On C-SPAN’s Washington Journal this morning, Pedro Echevarria hosted the Chief of New York University’s Primary Care Sports Medicine department, Dr. Dennis Cardone, who discussed ongoing efforts to protect athletes from sports-related concussions at every level of play, from the backyard to the NFL Statistics show that one of every ten sports injuries – 10 % – are concussions, which is a type of traumatic injury where there is ‘altered brain function’ present.
Dr Cardone clarifies further:
These are significant numbers and these are serious injuries. Th e key to this is that it’s not only a direct hit to the head that causes these injuries it can be a direct hit to any part of the body that transmits force to the head. So esp when you talk about short-term consequences long-term consequences
In the spring of 2014, at the Concussion Summit held at the White House, President Obama was introduced by Victoria Bellucci, from Huntingtown, Maryland, who suffered five concussions during her soccer career up through her graduation from high school. President Obama acknowledged that he had probably experienced concussions himself as a football players, but stressed that all contact sports are equally affected. The Concussion Summit had gathered together representatives of colleges, universities, and professional associations, as well as physicians, coaches, young athletes and their parents, and other stakeholders in assuring the safety of sports at all levels of play. A transcript of the event is also available.
In the interview this morning, Dr. Cardone confirmed that “any contact sport has the possibility of concussion, including boys and girls soccer, lacrosse, hockey, gymnastics, basketball,” and he pointed out that the worst history for catastrophic issues is cheerleading, including questions about how high to safely build a pyramid.
Acknowledging that research in this area of concussions is sorely needed, Dr. Cardone noted that medical science is “in the infancy of understanding concussion.” As to the specific questions yet to be answered are the following:
“We need to answer questions such as: How many hits are too many hits? How many hits will cause potential long- term consequences? When should we start introducing contact in sports? At what ages is it safe to introduce contact in sports?
Should we be monitoring the force of hits? Should we use these sensors that are getting popular – and maybe just like we do in baseball, with pitch counts – remove players from a game or remove them completely from a season if they hit a certain number of ‘head hits.”
Presumably, there is also a need for researchers to design standard for differential guidelines, which could also be useful in gathering meta-data for statistical analysis, nationwide. Dr. Cardone points to questions about when it’s safe to allow a player to return to sports, which can be accomplished with blood tests, where ‘biomarkers’ can be identified; and there is a need for better understanding of imaging studies, to assist with diagnosis.
In August of 2015, researchers at the Universitu of Virginia published a 10-page paper in the Journal of Neuro Surgery, about their findings that “Helmet-only, shell, and full-pad practices and games all significantly differed from each other in the mean number of impacts for each event,” which one would expect. They also found this:
“The cumulative distributions for both linear and rotational acceleration differed between all event types with the acceleration distribution being similarly greatest for games, … For both linear and rotational acceleration, helmet-only practices had a lower average impact severity when compared with other event types. However, the average impact severity did not differ between any comparisons of shell and full-pad practices, and games.”
This led the researchers to conclude that there were implications for the design of practice protocol:
“Both the number of head impacts and cumulative impact burden during practice are categorically less than in games. In practice events, the number and cumulative burden of head impacts per event increases with the amount of equipment worn. The average severity of individual impacts is relatively consistent across event types, with the exception of helmet-only practices. The number of hits experienced during each event type is the main driver of event type differences in impact burden per athletic exposure, rather than the average severity of impacts that occur during the event. These findings suggest that regulation of practice equipment could be a fair and effective way to substantially reduce subconcussive head impact in thousands of collegiate football players.”
While the industry in the 1970s engineered to prevent skull fractures, a helmet does not effectively prevent the kinds of injuries that are caused by those hits to places elsewhere on the body that can generate a kind of injury similar to a ‘whiplash’ Dr. Cardone explains, that represent an ‘acceleration force’ which is a hit to the head that is not linear in nature but ‘rotational,’ and it is this factor that even better helmets may not mitigate. The most essential action item for safety in this field is better education of the known variables, thus far, and the will to fund additional research. There is a long-term study underway now that is sponsored by the National Collegiate Athletic Association (NCAA).
While most symptoms of concussion are fairly straightforward, the loss of consciousness is only present in about 20% of individuals. When keeping a lookout for signs of concussion, one ought to look for any change in mental status, the ability to concentrate or to be oriented to time and place, whether there is the presence of slurred speech, nausea or vomiting, or acute headache. Most incidents resolve within a 10-day to 14- day period. It’s crucial for athletes to have an environment where they will feel that it’s safe for them to convey presence of symptoms if they do experience them, because treatment for those symptoms may reduce the long-term effects.
A call-in to the program pointed to a few interesting alternatives, such as tag ball – or ‘flag’ football – which also has the virtue of being gender neutral for the younger children, since competition is based more on skill, fast reflexes, strategy, speed and other factors, rather than brute force.
The National Football League said Dr. Cardone, has become more serious about treatment of concussion and about protecting their players in recent years, including consulting with an independent neurologist on the field. They are also “moving in the right direction,” by advocating for “proper tackling technique to protect the head/” Additional rule changes, he suggests, as has already done, like moving the kick-off up a little bit; and monitoring the safety of the equipment, beginning at the youth level.
Another caller to the program mentioned the “Heads Up” campaign, promoting new techniques for young players, both by the NFL ax well as the Centers for Disease Control.
An Associate Professor in the, Department of Orthopaedic Surgery, Dr. Cardone also sees patients at NYU Langone Trinity Center on Broadway, in Lower Manhattan, he serves as the head team physician for athletic programs, both at NYU and at Long Island University, and is chief medical officer for the New York City Public Schools Athletic League, and a team physician for the U.S. Open tennis tournament.