Head Injury in Young Athletes

1.2 million young athletes play football in the United States each week. 50% of them are likely to have a concussion some time in their high school playing career. 35% will have more than one head injury. Which one will be mild, improving uneventfully and which will result in severe disability is impossible to predict. We have learned over the last couple years that these injuries are more frequent and have an effect on the injured athlete for a much longer period of time than previously thought. Recent research tells us these young people are at much greater risk to develop problems later from seemingly mild head injuries as well.

More young people of both genders are participating in organized sports than ever. There are intrinsic differences in the young athlete that make them more vulnerable to injury because both the brain and body are still growing and have not reached their full mature potential. 60,000 sports related head injuries occur to high school athletes each year. High school football has been compared to notoriously dangerous jobs such as coal mining. Football is not the only sport where young athletes experience deliberate or incidental contact. Part of the challenge for responsible adults working with young athletes is the athlete’s lack of maturity and experience. It creates greater liability for injury and difficulty in even recognizing subtle but important signs. Young athletes often hide their injury or pain because of the eagerness to return to play, avoid embarrassment, not let their team down or try to meet unrealistic expectations. This is particularly important with head injuries as there may be no visible sign of the injury. The athlete may deny their symptoms of headache, confusion, dizziness with a determined attitude to return to play. Research over the last couple years has pointed to the importance of subtle signs which may be the only clue. Even seemingly mild blows to the head may lead to more serious injury. Certainly repeated small injuries increase the risk of serious complications. Coaches and parents need to be observant and conservative about monitoring athletes in contact sports or anytime there appears to be even mild head trauma. Under-treating these episodes lead to bigger short-term and long-term problems. The responsible adult must exercise a great deal of patience and restraint. Never encourage your young athlete to “play with pain”. Any potential head trauma should be evaluated thoroughly and cleared by a medical professional familiar with head injuries before the athlete returns to play.

The exact cause of concussions is not well understood but there are some recognizable patterns in symptoms and behavior. To understand what is happening to the brain we can compare a sharp blow to the forearm. There is certainly pain after the accident. The arm may feel unusual and not work well. Nothing is broken, symptoms resolve spontaneously and completely. A similar thing can happen to the brain after direct trauma to the head. After the accident there is pain. The pain is usually substantial and feels deep-seated inside the head. The person feels “funny”. Only a momentary lapse in memory or feeling dazed is possible. The brain temporarily may not work quite right exhibiting a wide range of random symptoms. However nothing is broken and it goes away spontaneously. Common symptoms of post concussion syndrome include headache, dizziness, fatigue, memory loss, light sensitivity and difficulty concentrating. Behavior can be minimally or profoundly affected by head trauma. Personality change, irritability or anxiety is not unusual. Other changes can be difficulty regulating emotions, poor coordination, or temporary learning disability. The precise cause of symptoms remains unclear and is a source of disagreement among researchers. At the microscopic or cellular level we still are not clear how the brain is operating. Research has shown changes in brain activity following even mild head trauma that was thought to be insignificant. Moreover these changes can have long-lasting effects on brain activity and the thought process involving a variety of behaviors.

More emphasis on preventing these common but serious injuries is needed. Parents and coaches should be instrumental in educating young athletes in proper training to prepare them for their sport. This must include conditioning, some strength training as well as attention to good technique and understanding how to play the game well. Knowing the rules and use of proper protective equipment is also mission-critical. We have learned that rest of both mind and body is important to allow the brain to heal. There is no exact formula for this. Each person must be cautiously evaluated on a case by case basis. A young developing body that has yet to reach its full potential for strength and durability needs patience and time to heal. Working together with your health care provider to formulate a plan for rest and transitional activity, can insure a rapid recovery and help prevent future injury.

A concussion is a complicated problem that needs thorough initial evaluation. Seek medical attention for head injures even if they seem mild and no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early and be the reassuring basis for ongoing treatment. The Center for Disease Control( http://www.cdc.gov/concussion/ ) is an excellent reference for head injuries in young athletes. Post concussion syndrome can be temporarily debilitating and frustrating. However the cautious prudent approach in conjunction with your health care provider will assure the best course of treatment for a life time of success for your young athlete.