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Update: Head Injuries Revisited

Head injuries in athletes resulting in concussions are more common than previously thought. We learn more about the problem and the important consequences. Each year, more than 300,000 athletes in the United States suffer from some form of traumatic brain injury (TBI). High school athletes account for 60,000 of these injuries. The consequences vary widely but can be both emotional and intellectual. TBI can lead to short-term symptoms as well as more serious problems that may not show up until years later. The type of problems that develop depends on the part of the brain affected, the severity of the blow, the number of repeated blows to the head, the pre-existing conditions of the individual, and the personality traits of the injured person.

The more blows to the head, even small ones, the greater the risk of mental retardation. Significant head trauma in a football player occurs hundreds of times a week during training and playing experience. Explore options for protective equipment in contact sports and teach fundamental techniques in sports that can reduce head injuries are essential to reduce the number of injuries and the serious consequences.

A 2000 study surveyed 1,090 former NFL players and found that over 60% had suffered at least one concussion in their career and 26% had three or more. Those who had concussions reported more problems with memory, concentration, impaired speech, headaches and other neurological problems than those who did not, according to the survey. Since these professional players have spent many years working their way up the ranks as amateurs, the frequency of head injuries is likely underreported. Head injuries are also a problem for many non-contact sports.

Other common issues are uncovered as we take a closer look at this challenge. Depression, insomnia, attention deficit, and personality changes occur with similar frequency in high school athletes. Long-term problems can take eight years or more to develop or worsen.

Immediate symptoms that necessitate withdrawal from athletic activities include amnesia, poor balance, headache, dizziness, or other neurological deficits on examination, regardless of how quickly they resolve on the sidelines. It is widely accepted that symptoms of a concussion can reappear hours or days after the injury, indicating that the player has not recovered from the initial blow. This requires strict guidelines that conservatively allow ample time for healing to occur. The question remains, how long is enough? A health care provider should be involved in the examination and investigation of these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to the serious consequences of the next episode, which in many contact sports is unavoidable.

Professional and collegiate sports authorities are changing their recommendations for contact sports. Reduce numerous blows to the head by imposing practices where there is no contact. Research has shown that the number of head shots in a college football season runs into the thousands for an individual player. Many of them have forces comparable to driving a car into a concrete wall at 40 miles per hour. Teaching better technique to reduce head contact and providing better equipment can reduce negative effects. The manufacture and testing of football helmets is not tightly regulated. New helmet technology and improved equipment monitoring after repeated impact can reduce the consequences of a head impact.

Repeated head trauma with serious consequences of traumatic brain injury should not come as a surprise. We can do more to preserve and protect athletes of all ages. A concussion is a complex problem that requires a thorough initial assessment. Seek medical attention for head injuries, even if they appear minor and without loss of consciousness. Symptom severity and initial imaging studies can detect serious problems early and provide a reassuring basis for ongoing treatment.

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