Commentary

Focus on ways to make youth sports safer, not boycott

The spring sports season has arrived. Although the issue of concussions starts to wane with the start of baseball season, we need to be involved in the management of concussions for all sports. Our vigilance is now a year-long effort.

Anthony A. Romeo, MD
Anthony A. Romeo

Concussions are most commonly recognized by witnessing a direct blow to the head. However, concussions are often caused by indirect forces applied somewhere else on the body that allow the head to strike another object or have enough force to cause a sudden change in the environment of the brain resulting in the common mechanism of disruption of the brain’s biochemical environment through biomechanical forces. Concussions are generally not associated with structural injury and brain imaging studies have not been valuable for acute treatment. When concussion is suspected, careful cognitive and clinical testing is necessary to identify if a brain is not functioning normally.

There have been tremendous strides in creating concussion programs in professional sports. However, young athletes are often briefly evaluated at the time of competition, then sent home with parents who are told to keep a watchful eye, but do not have the ability to truly evaluate for the subtle symptoms that confirm a concussed brain. Management guidelines have been established, but the variability of concussion diagnosis and lack of a single objective and effective “on-the-field” test has led to challenges and confusion about who is responsible for the diagnosis and treatment of young athletes, including removal of athletes from continued play.

Professional sports recognize that a person specifically trained in neurologic conditions is essential to recognize and effectively treat concussed athletes. However, youth, high school and college sports mostly rely on team physicians for this critical role, and most head team physicians are orthopedic surgeons without direct support from neurological specialists. If you are covering a sport that has any chance of a concussion episode, it is critical to be aware of the signs, symptoms and treatment. This can be challenging because concussions are often silent and can progress beyond the competitive event.

As one-third of all concussions occur during practice, team physicians need to educate coaches, players and parents about the signs, symptoms and immediate treatment of concussed athletes. Shared education allows for the removal of athletes from competition and reduces the risk of additional and possibly more permanent injury. We play a valuable role in efforts to prevent concussions when we educate about limiting contact in practice, improved protective equipment, neck strengthening, proper techniques, body control and sportsmanship.

Some of our peers have suggested we condemn collision sports, recommend parents not allow their child’s participation or boycott events. However, as orthopedic surgeons and team physicians, we need to remember that youth sports offer benefits. Team sports encourage physical fitness, improved social relationships, improved physical and mental health, academic success and teach life lessons.

Our goal should be to focus on methods to make sports safer, not to boycott or eliminate them. As a parent, I would not want to take away the opportunity for a child or teenager to experience the excitement and passion that sports provide. As Vince Lombardi once said, one of the greatest fulfillments in life, brought about by the participation in sports, “is that moment when he has worked his heart out in a good cause and lies exhausted on the field of battle – victorious.”

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and is a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.

The spring sports season has arrived. Although the issue of concussions starts to wane with the start of baseball season, we need to be involved in the management of concussions for all sports. Our vigilance is now a year-long effort.

Anthony A. Romeo, MD
Anthony A. Romeo

Concussions are most commonly recognized by witnessing a direct blow to the head. However, concussions are often caused by indirect forces applied somewhere else on the body that allow the head to strike another object or have enough force to cause a sudden change in the environment of the brain resulting in the common mechanism of disruption of the brain’s biochemical environment through biomechanical forces. Concussions are generally not associated with structural injury and brain imaging studies have not been valuable for acute treatment. When concussion is suspected, careful cognitive and clinical testing is necessary to identify if a brain is not functioning normally.

There have been tremendous strides in creating concussion programs in professional sports. However, young athletes are often briefly evaluated at the time of competition, then sent home with parents who are told to keep a watchful eye, but do not have the ability to truly evaluate for the subtle symptoms that confirm a concussed brain. Management guidelines have been established, but the variability of concussion diagnosis and lack of a single objective and effective “on-the-field” test has led to challenges and confusion about who is responsible for the diagnosis and treatment of young athletes, including removal of athletes from continued play.

Professional sports recognize that a person specifically trained in neurologic conditions is essential to recognize and effectively treat concussed athletes. However, youth, high school and college sports mostly rely on team physicians for this critical role, and most head team physicians are orthopedic surgeons without direct support from neurological specialists. If you are covering a sport that has any chance of a concussion episode, it is critical to be aware of the signs, symptoms and treatment. This can be challenging because concussions are often silent and can progress beyond the competitive event.

As one-third of all concussions occur during practice, team physicians need to educate coaches, players and parents about the signs, symptoms and immediate treatment of concussed athletes. Shared education allows for the removal of athletes from competition and reduces the risk of additional and possibly more permanent injury. We play a valuable role in efforts to prevent concussions when we educate about limiting contact in practice, improved protective equipment, neck strengthening, proper techniques, body control and sportsmanship.

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Some of our peers have suggested we condemn collision sports, recommend parents not allow their child’s participation or boycott events. However, as orthopedic surgeons and team physicians, we need to remember that youth sports offer benefits. Team sports encourage physical fitness, improved social relationships, improved physical and mental health, academic success and teach life lessons.

Our goal should be to focus on methods to make sports safer, not to boycott or eliminate them. As a parent, I would not want to take away the opportunity for a child or teenager to experience the excitement and passion that sports provide. As Vince Lombardi once said, one of the greatest fulfillments in life, brought about by the participation in sports, “is that moment when he has worked his heart out in a good cause and lies exhausted on the field of battle – victorious.”

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and is a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.