by Matthew Shores, MD, FastMed Urgent Care sports medicine specialist
With fall around the corner, many things come to mind: cooler temperatures, falling leaves, and, well, football, of course. Despite rising concerns over injuries, most notably concussions, football remains as popular as ever, and in fact, it is growing in popularity. For example, football is the number-one high school sport among boys. According to the National Federation of State High School Associations (“NFHSA”), nearly 1.1 million boys played high school football in the 2013-2014 season, followed by outdoor track and field, a distant second with approximately 580,000 male participants. In addition, the NFHSA reported that the 2013-2014 high school football season showed a year-over-year increase in participation for the first time in four years.
So, what are concussions and what is the risk of a concussion to high school football players?
Concussions are a form, or a subset, of a traumatic brain injuries (“TBI”). According to the Centers for Disease Control and Prevention (“CDC”), approximately 1.74 million people sustain a TBI annually; 75 percent to 95 percent of TBIs are mild. “Mild TBI” and “concussion” are two terms often used interchangeably. Concussions can occur in contact sports, like football, ice hockey, and soccer. The likelihood of an athlete experiencing a concussion is as high as 20 percent per season.
An estimated 10 percent of college and high school players sustain brain injuries annually playing football, according to research published in the Journal of the American Medicine Association (“JAMA”). As the brain continues to develop in children, adolescents, and even young adults, concussion symptoms can include a prolonged course as well contribute to long-term effects if not properly recognized and managed.
How can parents protect their children from the long term effects of concussions?
The good news is that only in rare cases can a concussion leave long-term symptoms, and for most children playing contact sports, the chance of a concussion lasting longer than a few weeks is slim. However, the chances of sustaining second impact syndrome or developing long-term effects from post-concussive syndrome increase if the child experiences another head injury while still recovering.
The best game plan is to play it safe. If your child takes a hit to the head that results in any of the following symptoms, seek medical attention immediately from an urgent care, primary care, or pediatric provider, preferably one trained in sports medicine and concussion management.
- Dizziness, lightheadedness, or imbalance
- Nausea and/or vomiting
- Amnesia or confusion (feeling like one is “in a fog”)
- Fatigue or difficulty sleeping
- Behavioral changes (such as emotional lability)
As many football games take place in the evening or on the weekend, keep in mind that FastMed Urgent Care locations are open seven days a week and have on-site digital x-rays, enabling appropriate evaluation to be completed in a timely manner.
All of the above symptoms signify a potential concussion requiring additional diagnosis to determine the severity as well as short or long-term impacts. Also, keep in mind, these symptoms may occur immediately following or several hours after the injury.
Even if the symptoms subside, medical attention at FastMed Urgent Care or your family’s primary care provider should be sought prior to a return to sports. Remember, risks of long-term impacts can increase if a second head injury is sustained during the recovery process, so it is important to get the appropriate diagnosis and management before letting your child back on the field.
How are concussions diagnosed?
As stated, if any symptoms of concussion occur, even if the symptoms subside, having your child examined by a FastMed Urgent Care, primary care, or pediatric provider is critical. Mild concussions are often unrecognizable by the patient, friends or family, but through a more thorough evaluation, a medical provider will be able to quickly diagnose whether or not the head injury may have resulted in a concussion.
A medical assessment should include a comprehensive history as well as a detailed neurological examination, including a thorough assessment of mental status, cognitive functioning, gait, and balance. The comprehensive history may specifically include progression (improvement or worsening) of symptoms since time of injury. In addition, information provided by parents, coaches, athletic trainers, and peers that may have observed the injury or progression of symptoms may be helpful.
A critical tool that incorporates many facets of the concussion assessment is the Sports Concussion Assessment Tool 3 (“SCAT3”), utilized both in the clinical setting as well as on the sidelines. Endorsed by the Consensus Statement on Concussion in Sports, the SCAT3 is increasingly used to provide a detailed clinical assessment. The assessment includes a review of subjective symptoms, the Glasgow coma scale, a cognitive assessment, neck evaluation, and an evaluation of the patient’s balance and coordination.
If the medical provider deems appropriate, other standardized assessment measures may be used to assess the impact of a concussion, such as urgent/emergent neuroimaging.
Should I take my child to the ER if he gets a head injury during a game?
While an emergency room (“ER”) can also complete all of the necessary tests to diagnose a TBI, ERs can be a timely and costly place for treatment. If the injury occurs in the evening or on the weekend, your local FastMed Urgent Care is the most efficient resource for diagnosis and treatment if symptoms are not severe. Whether you have medical insurance or not, ERs can be unnecessarily expensive option for non-life threatening injuries. Did you know that the average ER bill is seven times as much as a visit to FastMed Urgent Care?
Regardless of where you seek treatment for your child, be certain to request and sign a medical release form and ask the healthcare facility to send your child’s medical records for the visit to your primary care physician or sports medicine team physician. Keeping your child’s primary care provider or sports medicine team physician in the loop for all medical treatment received will ensure that appropriate follow-up and monitoring is completed.
Should I keep my child from participating in sports?
As a medical provider, I encourage parents to promote activity for their children. The benefits of playing sports, including team sports such as football, are numerous, and many parents believe the benefits far outweigh the risks. All types of sports can benefit a child by building self-confidence and promoting mental and physical well-being.
Of course, it is important that parents are well-educated regarding the risks various sports and activities, as well as safety measures to combat these risks, including when to seek medical care.
The final play of the game
As a sports medicine specialist, my recommendation to parents is to be proactive in supporting their children’s safe participation in sports and physical activities.
- Get an annual sports physical for your child, even if it is not required by the league or high school. Mention this article and get a sports physical at any FastMed Urgent Care for your child for only $25.
- If your child is participating in a contact sport, talk to your healthcare provider about baseline concussion testing. Baseline testing helps identify changes in your child’s cognitive function in the event of a head injury.
- Ensure your child is wearing all appropriate protective gear, such as helmets, during games, practice, and other activities that could present a risk of head injury. Make certain your child understands the importance of protective gear and how to put it on correctly.
- Talk to your child and his coach. If you are not able to attend all games and practices, ask your child how practice or the game was and if he sustained any hits to the head.
- Observe your child and be aware of concussion symptoms. Remember, consult a FastMed Urgent Care, primary care, or pediatric provider if any symptoms of a concussion occur, even if the symptom subsides.
The key to success in sports and healthcare is a good team, and you, as a parent, are an important person on that team. At FastMed, we also count ourselves as part of your family’s team and are here to complete your child’s sports physical, educate you and your child on how to stay injury-free, and treat your whole family when illnesses or injuries occur.
Matthew Shores, MD is the sports medicine program director and urgent care physician at FastMed Urgent Care in Scottsdale. For more information on Dr. Shores and the sports medicine program, visit FastMed.com/SportsMedicine. To find a FastMed Urgent Care near you, visit FastMed.com.
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