Back to School: Team Sports and Concussions

Photo by Dick Rochester, via Flickr

My sons played ice hockey and football in their high school years, what my husband and I referred to as “collision sports.” The unmistakable sound of helmet-hitting-helmet always made me cringe, especially in hockey where a good skater can generate considerable speed (and therefore force) before impact. I’ve witnessed many players being helped off the ice. The coach, who knew I was a nurse, would sometimes signal to me to come to the bench and check out a player. Most of the time, the player was fine; but there were a few times when it was clear that the player was a bit more than just shaken up.

I recall one 12-year-old who had nystagmus and ringing in his ears and kept asking the same question in a slow, sleepy voice. The coach wanted to put him back out on the ice (“He just saw a few stars, right?”), but instead I sent him with his parents to the ED for evaluation. After an overnight stay in the hospital he was released, but was cautioned not to play hockey for two weeks because he’d suffered a concussion. So he waited two weeks and went back to playing, even though he still had frequent headaches. I also remember a girl who was an excellent high school soccer player. She was hoping to play in college, but by the end of her senior year she’d sustained three concussions and was having cognitive issues—she had trouble working with numbers and suffered headaches. Her neurologist told her she shouldn’t play competitively for at least a year, and perhaps permanently. She was resistant, but her parents enforced the neurologist’s ban. Good for them.

On August 30, the American Academy of Pediatrics (AAP) published an online report in Pediatrics on sport-related concussion in children and adolescents, noting in an accompanying press release that “adolescent concussions can cause serious long-term injury or death, and should always be taken seriously.” A related article describes the incidence of ED visits for sport-related concussions in children and adolescents. Despite an overall decline in participation by school-age children in organized team sports during the 10-year period examined, the number of ED visits for concussion increased significantly, especially in the 14- to 19-year-old age group, which had more than a 200% increase. (Both articles are currently free online and will also appear in Pediatrics’ September 10 print issue.)

School nurses, parents, coaches, and teachers need to be aware of the potential long-term effects of repeated concussion.  One only has to look at aging former boxers and football players to see what the deficits can be. It’s not something to be taken lightly—yet it often is. (See Diana Mason’s post on this from last summer.) In the press release summarizing its updated guidelines, the AAP states, “After a concussion, all athletes should be restricted from physical activity until they are asymptomatic at rest and with exertion. Physical and cognitive exertion, such as homework, playing video games, using a computer or watching TV, may worsen symptoms. ” Athletes and parents need to know that while symptoms may resolve within 10 days, sometimes it takes months to recover completely. And in some cases, recovery may require finding an alternative to competitive sports—a difficult choice for the child, and sometimes even more so for the parent.