The Bone and Joint Clinic

The annual incidence of sports-related concussions is estimated at 300,000 for U.S. athletes alone. Participants in contact sports experience mild head injuries at a projected rate of 19% per season. The good news is that the majority of athletes who sustain a concussion in sport recover fully. Unfortunately, there are certain individuals who experience lasting problems related to their head injuries. Conditions that have been linked to unresolved sports-related concussions are: frequent headaches, learning problems, coordination difficulties, slowing of reaction times and even depression. Recent research has shown that even minor blows to the head (for example, those not associated with loss of consciousness) may be associated with long-term problems—if not addressed properly.

The Bone & Joint Clinic, in conjunction with Williamson County Schools, Battle Ground Academy and Brentwood Academy, has initiated a program for addressing sports-related concussions in this area. This program, which was started in the summer of 2007, includes three components: education, computerized neuropsychologic testing and monitoring of injured athletes.

The educational component consists of training seminars, which target special interest groups. Topics covered in these meetings include: “What is a concussion?” “How to recognize sports-related concussions?” and “What is the proper treatment for sports-related concussions?” An important aspect of these educational meetings is to inform the public about the work of an international organization, which calls itself the Concussion in Sport Group (CISG). The CISG, which includes representatives of various sports organizations and medical institutions from all over the world, has established a new standard of care for sports-related concussions. Stated briefly, the CISG recommends that for any athlete who sustains a concussion in sport:

The athlete is to be removed from a practice/game following any signs or symptoms of concussion.
There should be no return to play in the current practice/game.
A medical evaluation should occur following the injury to rule out serious intracranial pathology, which would require hospital-based care.
The medical evaluation should included neuropsychologic testing and monitoring of symptoms so that safe return to play is insured.
A step-wise return to play is followed so that a recurrence of concussion symptoms is caught early and addressed properly.

These recommendations from the CISG are now being followed by all members of the National Football League, the National Hockey League, the International Olympic Committee, FIFA (the organization that governs international soccer), the U.S. Ski and Snowboard Teams, U.S. Soccer, U.S.A. Boxing, U.S.A. Hockey, IRL, CART, Formula One, 18 Major League Baseball teams, the Professional Baseball Umpire Corporation, over 300 U.S. colleges and universities, and over 800 U.S. high schools.

The key to proper management of sports-related concussions is monitoring brain function until there is evidence for full recovery, so that athletes are returned to sports safely. The main goal of treatment is to allow the brain to heal before risking another injury. Neuropsychologic testing—before and after head injury—allows doctors and athletic trainers to evaluate recuperation, without having to rely solely on symptoms reported by the athletes. Furthermore, pre-season testing affords a means of comparing results specific to each individual opposed to using normative data from research studies. This testing system, which is called ImPACT, has proven to be a major advance in the care of athletes with head injuries and is now available at all the high schools in Williamson County, as well as the Bone & Joint Clinic.