Sports Related Concussions on the Rise

Losing the big game isn’t the only thing parents and coaches need to worry about. New data shows an increase in sports-related concussions with more than 800,000 children seeking treatment for traumatic brain injuries (TBIs) every year.

Ian Crain, MD, an associate professor at the University of Arizona College of Medicine – Phoenix and director of Banner’s Brain Injury Center, discusses what parents needs to know about traumatic brain injuries.

What is a Traumatic Brain Injury (TBI)?

TBI is a term used to describe an injury to the brain caused by an external force. This can be from a direct blow to the head, rotational forces to the head (think a whiplash-type injury from a car crash), or a force transmitted through the body into the head.

What is the likelihood that my child will suffer a TBI while playing sports? 

New data shows a concerning increase in sport-related concussions. The reason is unknown, but it is believed to be from heightened attention due to increased awareness of the injury, rather than an increase in occurrences. Fortunately, the incidences of catastrophic brain injuries (intracranial bleeding or severe brain swelling) have not seen a similar increase.

Does the age you receive a TBI impact the severity?

Generally speaking, the younger you are increases the risk of a more severe injury. The reasons for this are not entirely clear, but it may have to do with myelination. Myelination is the process that involves covering brain cells with a protective sheath. This coating may make the brain cells tougher and more resistant to injury. Myelination occurs rapidly over the first two years of life, but involves different areas of the brain at different times. For example, the frontal lobes of the brain are not finished with myelination until age 25 or 30. 

How can a TBI (or multiple TBIs) as a child impact you later in life?

The long-term effects remain unclear. The most important thing is that athletes need to recover from the injury they have before returning to activities that have a high risk of sustaining another injury. While most people completely recover from their injuries, there are risk factors for continued symptoms. Typically, this has been linked to multiple injuries (four or more) or getting a second injury before healing the first. Injuries before the age of 12 have been linked with higher rates of mood, behavior and cognitive function later in life. There have been studies linking as few as one concussion with increased risk of neurodegenerative diseases such as Parkinson’s or Alzheimer’s disease. These are only observational studies, but it is concerning.

The biggest long-term concern from concussions is chronic traumatic encephalopathy, or CTE. This is a progressive, neurodegenerative condition described in the brains of individuals with a history of repetitive head trauma. This was first found almost a century ago in boxers. Today, the focus is on professional football players, but other college athletes can have CTE. This diagnosis cannot be made while a person is still living.

Is there a minimum age experts recommend children start playing contact or collision sports?

There are no specific guidelines regarding the appropriate age to participate in contact sports. Despite the lack of guidelines, there are many health care providers who argue against playing a collision sport for children 12 years. That recommendation is based on studies showing a correlation between longer recovery times, susceptibility for more severe injury and later-life mood, behavior and cognitive dysfunction for these participants. These are only correlational studies, but the argument is that we should err on the side of caution when our children’s brains are on the line.

As a parent, what do I need to know about TBIs?

Concussions remain rare despite the amount of attention they get in the media. Yet there are some sports that are high risk for these injuries. We know that sport participation by youth overall, including collision sports, can result in long-term beneficial effects. Many concussions resolve quickly, but athletes, coaches and parents need to know the signs of a concussion so the athlete can be removed from play immediately to avoid further injury.

What are the warning signs for a TBI?

Symptoms include headaches, dizziness, vision changes, sensitivity to light, sensitivity to noise, balance problems, fatigue, difficulty thinking, “fogginess” and problems finding words. These symptoms can take up to three days to reach their most intense level. Dangerous signs that could point to something more than a concussion include unequal pupils, inability to wake up, a headache that gets worse and does not go away, slurred speech, weakness, numbness or decreased coordination, repeated vomiting or nausea, convulsions or seizures (shaking or twitching), unusual behavior, increased confusion, restlessness or agitation. If these danger signs are present, then seek emergency care.

What should I do if my child is showing these symptoms?

First, remove the athlete from play. A commonly cited rule among concussion providers is “if in doubt, sit them out” until a health care provider familiar with concussion management can clear them to return to play.  Most concussions are treated by initial rest with a gradual return to school and physical activity. It is no longer recommended that you wake up an injured child throughout the night. Let them rest as much as needed initially. Laws vary by state, but in Arizona the law states that an athlete must be cleared by a health care professional trained in the evaluation and management of concussions and head injuries. In Arizona, this includes a doctor (MD or DO), physician assistant, nurse practitioner or an athletic trainer.