The responsibility for determining when and if brain-injured athletes can return to full participation in their sports is often the most difficult decision a sports medicine specialist must make. A concussion is the mildest and most frequently encountered form of TBI.
Medical technology offers a vast array of imaging, as well as psychological and electrodiagnostic examinations, as part of the neurological evaluation. Despite the magnitude of the decision to return to play, there is no single test or formula to rely on for guidance.
Before 2008, a rating scale based on the presence or absence of loss of consciousness was used. Unfortunately, the scale was an unreliable indicator of when it was safe to return.
The most dependable approach to this dilemma involves two stages:
• The first is careful analysis of the clinical data, history of the incident and previous TBIs, physical examination and observation. An athlete must be symptom-free, including headaches, dizziness, confusion and visual changes.
Based on this information, it is determined whether an athlete can safely begin a rehabilitation program aimed toward full activity. This decision is best made by a physician experienced in treating athletes.
• The second stage in the recovery process includes returning to activity without symptoms. This procedure begins with a low-impact aerobic exercise for 20-30 minutes, then light resistance training and finally concludes with sport-specific activities performed under observation by a certified athletic trainer.
The rehabilitation process after TBI can take months and, sadly, many outstanding athletes never return to their sports.
Interestingly, it is often the great athletes who take the lessons learned from years of hard work and channel them into immense success in another field of endeavor.
The iliopsoas muscle is formed by a combination of the psoas major, psoas minor and iliacus muscles. These muscles originate from the lumbar spine and pelvis and attach to the upper portion of the femur. Any injury in this area will result in poorly localized pain in the low back, hip and groin.
Typical injuries include iliopsoas strain, where there is tearing of muscle fibers, and iliopsoas tendonitis that is marked by inflammation of the iliopsoas tendon. These injuries are the result of sudden stretching of the muscle by flexing the hip or externally rotating the thigh. Repetitive hip flexion can also cause harm.
Symptoms of iliopsoas injury include pain and stiffness in the hip that can often radiate into the thigh. The pain can be very intense and often results in an athlete withdrawing from competition.
Iliopsoas injuries are most common in gymnasts, dancers, track and field athletes and soccer players. Venus Williams was recently forced to withdraw from the Australian Open due to what was reported as an injury to the iliopsoas. Any activity that requires repeated hip flexion can result in damage.
These injuries can be avoided through a stretching program performed regularly. Strengthening of core muscles including the hip and pelvis will not only improve overall athletic performance but avoid injury to the hip, pelvic and upper leg muscles.
Treatment includes rest, ice and anti-inflammatory medications. A stretching program should be instituted when pain subsides. Unfortunately, an iliopsoas injury often requires up to three weeks of rest.
Many musculoskeletal hip injuries can be avoided and successfully treated with a carefully executed stretching regimen.
The current collective bargaining drama involves the NFL and the NFL Players Association. While financial issues are central to most employment agreements, this negotiation appears to have a focus on safety.
Dave Duerson was a 50-year-old, successful businessman and former Chicago Bears safety. In recent years, his life began to unravel with marital problems, business failures, uncharacteristic temper outbursts and an inability to remember simple information.
Duerson was diagnosed with Chronic Traumatic Encephalopathy (CTE) as a result of the multiple concussions he had suffered during his years of playing football. He was also an active NFL alumnus fighting for better health benefits for retired players and making the game safer for younger players.
Unable to face a future of dementia, on Feb. 17, Duerson committed suicide by shooting himself in the chest. He chose this manner to preserve his brain for future study. His desperate action has placed a new light on the current negotiations.
Neuropathologists around the world have recently begun to delve into the study of cumulative brain trauma and subsequent Alzheimer’s-like dementia. Some studies have shown changes in the brains of teenage athletes involved in violent collision sports like football and hockey.
“There is no reason, no medical justification, for any child younger than 18 to play football, period,” said Dr. Bennet Omalu, a neuropathologist in California. His opinion is based on studies emphasizing the importance of brain development in the first 18 years of life and the fact that when brain cells are destroyed there is no cellular recovery.
Young people everywhere often believe they are indestructible and are willing to take unacceptable risks for financial reward. The NFL is no exception. It will be interesting to see if the wisdom of elder veterans will direct these negotiations.