Ask Dr. Scott Laker:
Seattle Sports Concussion Program
How do I know if my doctor is knowledgeable about return-to-play guidelines?
Answer
NFL toughens stance on concussions, acknowledging long-term risks and life-changing potential
Recently released NFL helmet-impact test results should not be applied to collegiate, high school or youth helmets
NFL considers changes to camps and practices to limit concussions; concerned about sub-concussive hits
NCAA makes 3-man wedge illegal this year hoping to reduce concussions, same as NFL
Tennessee tightens concussion policies for coming school year
Study suggests athletes may need even more time after concussion to fully heal
NJ female teen athlete suffered 15 concussions now struggles daily
DC MLS star Namoff suspends career due to lingering symptoms from concussion suffered Sept 09
MLB All-Star players choosing reinforced helmets to reduce head injuries
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Emergency room visits for kids with head injuries increased 43% in the last five years
LaPorta passes neuropsychological test but doctors don't allow him to return to play
Indians LaPorta shows no sign of concussion after on-field collision and CT scan
High school softball adds concussion rule
Pro soccer player Twellman ends season due to symptoms from concussion suffered 2 years ago
Former Bengals receiver who died of unrelated causes showed signs of trauma-related brain damage at age 26
Pirates players collide leaving second baseman unconscious; out for series with concussion
Study shows most parents unaware of their local school's concussion policies
Six-yr-old sustains concussion attempting flip off diving board
Quebec bans bodychecking in youth hockey and reduces concussions significantly
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Canadian amateur football association implements concussion rules to protect all amateur players
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ESPN's Preston Plevetes' concussion story, former La Salle football player
Zackery Lystedt inspired WA State's concussion law, the Lystedt Law
Eagles wide receiver felt pressured by asst coach to return after concussion last season
Concussion Basics
Air Force Academy basketball player plaqued by headaches since Nov. concussion, hopes new medication helps
Are headguards the answer for soccer players? Some athletes and coaches in ME believe so
Your concussion questions answered...
Q: How can I make sure that my doctor is knowledgeable about current return-to-play guidelines? I don't want my daughter cleared too early.
A: Dr. Scott Laker Seattle Sports Concussion Program
Most doctors’ office staff will know exactly what their doctors specialize in. Ask them before you schedule your appointment if the doctor takes care of concussions frequently. Once you are at your appointment, feel free to ask how many concussions your doctor manages, how they manage them, and how they make their decisions for return-to-play. You should hear answers that involve a stepwise return-to-play and never allow a symptomatic athlete to return early. However, if your athlete has had multiple concussions or has severe or long-lasting symptoms, I recommend that they see a doctor that specializes in sports concussions.
Gradual return-to-play guidelines
Q:I'm a coach and one of my players was cleared by his doctor, but I've heard from others that he still has headaches. What should I do?
A: Dr. Scott Laker Seattle Sports Concussion Program
This is a tough position to be in for any coach. You know your athletes better than anyone and have a clear decision to make. If you are concerned that the athlete is still having symptoms, sit them down and ask them exactly what they are feeling. Be specific and make sure that they are totally symptom-free before putting them back in the game. If they are still feeling sick, then do not return them to practice or play. If you need clarification, ask the athlete’s parents to have the doctor contact you to discuss the case. No doctor wants to return an athlete if his or her coach thinks they aren’t ready and should be happy to talk with you once they get permission from the parents. If you are still concerned, sit the athlete out and recommend a second-opinion before returning them. It’s the right thing to do and it will make sure you and your team have a healthy season.
Gradual return-to-play guidelines
Q: My high school does not have a concussion policy and we do not have a state law either. What can I do to ensure that athletes are properly cared for?
A: Dr. Scott Laker Seattle Sports Concussion Program
It is great that you are working to keep your athletes safe this season. The most important thing that any school can do is to make sure that the athletes know the symptoms of concussion and report them to their coaches or trainers immediately. At that point, the athlete should be removed from play or practice and not return to sports until symptoms resolve. When in doubt, sit them out. You can also work to find a doctor in your area that specifically takes care of athletes with concussions. This may be a physiatrist, neurologist, orthopedist, or pediatrician. Your family doctor or team physician is a great person to ask for a recommendation on a doctor in your area that can help take care of your athletes with concussions.
The CDC just released a new concussion video for coaches which would be of great value, particularly in schools where there might be limited information. Coaches, parents, and athletes should be encouraged to view the program and distribute the accompanying free, downloadable CDC materials to all concerned. Education really is the key to protecting your athletes, along with the other avenues I mentioned. Keep up the good work.
Q: Now when I watch my 9-yr-old daughter play soccer I am concerned that she will suffer a concussion and I won't know it. Are the symptoms different in younger children than in high school athletes?
A: Dr. Scott Laker Seattle Sports Concussion Program
Recognizing concussions on the field can be challenging, regardless of age. The symptoms of concussion are similar in young athletes and older athletes. It is important to remember that our younger athletes might not recognize that something is wrong. An athlete is having balance problems, confusion, or is simply not “acting like themselves” should be removed from practice or play and evaluated. For that reason, we recommend our coaches and parents be even more careful with younger athletes
Q:It's not uncommon for students who have suffered concussions to return to school with headaches and other symptoms. Should they stay out of school until they are completely symptom-free? They typically want to return so they don't fall behind. (submitted by school nurse)
A: Dr. Scott Laker Seattle Sports Concussion Program
In general, we prefer to have student-athletes get back to school as quickly as possible even if it requires a modified schedule. One solution is to make use of easy changes to avoid the athlete’s main symptoms. We often suggest shortened school days, decreased homework, frequent breaks during class, and extended test-taking time. If the symptoms are too severe and the athlete simply cannot attend school successfully, we do recommend that the student-athlete stay home temporarily. If you have a student that is having difficult returning to school after a few days, I would recommend that they see a physician.
CDC Heads Up to Schools: Know Your Concussion ABCs for additional information and downloadable materials for school nurses and other school personnel
Q: What happens inside the brain when a concussion occurs, and what are we waiting for as the brain heals?
A: Dr. Stanley Herring Co-Medical Director, Seattle Sports Concussion Program
Essentially, it’s a mismatch of supply and demand. The brain cells need energy to repair themselves during a time when they can’t get enough. These changes that happen during concussions occur at the cellular level. While the brain tissue itself appears completely normal on MRI or CT imaging, the brain cells are not functioning properly. After the initial hit that causes the concussion, there is a release of neurotransmitters that cause ions to move in and out of the brain cells abnormally. Calcium rushes in while potassium rushes out of the cells, disturbing the balance of electrical charges. The brain cells have to work very hard and use a large amount of energy to restore their normal balance. At the same time, there is a decreased blood flow to the brain, limiting the cell’s energy supply. It is this “energy crisis” is why the brain is so vulnerable when an athlete is concussed.
What are we waiting for as healing takes place? The management of concussion is largely keeping the athlete safe while the supply and demand mismatch resolves. The majority of athletes resolve over the course of 1-2 weeks but some athletes may take months to completely recover. There are a number of factors that seem to influence recovery time including past medical history, previous concussions, age, etc. It is vital that athletes do not return to play while still having symptoms of a concussion.
Q: My school district just implemented computerized "baseline" testing for all athletes. Do these tests work?
A: Dr. Gerard Gioia Chief, Division of Pediatric Neuropsychology, Children's National Medical Center, Wash DC
Computerized baseline neuropsychological tests can work but only if handled properly by the appropriately trained personnel. It is important to recognize several important points:
(1) Do not be fooled by the apparent “ease” of this testing simply because it is delivered on a computer. They are complex cognitive measures that must be handled properly.
(2) The tests must be properly administered by trained testers, and taken seriously by the student-athlete to obtain valid findings.
(3) The tests are only one part of the post-concussion clinical exam. Symptom assessment, assessment of balance, and response to cognitive and physical exertional activities must also be considered.
(4) The interpretation of the neuropsychological test findings is a complex process, and should include a well-trained neuropsychologist at the very least as a consultant to the school district.
Q: My teenage daughter was playing soccer and collided with a teammate. They bumped heads, both were knocked to the ground, but neither of them lost consciousness. My daughter was a little slow getting up but both girls said they were fine. Should I be worried?
A: Dr. Scott Laker Seattle Sports Concussion Program
Collisions occur frequently in sports, especially soccer, and we need to do a better job recognizing them when they occur. It is important to watch athletes that have been involved in collisions for developing signs and symptoms of concussion. We know that less than 10% of concussions involve any loss of consciousness so we have to be aware of other, more subtle signs like headache or confusion. Many athletes, including teens, are unfamiliar with other important symptoms of concussion such as sensitivity to light or noise, balance problems, etc.
If you, or anyone, is concerned that your daughter may have suffered a concussion, she should be removed from play immediately, evaluated with a sideline assessment, like a SCAT 2, which should include an exertional challenge. It's important to observe the athlete after the collision as some symptoms don't show up right away. If she feels well, does not have any symptoms, and performs well on her sideline testing she can return to the game if cleared by the sideline medical staff. Remember, when in doubt, sit them out.
