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Head Games

Research on brain injury is changing athletics

Illustration by James Steinberg

By Theresa Hogue, News and Research Communications

A decade ago, a high school football player who had suffered a blow to the head during a game would likely be put on the sidelines, watched carefully and sent back out to play once he appeared to be acting ‘normally’ again. Walking it off was common practice, without much consideration of the long-term impacts of the blow or a thought to the cumulative effect of frequent head trauma, big and small.

Today, the evolving science of identifying, treating and preventing concussions is taken extremely seriously by sports professionals. High-profile cases of severe injury and death as a result of head trauma, as well as a growing body of research on concussions, has profoundly changed the way athletes, both professional and amateur, are treated when they receive a blow to the head. And those changes are saving lives.

Dr. Doug Aukerman is a sports medicine physician with Samaritan Health Systems in Corvallis and a senior associate athletic director for sports medicine at Oregon State University. He manages the sports medicine program for all of OSU’s intercollegiate athletic sports teams. He studies concussions and other sports-related trauma, and applies the latest research directly to the care being given to OSU athletes. For Aukerman, the beauty of working in the Samaritan Athletic Sports Medicine Center on campus is partnering with the OSU research community.

Watching for Signs

A concussion typically occurs when a blow to the head or to the body exerts enough force on the brain to produce immediate and transient symptoms of traumatic brain injury. Such symptoms can include a rapid onset of impairment and other neuropathic signs (changes in peripheral nerves) and symptoms that can’t be explained by drugs or other injuries. Symptoms of a concussion can include confusion, stumbling, balance problems, mood shifts and headaches.

“We’re looking for changes to an athlete’s behavior or actions that aren’t congruent with what we normally see,” Aukerman says. This can be the result of one large blow or a series of multiple small blows that accumulate.

The actual collision isn’t always immediately recognized, but in the case of college sports, a person who serves as a concussion monitor is typically present during games to pay attention to potentially harmful collisions or blows. Coaches and athletes are trained not only to look for such events but to also pay attention to physical or behavior changes in teammates that may indicate that a concussion has taken place. At that point, the concussion monitor can replay recent footage and determine if a collision occurred.

Swift diagnosis is vital, Aukerman adds. Studies show that delayed reporting and treatment lead to a longer recovery time. And if an athlete receives a second blow without the first impact being recognized, the results can be much more severe, including massive brain swelling and the possibility of death.

“What happens during a concussion is a very complex process, and I don’t think that we have all the answers yet,” Aukerman says. “The things that are happening on a cellular and microscopic level are enormous. There are so many things happening at once.”

Ask the Athlete

While the science of concussions is still evolving, physicians have a fairly straightforward way of diagnosing them. A series of physical and mental tests can be applied quickly and easily on the sidelines of practice or a game to assess the athlete’s physical and mental state. The questions range from the time of day, to the last time the team scored, to the ability to remember and repeat a series of words.

If a physician determines that a concussion has occurred, the player is pulled from the field and further assessment is done. Then a plan of treatment is established. It includes cessation of any physical activity for a period of time and often academic activity and screen time as well. This can be difficult for students, especially when phones and computers become off limits. But screen time stimulates the brain areas that need to heal after a blow to the head.

It’s hard for athletes to stop playing, even briefly, but the break is crucial to healing.

“We’re very fortunate here to have a group of coaches who want what’s best for their student-athletes,” Aukerman says. “They want to win but not at the risk of their players being injured or hurt. And we’re doing a good job with educating coaches and athletes. They know if they report concussions and we manage it quickly, there will be far less loss of time on the field. Not reporting it could lead to weeks of recovery before they’re able to return to play.”

New Research Study

As part of the Pac-12 Conference, OSU will be taking part in the CARE Consortium as a CARE Autonomous Program (CARE stands for concussion assessment, research and education), an alliance between the NCAA and the Department of Defense. The large-scale, multisite study will focus on concussions in men and women in multiple sports in hopes of filling gaps in current knowledge and creating a large group of datasets for public use.

Doctors and researchers now recognize that there is not one type of concussion, Aukerman says. Subsets of the injury have different impacts to vision, emotion, balance and mental clarity. Some trigger headaches. Each subset must be treated differently. Some may allow a faster return to physical activity, while others demand longer rest periods.

NCAA Division 1 athletic teams commonly use computerized and in-person tests to establish a baseline of “normal” functioning for every athlete. Having such a profile helps physicians determine when an injured athlete has returned to his or her pre-concussive state.

“It’s just one tool out of the box,” says Aukerman. “It guides us in terms of returning the athlete back to normal.”

Small Steps to Injury Reduction

While concussions aren’t completely avoidable in high contact sports, both researchers and athletes are beginning to recognize that many small changes can add up to fewer harmful blows. Such changes may include reducing the amount of full contact during practice and looking at how protective gear, especially helmets, can increase the severity of blows if not properly fitted. Athletes are being trained to be more conscious of how contact on the field can negatively impact themselves and their opponents. Coaches can experiment with alternating practice with rest and recovery times to limit the amount of contact episodes.

Dr. Nicholas Phillips runs the concussion clinic at Samaritan Athletic Medicine Center and is a certified impact practitioner. Current research and testing hasn’t revealed anything that can effectively prevent concussions, he says, but focusing on best practices is a good start.

“Concussion prevention overall is a very difficult thing to study and to achieve,” Phillips adds. “The best practices for prevention will likely be through appropriate equipment, appropriate rule adherence (with the possibility of evidence-based rule changes), proper technique on higher risk activities such as tackling, and potential activity restrictions to limit unnecessary exposures.”

There are also still myths surrounding concussions that have to be dispelled, says Phillips.

“One myth that I still frequently run into is that regarding a pre-determined, finite recovery period for concussion. I commonly hear that a coach said that a player must sit out for one week after the injury, but every concussion timeline is variable and return to play must be tailored to each case.

“I’m also still concerned about the downplaying of potential concussions in which coaches and parents say the athlete just ‘got their bell rung.’  By definition, if a player exhibits any abnormal neurologic signs or symptoms after a potential head injury, then that should be classified as a concussion.”

Athletes suffering from a concussion may discover that their symptoms are worsened by certain activities, including screen time, dehydration, intense physical and cognitive activities. “That’s why it’s so important to tailor treatment to each individual,” Phillips adds.

“Our community clinic and student-athlete management focus on early identification of concussion to allow appropriate management of the injury. While there is no one particular intervention to ‘cure’ concussion, the right combination of recommendations can lead to the quickest and safest recovery.”

Resources for Local Schools

In addition to work with OSU athletes, Aukerman, Phillips and others provide resources to local junior high and high schools regarding concussion prevention, identification and treatment.

And despite the risks of full-contact sports, Aukerman, who is a parent himself, says he hopes that families recognize that the benefits of taking part in team sports far outweigh the potential risks, especially when coaches and athletes are actively looking to minimize injury.

“There is so much that can be gained from sports participation,” he says, “including working as a team, interacting with people who are different from you, learning how much can be accomplished together, so many positive things. I hope parents wouldn’t say ‘I won’t let my child have that option.’ Sports can be approached in a safer way. There is no way we as parents can mitigate every risk to our children, but there is a risk in
being overprotective.”

By Nick Houtman

Nick Houtman is director of research communications at OSU and edits Terra, a world of research and creativity at Oregon State University. He has experience in weekly and daily print journalism and university science writing. A native Californian, he lived in Wisconsin and Maine before arriving in Corvallis in 2005.