Q&A: Frequently asked questions about youth sports concussions

I recently had the opportunity to address a group of coaches, parents and athletes regarding concussions in youth sports. The seminar, sponsored by Backus Hospital, was designed to help the audience recognize the early signs of concussion and take appropriate action.

Many good questions arose from the discussion and the information may be helpful to others:

After suffering a concussion, when is it safe for an athlete to return to competition? Recovery time varies depending on the severity of the incident. In general, the athlete should be symptom-free before beginning a program where activities gradually escalate from stationary cycling to a full return. If at any time symptoms return, the progression stops and the previous level resumes.

If an athlete suffers a concussion, who determines when to resume an activity? After suffering a concussion, no athlete should return until they have been evaluated by a medical professional with experience in the treatment of concussion. Proof of medical clearance should be provided in writing.

In a situation where there are complaints of a headache and nausea but head trauma is uncertain, should the athlete be removed from the contest? Absolutely. It is sometimes difficult to determine if and when head trauma occurred and the patient may have amnesia. When in doubt, it is best to eliminate the possibility of further harm.

At what age should an athlete begin neck strengthening exercises to prevent indirect concussion? Any strengthening program in a child should be initiated in conjunction with a strength and conditioning specialist.

For those who could not attend this seminar, more information, including a video, can be obtained at www.backushospital.org/concussion. It was encouraging to see so many adults who are involved in youth sports become trained in the recognition of this potentially deadly injury.

Weightlifting can be part of youth exercise programs

Health club membership for participants between the ages of 6 and 17 is increasing. Along with this rise comes questions of what activities these athletes should be performing, especially with respect to weight lifting.

Exercise can be classified as primarily cardiovascular or aerobic and resistance or anaerobic. Sports like running, cycling or swimming are principally aerobic and designed to increase heart and lung capacity. Weight lifting and other strength-related challenges are designed to repeatedly stretch muscles against force to increase muscle fiber size and power.

The issue of safety regarding resistive exercise involves applying excessive force to developing muscles and joints resulting in tearing and deformation.

According to the American Academy of Pediatrics and other organizations, resistance activities are an essential part of a balanced exercise program, but must be performed properly. Benefits such as improving bone strength, maintaining a healthy weight, establishing a healthy lifestyle and better self esteem are some of the advantages.

Chris McNally, and his wife Sheri, of Norwich, are family fitness specialists with 20 years of experience working with children. They believe all children should start with “body weight exercises” like pushups, pull-ups and squats. In younger children, these should be performed as part of a game or other entertaining activity.

“If children start with a well-supervised program, the risk of harm is minimal. The bigger risk is not challenging their bodies when they are young and missing out on the benefits of being fit,” said McNally. He believes weight lifting can begin safely in a physiologically mature child at age 11.

As in most activities, children tend to imitate their parents or other adults they admire. A balanced fitness program is definitely a family investment that will pay huge dividends.

We can prevent concussions in youth sports

On July 1 , Connecticut proudly joined the growing ranks of states that have come forward and placed the safety of young athletes as a high priority on the legislative agenda.

A new law is now in effect that requires all scholastic coaches to attend a seminar on recognizing the early signs of concussion. The law also prohibits athletes from returning to a contact sport until cleared in writing by a medical professional with experience in the treatment of concussions.

As in other states, this law has had the added benefit of prompting serious discussion about how to make sports safer at all levels. In Connecticut, thanks to concerned parents, similar concussion restrictions are being implemented voluntarily at the youth sports (pre-high school) level.

As a neurologist involved in the field of sports neurology, I witness the devastating effects of concussion on a regular basis. A typical scenario is one where an athlete suffers a head injury but does not report it to a coach or parent. The first injury is then followed by a second impact before allowing the brain enough time to rest and heal. This second injury can result in more long-lasting and sometimes permanent symptoms of headache, dizziness and cognitive impairment.

Head injuries in younger children take longer to heal and are generally more severe. Ironically, it is the youth level of play where there are the fewest medical resources available, like a certified athletic trainer at every game.

On July 22, Backus Hospital is hosting a free lecture and discussion on the subject of head injuries in sports. It is designed for coaches, parents and athletes and will allow them to recognize early symptoms and take appropriate steps.

I highly recommend attending this seminar since the most effective treatment for a concussion is early recognition and rest.

Field conditions can cause injuries

Among the most prominent and often overlooked factors impacting athletic injuries at any level of play is the condition of the playing field. Many of these injuries are avoidable.

Athletic fields vary greatly depending on the sport, climate and funds available for upkeep. Most community sports teams cannot afford full time grounds-keeping staff. Parents shouldn’t hesitate to get involved by following some helpful hints:

• Get to the game early and walk on the field. Often coaches and officials are preoccupied with game preparation and don’t have time to inspect the grounds. Remove any debris, check for holes and be sure goal posts are securely padded.

• Baseball diamonds should be evenly mowed with no impediments that can cause a “bad hop” on the infield. Outfield fences should be inspected for sharp protrusions sticking out in the event a player runs into it.

• Indoor courts should be examined for moist areas that will affect traction.

• Seating must be a safe distance back from the players to avoid collisions between players and fans when chasing a loose ball.

“The amount of moisture on a field is crucial to avoid slipping. If a field is too moist or too dry, athletes will not be able to maintain firm footing and may potentially be injured,” said Ryan Lefler, Assistant Director of Stadium Operations and Turf Management at Dodd Stadium. Uniform moisture and smooth transitions from turf to dirt are essential in preparing a baseball field.

Despite 40 years of experience, the jury is still undecided regarding the safety of artificial turf when compared to grass. Technologic improvements in artificial turf make them more comparable each year.

When it comes to field safety, a vigilant coach, parent or fan may be the key to avoiding serious injury.