There is a certain ferocity, propped with adrenalin, that pushes athletes in scoring goals, sliding into base, spiking a ball ... often with jarring contact from a ball or an opponent’s knees, elbows, and head.
It may result in a winning run with the possibility of concussion.
“You can get a concussion at any sport,” said Dr. Ryan Szepiela, a sports medicine physician with ProMedica who conducts acute evaluations on the sidelines for such schools as the University of Toledo, and Perrysburg, Anthony Wayne and Northview high schools. “Protecting our players is the No. 1 job on the sidelines. If in doubt, sit them out.”
The Ohio Department of Education reported in 2019-2020 that nearly 13 percent of student-athletes had self-reported a concussion in the previous 12 months. Nationally, the CDC set that figure at 15 percent.
It’s not just impacts associated with football. Girls soccer, and even volleyball, are sports that sustain risks.
“Women’s soccer tends to have the highest number of concussions per person,” said Andrea Cripps, an athletic training program coordinator at Bowling Green State University. “Females are just more aggressive on the field. They are very aggressive compared to men’s soccer.
“Cheer teams also see a lot of concussions, because a member may be dropped or a head may hit someone’s elbow or knee,” Ms. Cripps said.
Some of the national research on concussions in high school sports, including football and ice hockey, are no-brainers. Others come as a surprise, such as girls’ soccer.
Boys football has the highest overall concussion rate with 10.4 occurring per 10,000 practices or competitions, according to a 2019 study published by the American Academy of Pediatrics.
Girls soccer (not boys) rated second with 8.19 occurrences per 10,000 practices or competitions; and boys ice hockey had the third highest rate of incidents with 7.69 concussions per 10,000 practices or competitions.
“You see a lot of boys getting them in football, but you also see girls getting them in soccer,” confirmed Katie Larue Martin, president of the Ohio Athletic Trainers Association.
Know the signs
“In Ohio, there is a concussion law in place, which requires a player to be removed from play for the day to be evaluated,” said Ms. Martin, adding that athletic trainers work with a physician or have a collaboration agreement.
And recognition of concussions, which happen when the soft and squishy brain bounces against the inside of the skull, has increased.
“The research has evolved a lot in the past 15 years,” Ms. Cripps said. “We know more about concussions in the past 10 years than we knew in the 30 years previous. Before, a lot were probably going undiagnosed.”
As understanding of the long-term repercussions of repetitive concussions has increased, athletic trainers and physicians are attending high school and college games.
“We are on the sidelines watching plays. Some of this is self-reporting. We can’t see everything,” said Dr. Karen Shafer, a sports medicine specialist with the University of Toledo Medical Center. “Sometimes athletes are scared to report because they don’t want to get pulled.”
That is where education and awareness come into play. More is known about the long-term effects of multiple concussions, including a higher risk for dementia and for chronic traumatic encephalopathy, which can result in increasingly aggressive behavior, memory problems, and loss of coordination.
Athletes may be hurting themselves more when they are not addressing the immediate impacts of one concussion, according to Ms. Martin. The next one becomes more significant, if an athlete has not recovered from a previous concussion.
“They come up weekly for most of us who deal with contact sports. We have tried to do lots of things to keep them from happening,” said Ms. Martin, pointing to attempts to lessen impacts during practices, including doing away with body checking during hockey practices.”
Dr. Szepiela reports that symptoms range from headaches, to nausea or vomiting to confusion.
Sometimes athletes may not know what quarter they are in, or they might have balance issues when they get up, he said.
“These are high-level athletes who don’t want to come off the field. They are competitive,” said Dr. Szepiela of athletes at the university level.
“You can’t get involved in the game. You can’t give in when the coach says he needs that player,” said Dr. Szepiela of working on the sidelines.
Recovery protocol
Once diagnosed with a concussion, recovery times can vary. Rest is most important, both mentally and physically, according to local experts. However, even before completely symptom free, low-level exercise including walking or use of a stationary bike, has been shown to be beneficial to recovery, Ms. Martin said.
Schools are required to do some baseline testing, which may be as simple as a pencil and paper test or may be a scan of the brain so that comparisons may be made if a student-athlete gets a concussion, according to Ms. Cripps.
Research data at the University of Pittsburgh shows that there are between 1.7 and 3 million sports-related and recreation-related concussion each year. Half of all concussions go unreported. Notable is that sport-related concussions were dramatically decreased during the coronavirus pandemic and its lockdowns. Those who did suffer from a concussion, often through recreational sports, significantly delayed seeking care, according to the data collected.
“Patients waited nearly a month, an average of 26 days, longer to seek care for their injuries during the COVID-19 pandemic than before, and our previous research indicates that waiting to seek care following a concussion results in longer recovery times,” said Dr. Anthony Kontos, research director at Pitt’s Sports Medicine Concussion Program.
Prior to the pandemic, an analysis of data collected from 2015 to 2017 by the American Academy of Orthopaedic Surgeons concluded that concussions in high school athletics were on the rise. Local experts say there could be a number of explanations for that, including an increase in the number of participants as well as more awareness of concussions.
“Personally, I want to believe people are taking it more seriously,” Ms. Cripps said.
First Published September 24, 2023, 4:00 a.m.