The tragic consequences of repeated concussions in athletes has been in the news frequently in recent years as several thousand former NFL players and the families of players who have passed away prematurely sue the league for debilitating injuries related to head trauma.
New research comes out regularly showing, in more detail, how head injuries affect athletes, not only in the weeks following the injury, but decades later as well.
The recommendations generally agree with a brief position paper the academy issued in 2010, but add details on evaluation and management. The guidelines are based on a comprehensive review of scientific research.
The medical group added that athletes shouldn't resume playing until they've been fully evaluated and cleared by a doctor or other professional with concussion expertise.
These guidelines are reflected by rules put in place by the Michigan High School Athletic Association and followed by area sports teams.
Coaches, parents and especially athletes can become so wrapped up in competition and the desire to win, that a young person's long-term health may be forgotten in the moment, said Adam Ancel, athletic trainer for Petoskey High School.
This is especially true, he said, of the athlete him-or-herself.
That is one reason his job, as an uninvolved medical professional at practices and games, is so important, he said.
"The athlete may not feel like there is anything wrong with them, so they want to get back (in a game or practice)," he said. "Most coaches these days are understanding the severity of this, but they do get a little impatient. They generally have the feeling that the student should be out for a week, but if it takes longer, and it generally does, then they get impatient. The student is the one usually really wanting to get back."
For those reasons, it is absolutely vital, Ancel said, that students, parents and coaches all understand the severity of a concussion and are aware of the process required to return to play after one has occurred.
The first thing those involved with high school sports should recognize is that concussions can happen in just about any sport, not just football, according to Ancel. He usually sees around five or six a year in Petoskey's athletic program, some years as many as 10, and they usually happen in football, basketball, soccer, wrestling, hockey and lacrosse. But, any sport where there is the risk of two athletes colliding, or an athlete falling to the ground, there is the risk for a concussion, he said.
Symptoms can include dizziness, headache, confusion, nausea, slurred speech, difficulty remembering and the inability to answer questions or carry on a conversation.
If there is even the remote possibility a student has suffered a concussion, they should be removed from play immediately, and remain out of practice or games until they have been evaluated by a medical professional, according to the Michigan High School Athletic Association.
"Sometimes it's obvious" a concussion has occurred, Ancel said, such as when an athlete is knocked unconscious.
"But when you can't tell for sure, that's when kids go back in to play and get hurt worse," he said.
A concussion is a head injury, he said, and if a young person continues to play they run the risk of making that head injury worse.
The consequences are "anything from paralysis to death," he said.
Ancel rattled off a list of possible results of a concussion: "Permanent memory loss, long term or short term, inability to concentrate in school, depression."
And then there are the long term effects scientists are continuing to discover.
"They're still trying to figure those out," he said, but as scientists have begun to dissect the brains of deceased professional athletes, it has become clear head injuries "are causing some pretty serious issues," such as depression and dementia.
One of the most important keys to preventing long-term negative consequences of concussions is monitoring the number a young athlete has suffered over the course of a year as well as over their lifetime, Ancel said.
That is something he as an athletic trainer can do, he said, as long as athletes and parents are forthcoming with information and the injuries are reported.
Also, the information should be provided to a doctor when he or she is evaluating whether a student can or cannot return to play.
"It's just that the risk of the long term effects are so important that if something were to happen you can really do some damage that you can never reverse," he explained. "As far as athletes, if they feel like they have an issue or may have a concussion they need to talk to somebody about it."
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