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Football isn’t highest-risk sport for athletes and concussions, doctor for Blue Raiders says

By Dan Miller

danmiller@pressandjournal.com

717-944-4628
Posted 8/22/18

Concussion.

The word conjures up images of head-to-head collisions between football players, most likely in the NFL because that gets the most attention.

But you are at just as much risk of …

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Football isn’t highest-risk sport for athletes and concussions, doctor for Blue Raiders says

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Concussion.

The word conjures up images of head-to-head collisions between football players, most likely in the NFL because that gets the most attention.

But you are at just as much risk of getting a concussion in other sports.

Football isn’t even the highest risk when it comes to athletes getting a concussion.

If you are a women’s ice hockey player, you are three times more likely to have a concussion than if you play football, Dr. Jayson Loeffert, a specialist in family medicine and primary care sports medicine with Penn State Hershey Medical Group, told a group of parents in the auditorium of Middletown Area Senior High school on Wednesday, Aug. 15.

“Everybody thinks football is the issue. Football gets the most talk, but football actually isn’t the highest risk in terms of sports,” said Loeffert, who is team physician for the Blue Raiders. He also treats athletes at Penn State Harrisburg and the Harrisburg Senators.

“Just because your son or daughter does not play football doesn’t necessarily mean they are immune from getting a concussion,” he added. “It can happen in any sport.”

District Athletic Director Cliff Smith arranged for Loeffert to give the talk, to educate parents on a topic that Smith noted is “constantly changing.”

That’s true, judging from what Loeffert had to say during his 25-minute long presentation before the group of about 20 people, including several district staff members.

One point Loeffert sought to drive home to the parents  was the need for a student athlete to come to a team doctor or coach as soon as possible, if he or she is experiencing symptoms from a concussion.

Athletes are often reluctant to say they are experiencing symptoms because they don’t want to be out of the game. But this can lead to athletes being on the sidelines longer, and putting themselves at greater risk.

“When athletes are unwilling to come to me, it makes my job very difficult and it makes their rehab and their recovery difficult a lot of times, too,” Loeffert said. “What I like to promote is openness. We know that athletes who are treated quickly and treated in the right away, which is generally just rest and a progressive return to activities, get better far faster than the athletes that keep playing, get more hits, and can have progression of their symptoms. … Usually the athletes I take care of who have a long-term duration of symptoms didn’t come forward right away with their diagnosis and their symptoms.”

Categorizing

Loeffert grouped symptoms into four categories: physical, mental, emotional and sleep.

Physical symptoms include dizziness, trouble with light and sounds, and headaches.

Mental symptoms include trouble with memory, trouble staying focused or trouble paying attention in class — are they falling behind in their homework?

Emotional symptoms include anxiety, depression and anger — sadness, irritability or feeling worried or scared.

Loeffert emphasized that a concussion is “a very complicated thing” that can vary widely from person to person.

For example, someone can receive “a very, very hard hit” that doesn’t cause a concussion, and someone else can receive a fairly mild hit that does.

“We don’t really know why that happens,” Loeffert said. “There’s no real good prediction as to what is going to cause a concussion.”

The easy way to think of a concussion is, you have trauma to the brain that causes changes to cognitive function, and then can cause symptoms afterward.

Some athletes develop amnesia but this is “really rare,” occurring in fewer than 1 or 2 percent of athletes diagnosed with a concussion, Loeffert said.

Not all athletes who have a concussion report having headaches. They think that if they don’t have a headache, they could not have had a concussion. Not so.

“If you have all these other symptoms, you don’t have to have a headache,” Loeffert said. Headaches are “just part of the picture” involved in having a concussion.

Loss of consciousness is also rare, Loeffert said. An athlete suffering a concussion will say they were out, and their parents will say, “No, you got up really quick.”

Loeffert put up a graph showing a continuous rise in concussions in the United States since 2007.

Girls at risk

Until 2005, a concussion diagnosis had to include loss of consciousness. In 2005, the requirement that an athlete had to lose consciousness in order to be diagnosed with having a concussion was removed.

That change has led to the steady rise in athletes being diagnosed with concussions since 2005, Loeffert said, although “a lot more knowledge and a lot more openness for admitting symptoms” are also factors behind the increase.

Young girls are at greater risk of having a concussion than young boys, because young girls have weaker neck muscles and they jump differently, Loeffert noted.

Loeffert used a scenario about a hockey player to illustrate the state requirements in Pennsylvania for an athlete who has symptoms of a concussion, and what happens afterward.

The hockey player gets slammed into the boards. He complains of headache and dizziness, and has trouble with sounds.

He is removed from play and monitored on the bench. But his symptoms appear to clear up, and after 10 minutes he feels normal. Can he return to the game?

No.

“The rule is if you have concussion symptoms you are automatically removed from that game, and you can’t return to any physical activity until at minimum the next day,” Loeffert said, adding that this is a state rule in Pennsylvania intended to protect the athlete.

If diagnosed with a concussion, you can expect to be out of action for at least seven days. This is also a state-mandated rule, Loeffert said.

Returning to the field

Before an athlete can return to his or her sport, they have to be “asymptomatic” — lacking obvious signs or symptoms — without the aid of medication, he noted.

All medicines have side effects, Loeffert said. He tries as much as possible to avoid prescribing medicine to an athlete diagnosed with a concussion.

Loeffert said he doesn’t have to rely on medicine very often, “because I am getting my athletes treated really well, really fast. They are clearing up their symptoms quick and they are getting back to their sport, which is ultimately what they want to do.”

Loeffert also utilizes a “return to play progression” for getting an athlete diagnosed with a concussion back in action.

The athlete must first be symptom free for at least a day. Then each day the athlete undergoes steps that gradually become more intense, in terms of physical activity.

For example, in the first day after being symptom free you do light aerobic activity, such as a jog or a long walk.

If you don’t experience a return to symptoms, gradually over the next several days you progress to more intense “sport specific” exercises, Loeffert said.

If some or all symptoms return during this progression, the athlete doesn’t have to go back to the beginning of the process.

“They just stop for the day, and then the next day they try those sports specific activities again,” Loeffert said. “That’s a really important thing to tell the athlete, because if they think they are going to have to start over they are not going to tell you they are symptomatic. But if you say you are just losing a day, then usually they are more able and open to admit they are becoming symptomatic.”

Loeffert explained why it is critical that if an athlete does experience a return to symptoms during this return to play progression, that he or she tell their doctor or coach — in order to prevent “second impact syndrome.”

“Second impact syndrome is the idea where you get a concussion, you are still symptomatic and you suffer another head impact,” Loeffert said. “Nobody has ever died of a concussion … but there is what is believed to be some inflammation quality when you get a concussion. If you get a second hit, that inflammation can kind of skyrocket. You can get swelling on the brain which people have been reported to die from. All the protective stuff we are doing is to prevent this.”

Helmets can’t prevent them

Loeffert also had a word or two to say regarding equipment such as helmets.

Helmets don’t protect people from having concussions, Loeffert said, and he doesn’t expect they will “now or in the foreseeable future.”

“Our brains sit inside of our skull and it’s kind of surrounded by fluid. And it floats,” Loeffert added. “Everything in there shakes around. That’s what happens within our skull. You can’t prevent that no matter how much padding we use, no matter how much protective layer. That brain is still going to move. That’s what puts you at risk of a concussion.”

The Food and Drug Administration even forbids a helmet maker from saying that his or her product will prevent a concussion, as “nothing has been found to truly prevent concussion,” he said.

Moreover, the testing of helmets in a scientific lab does not adequately replicate what happens to an athlete in a real practice or game situation, he added.

Helmets can protect student athletes from skull fractures and scalp lacerations, he said.

Last year, Loeffert said he was asked about the value of putting a pad over the top of a helmet.

This won’t prevent a concussion, and the padding could make things worse by adding weight to the top of the helmet, putting extra force on the neck, he notes.

Head gear for soccer players has been investigated, but Loeffert noted one study suggests athletes who wear head gear may take risks they wouldn’t otherwise take while playing, because it gives them a false sense of security.

Are students educated?

During a brief question-and-answer period following Loeffert’s presentation, a parent asked Smith about whether the school district is providing this same information about concussions to the student athletes.

Smith said that typically, student athletes are not educated about a concussion unless they have one, and then “they are educated as the doctor is treating them.”

However, he seemed open to the possibility of the district being more pro-active about providing information about concussions to all student athletes.

As one parent noted, if student athletes know “ahead of time” that they might not have to sit out as long if they report symptoms quickly, “they might be more prone to come to you and say ‘this is what I am feeling’ and nip it in the bud.”

Smith urged district parents with questions about concussions email the questions to him, so he can forward the questions to Loeffert for answers.

You can reach Smith at cliffsmith@raiderweb.org.

Smith also encouraged parents contact him with ideas for other student athlete-related topics that can be the subject of future presentations.