national recipients of the Citation of Merit Award at the National Conference in Grapevine, Texas.
I am excited about the newest proposals that have been posted by the Championship Committee. As a member of that committee and representing the OADA the 4a/5a/6a proposal is nothing short of precedent. I can not recall when the Athletic directors of any classification have ever been unanimous about any issue!! The work of many individuals has not gone unnoticed; thanks to all the 4A/5A and 6A AD’s who have worked beyond the call to get these proposals presentable. There is, however, still much work to be accomplished.
In the positions of athletic directors or coaches, even if you do not want to be a role model, you are one. Saying you’re a role model and being a role model, are two completely different things. To be a true role model is not personal perfection but the stereotypical “walking the walk and talking the talk.” In any position of leadership, from day one you are a role model. As an athletic director, you are a role model for your coaches. As a coach, you are role model for athletes and fans.