Playing With a Concussion Doubles Recovery Time

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High school athletes who kept playing in the minutes after a concussion took nearly twice as long to recover as those who left the game immediately after the head trauma, a new study shows.

The finding, published in the journal Pediatrics, is believed to be the first to focus on one of the most difficult social challenges of treating concussions: a pervasive sports culture that encourages young athletes to keep playing through pain. Medical guidelines call for benching the athlete immediately after the head injury to prevent long-term complications and the potentially devastating consequences of a second hit.

“Kids are often reluctant to acknowledge a concussion,” said Dawon Dicks, a youth football coach with CoachUp in Andover, Mass. “The kid may want a scholarship and want to go to college, or it could be that ‘Dad or Coach wants me to play.’ That’s when they’re going to start to be a little dishonest in what they’re truly feeling.”

The latest study tracked the neurological symptoms of 69 athletes who visited the University of Pittsburgh Medical Center Sports Medicine Concussion Program after suffering head trauma during a contact sport. The athletes, who ranged from 12 to 19 years old, came from football, soccer, ice hockey, volleyball, field hockey, basketball, wrestling and rugby.

The sample included 35 athletes who were removed from games right after getting a concussion and compared their symptoms and recovery to 34 athletes who kept playing in the game or match after taking a hit. The study found that players who stayed in the game after head trauma took an average of 44 days to recover. By comparison, athletes who left a game immediately after signs of concussion took only an average of 22 days to recover.

While there were no meaningful differences in recovery time among girls or boys, and no differences by sport, that may be because of the size of the study. Researchers say that while the sample size was small and involved just one clinic, the results clearly highlight the importance of physical and cognitive rest promptly following concussion.

The findings may help doctors promote the message that taking immediate precautions after concussion will actually allow the athlete more opportunities to keep playing, not fewer. Resting immediately in the 24 to 48 hours following a concussion (and then slowly returning to normal activities under the supervision of a physician) reduces the possibility of further stress on the system and allows brain cells to heal faster so that athletes can get back to their sport more quickly. “It’s something that we consistently preach to coaches, parents and kids,” said R.J. Elbin, who led the study while at the University of Pittsburgh but who now is director of the Office for Sport Concussion Research at the University of Arkansas. “However, until now, there really has not been any data that supports this idea.”

Estimates show that each year in the United States, there are up to 3.8 million sports-related concussions, which can happen when there is a blow or jolt to the head that causes the brain to bounce within the skull, stretching and damaging brain cells. Symptoms of concussion may include dizziness, confusion, nausea and sensitivity to light.

Young athletes are particularly prone to prolonged recovery and complications from concussion. “The developing brain has been shown to be more vulnerable to the physiological effects of the injury,” said Tad Seifert, a neurologist and director of the Sports Concussion Program for Norton Healthcare, in Louisville, Ky.

Despite increased awareness of the dangers of concussions and efforts to educate those in the sports community on how to recognize and treat the head injury, an estimated 50 to 70 percent of concussions go unreported. While some athletes and coaches may not always recognize the signs of concussion, the larger concern is a sports mind-set that frowns on leaving the game.

“The idea of being a football player is that we’re tough. We get back up. We don’t cry. We don’t make a big deal out of it,” Mr. Dicks said. “There is the idea that you must sacrifice your body and your brain for the overall greater good of the team.”

Mr. Dicks said he tries to counter that notion and teaches his athletes about the severity of concussions, which can not only sideline players from sports for a few weeks but can also cause pain, trouble sleeping and difficulty in school for months or longer. But awareness varies depending on the economic resources of the school.

At the private high school where Mr. Dicks used to coach, “they go above and beyond to make a big deal out of concussions,” Mr. Dicks said, and noted that there was a certified athletic trainer at every practice and game looking after the health of the athletes. “At the urban high school where I coached, a kid might get a handout about concussion.”

The study authors acknowledged that their data did not show whether the athletes who kept playing following concussion suffered additional head impacts or simply continued physical exertion. Further research is needed to determine exactly why staying in the game post concussion can slow recovery times.

Hearing that leaving the game speeds recovery may finally motivate young athletes to stop playing as soon as they’re hit, said Dr. Jeff Bazarian, professor of emergency medicine and physical medicine and rehabilitation at the University of Rochester. “Now, armed with this study, I think I’m going to be able to say to athletes who did not come out of the game right away that, ‘your recovery might take longer than average because of that,’ ” he said. “I can tell my athletes that this is one thing you can do something about, maybe not this time, but next time.”