July 10, 2014
News Review From Harvard Medical School -- Doctors' Duty: Protect Brain-Injured Athletes
Doctors have a moral duty to help protect athletes from the effects of concussions, a new policy statement says. The statement comes from the American Academy of Neurology. Neurologists treat concussions and other brain conditions. The statement says doctors should resist pressures from coaches, parents and others to return athletes to play too soon. Doctors also should educate athletes and their families about concussion risks that occur in sports. The statement calls for more baseline tests of brain function before the sports season begins. The doctors also urged creation of a national concussion registry. Reporting should be required, they said. And neurologists also should receive more training about concussions, the statement said. The journal Neurology published the statement. HealthDay News wrote about it July 9.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Not so long ago, head injuries were an expected -- and accepted -- part of many sports.
Even now, football commentators excitedly talk about someone "having his bell rung" when a head impact leaves a player woozy on the football field. And the opposing player who caused the injury might be praised as tough or fearless.
Fortunately, things are changing. We know that repeated concussions and other head injuries can have devastating effects. These effects are now a major focus of concern and research. They include:
- Changes in mood or personality
- Problems with concentration and learning
- Repeated headaches
- An increased risk of suicide
Neurologists are experts on brain disease and function of the nervous system. They have played a key role in researching the effects of head trauma on brain function. Now the American Academy of Neurology has issued a new report on brain injury.
This report goes beyond providing specific medical guidelines for the evaluation and treatment of concussions. It suggests that doctors have an ethical obligation to actively protect athletes from the effects of head injuries.
The advice includes these highlights:
- Doctors should clear an athlete to return to competition only when the athlete is ready.
- Doctors should resist pressure from coaches, parents or the players themselves to let injured athletes play too soon.
- Doctors should educate players and parents about the risks of repeated concussions.
- Training of neurologists should include more about concussions and sports-related head injuries.
- Athletes should have tests of brain function before competition begins (as a point of comparison).
- Athletic programs should be required to collect data on concussions as they occur.
Doctors and other health professionals face significant pressures when evaluating an athlete with a head injury. For example, parents or coaches may want a star competitor back on the field when a big game is coming up. Missing games can have a major financial impact on high school athletes hoping to play in college or college athletes hoping to play at a professional level.
But I think this new report gets it right: doctors should put the interests of their athlete patients ahead of other concerns when deciding whether they are fit to play.
What Changes Can I Make Now?
If you or your child takes part in a sport in which head injuries are common, do what you can to reduce risk. This is especially important in football, boxing and ice hockey.
- Know the rules of the sport, especially ones intended to protect athletes.
- Know which types of injuries are most likely to cause a concussion.
- Review the procedures for evaluation and the types of symptoms that should lead to a player's removal from a game.
- Wear recommended safety equipment (such as a helmet). Wear it properly and wear it every time.
- Let medical personnel know about any symptoms that occur after a head injury. Follow their advice.
Let your doctor know if you had concussions or other head injuries in the past. A concussion should be suspected after head trauma if any of these symptoms occur:
- Loss of consciousness
- Impaired judgment
- Poor coordination
- Poor balance
Whether you compete or just watch, change how you think about sports head injuries. Understand that an injured player needs to be evaluated before he or she can return to action. It's not a sign of weakness if a player is sidelined for a few plays, the rest of the game or even the rest of the season. And it's not a sign of toughness to return to action right away.
Increasingly, it's likely that trainers and doctors will err on the side of caution. They will be more likely to remove players from competition after a head injury. It will be important for players, coaches, parents and spectators to accept this as a necessary change.
What Can I Expect Looking to the Future?
Almost 4 million sports-related concussions occur in the United States each year. That does not count milder head injuries that might also have long-term effects. As we have recognized the problems these common injuries can cause, some have speculated that high-impact sports, such as football, may become less popular.
I doubt that concerns over head injuries will spell the end of organized football any time soon. But we have already seen changes in how athletes are evaluated and cleared during games. And we've even seen rule changes, such as how football players are allowed to tackle each other. It seems likely that we'll soon see even more changes in screening, evaluating and preventing sports-related head injuries.
Research and attention will continue to focus on this issue. And so I hope that in the future we'll also see fewer cases of dementia and psychological problems caused by sports-related head trauma.