In the JournalsPerspective

Multiple hits over time can cause concussion

The number and severity of head impacts — not just a single large head impact — may cause concussion, according to findings recently published in Annals of Biomedical Engineering.

Studies of football athletes have implicated repetitive head impact exposure in the onset of cognitive and brain structural changes, even in the absence of diagnosed concussion,” Brian D. Stemper, PhD, of the joint department of biomedical engineering at Marquette University and Medical College of Wisconsin, and colleagues wrote.

“Those studies imply accumulating damage from successive head impacts reduces tolerance and increases risk for concussion. Support for this premise is that biomechanics of head impacts resulting in concussion are often not remarkable when compared to impacts sustained by athletes without diagnosed concussion,” they added.

Researchers quantified repetitive head impact exposure in 50 NCAA Division I college football athletes with concussion vs. controls matched for position and team. For those with concussion, researchers also quantified the number of head impacts and risk-weighted exposure both the day of injury and for the season to the date of injury.

Stemper and colleagues found:

  • 72% of athletes with concussion had the most or second-most severe head impact exposure vs. control.
  • 46% of athletes had the highest number of head impacts for the season up to and including the injury date vs. control.
  • 43% of athletes had the highest number of head impacts on the date of injury vs. control.

“This unique analysis provides further evidence for the role of repetitive head impact exposure as a predisposing factor for the onset of concussion among Division I college football athletes,” Stemper said in a press release.

Concussion Examination 

The number and severity of head impacts — not just a single large head impact — may cause concussion, according to findings recently published in Annals of Biomedical Engineering.

Source:Shutterstock

“While these trends require further validation, the clinical implication of these findings supports the contemporary trend of limiting head impact exposure for college football athletes during practice sessions,” he added.

Healio Family Medicine has reported extensively on the signs of concussion. Managing patients with concussion starts with recognizing the symptoms, such as disorientation, confusion, impaired concentration, irritability, anxiety, altered sleep and sometimes loss of consciousness. Mood-related symptoms might include irritability, anxiety, mood lability, or altered sleep. Other Healio reports have examined these head injuries’ link to vision problems and their link to suicide. – by Janel Miller

Disclosures: Stemper reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

 

The number and severity of head impacts — not just a single large head impact — may cause concussion, according to findings recently published in Annals of Biomedical Engineering.

Studies of football athletes have implicated repetitive head impact exposure in the onset of cognitive and brain structural changes, even in the absence of diagnosed concussion,” Brian D. Stemper, PhD, of the joint department of biomedical engineering at Marquette University and Medical College of Wisconsin, and colleagues wrote.

“Those studies imply accumulating damage from successive head impacts reduces tolerance and increases risk for concussion. Support for this premise is that biomechanics of head impacts resulting in concussion are often not remarkable when compared to impacts sustained by athletes without diagnosed concussion,” they added.

Researchers quantified repetitive head impact exposure in 50 NCAA Division I college football athletes with concussion vs. controls matched for position and team. For those with concussion, researchers also quantified the number of head impacts and risk-weighted exposure both the day of injury and for the season to the date of injury.

Stemper and colleagues found:

  • 72% of athletes with concussion had the most or second-most severe head impact exposure vs. control.
  • 46% of athletes had the highest number of head impacts for the season up to and including the injury date vs. control.
  • 43% of athletes had the highest number of head impacts on the date of injury vs. control.

“This unique analysis provides further evidence for the role of repetitive head impact exposure as a predisposing factor for the onset of concussion among Division I college football athletes,” Stemper said in a press release.

Concussion Examination 

The number and severity of head impacts — not just a single large head impact — may cause concussion, according to findings recently published in Annals of Biomedical Engineering.

Source:Shutterstock

“While these trends require further validation, the clinical implication of these findings supports the contemporary trend of limiting head impact exposure for college football athletes during practice sessions,” he added.

Healio Family Medicine has reported extensively on the signs of concussion. Managing patients with concussion starts with recognizing the symptoms, such as disorientation, confusion, impaired concentration, irritability, anxiety, altered sleep and sometimes loss of consciousness. Mood-related symptoms might include irritability, anxiety, mood lability, or altered sleep. Other Healio reports have examined these head injuries’ link to vision problems and their link to suicide. – by Janel Miller

Disclosures: Stemper reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

 

    Perspective
    Joseph D. Smucker

    Joseph D. Smucker

    This study underscores the importance of serious consideration of every person who has a traumatic event to his or her head.

    As Stemper et al findings suggest, there is still a lot of variability in the data we have. Previous research has suggested that not every athlete is the same with respect to these injuries some athletes are affected by a single injury, and other athletes can be hit multiple times and not be impacted in the short-term. Prior studies have also shown differences between age groups when it comes to concussion symptoms, and self-reporting of injury has also been an issue. So while the idea of treating athletes as they come in to a primary care physician’s office is important, this variability makes it difficult for PCPs because there is not a universal protocol, or a “this is what we always do,” or “this is the one and only test to use” type of approach that can drive the PCP down the road to a correct diagnosis.

    The most encouraging thing we are seeing is a recognition of the importance of head trauma in athletic participation. As we consider these injuries and report on our experiences, it is the collective hope that athletic participation will become safer, while allowing athletes an opportunity to enjoy participation in their sport. The balance of healthy athletes and reasonable changes in sporting activities to minimize a significant effect on the enjoyment of sport is a shared goal in primary and specialty health care.

    Until such a universal protocol can be established, at the time of injury PCPs should ask the individual with the concussion or sports-related head injury questions like “What field are we playing on?”, “What quarter is it?”, “How far along in the game are we?”, and “Who participated in the last scoring play?”, since these patients will typically have problems with their short-term memory, despite being neurologically normal. PCPs may also consider use of the Sport Concussion Assessment Tool, currently in its 5th edition (SCAT5), to determine if a patient is indeed concussed.

    • Joseph D. Smucker, MD
    • Orthopedic spine surgeon, Indiana Spine Group

    Disclosures: Smucker reports no relevant financial disclosures.

    Perspective
    Jaclyn Demeter

    Jaclyn Demeter

    This study brings to greater light the fact that concussions and their neurological impact should be looked at collectively in health care and sport rather than as isolated events. To expound upon the data analyzed by Stemper et al, a concussion may result from hits throughout a season, rather than a single forceful contact. It also reinforces the idea that repetitive hits to the head and neck can serve as insults to the brain and can lead to a concussion that can end a patient’s season and sometimes their career.

    Health care is so much more than just diagnosing and treating patients it is about educating patients, too. In some ways, these injuries should be looked at in the global context of athlete health and age/level-based participation. We need to treat these injuries in the population from which they come, rather than appropriating data from other sources of trauma literature or personal experience. Since we still do not know how many hits can cause long-lasting neurological impact, and since the symptoms of such neurological damage are not always readily apparent, primary care physicians can use this study to inform coaches and players. Reinforcing the idea of playing safely during both practice and game settings, including avoiding head-first contact, may allow a patient to continue participation in their sport with a decreased risk of injuries.

    • Jaclyn Demeter, PA-C, MPAS
    • Physician assistant, Indiana Spine Group

    Disclosures: Demeter reports no relevant financial disclosures.