MMA Viewpoint
When in Doubt, Sit Them Out
It’s a close game, and the star running back takes a hard hit. He initially feels woozy, but 10 minutes later, says he’s fine and wants to get back in the game. Do you send him back in to play?
Working the sidelines at Mahtomedi High School football games, I confront some version of this scenario at nearly every game. And, as a sports medicine physician, I see the consequences of not sitting out a player with a suspected concussion. I have a 21-year-old patient who had a concussion in a soccer practice and continued to play. He suffered two additional concussions that same day. More than year later, he can no longer play and has trouble with school work and other tasks that require sustained attention.
Although judging the severity of an injury to an ankle or knee is usually straightforward, diagnosing the severity of a head injury is not. Determining when a student athlete who has sustained even a minor head injury is ready to return to play is one of the toughest decisions I have to make; a wrong call can lead to lifelong brain damage. That’s why I strongly believe that medically trained people, not coaches, players, or parents, should make those return-to-play decisions. Minnesota needs to do more to ensure that happens.
Some progress has been made. The National Federation of State High School Associations (NFHS) implemented a standard rule change this year stating that any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion be immediately removed from the game and not return until cleared by a health care professional. The Minnesota State High School League adopted new concussion guidelines last August that incorporate the NFHS language and require additional education for coaches and parents about the risks for and signs of concussion.
Ideally, we need to get to the point where a physician, physician assistant, certified athletic trainer, or someone trained in the principles of concussion recognition and evaluation is on the sidelines in every sport where kids are most at risk for head injuries. But for now, we need to make sure coaches who work with kids at all levels receive training about concussion.
Determining whether a concussed athlete can return to play requires a history, physical exam, neurological testing, and simple cognitive and memory tests. If the athlete is not able to pass these tests, he or she should not be returned to practice or play. There has been a lot of publicity about computerized neuropsychological testing to help evaluate athletes for return to play. But these tests cannot be done on the sideline and they require pre-injury baseline testing to be meaningful. Therefore, the decision to return an athlete who may have suffered a concussion to play is still a judgment call.
A number of resources are available to assist physicians and others who may see student athletes who have suffered concussions. The Minnesota State High School League’s website has information to assist physicians, parents, and coaches. The Centers for Disease Control and Prevention’s website has a free physician tool kit as part of its Heads Up campaign along with resources for coaches and parents. The American College of Sports Medicine, American Medical Society for Sports Medicine, and American Academy of Family Physicians offer assistance as well.
Physicians cannot prevent a first concussion from happening; but if we, the coaches, and the parents all work together we can keep injured athletes from suffering a second one.
Given what’s at stake for our star running back, I’d have to say, When in doubt, sit him out.