This week, the NFL and the CFL have announced they will introduce a new sideline concussion test this season. The NFL was founded 1922. The CFL had its genesis as the Canadian Rugby Football Union in 1884.
These sports have been around for more than a century. Finally, with a not-so-delicate push by documentaries such as League of Denial and lawsuits brought by former players suffering from chronic traumatic encephalopathy, or C.T.E., professional sports organizations are beginning to admit what they don't know about concussions.
Now, children should hope there is a trickle-down effect to coaches, and especially parents.
I suffered a concussion at the age of 12. I regained cognitive function while standing in my living room, unable to explain the scrapes down the right side of my body.
I had apparently been in a bicycle accident. After spending 24 hours in a hospital observation room—being awoken every hour—I returned home, and resumed my regular sporting activities a short while later.
That course of treatment could have killed me.
It would not really have been anybody's fault. Little was understood about concussions in 1984, or 1994, or even 2004.
But, in 2015, there are fewer and fewer excuses for coaches, doctors, trainers, and parents to rely on when they send an athlete back onto the field after they've suffered a head injury, as minor as it may seem at the time.
Knowing that, there will still be young hockey, rugby, and football players (three of the most violent sports as far as concussions are concerned) who will be told to "Man up!" or to "Get back out there!" because "Everybody gets hit; it's part of the game."
John Boulay is a certified athletic therapist, a part-time professor at Concordia University's Department of Exercise Science and Athletic Therapy, and teaches Advanced Emergency Care in Sports.
He is also part of an provincial body studying concussions.
His first suggestion, even before I began the interview, was to post this great YouTube concussion primer, put together by Doctor Mike Evans:
Mr. Boulay emphasizes how difficult it is to diagnose a concussion, especially for parents. The real problem is, if you aren't careful, you could be ignoring a dangerous situation.
As hard as it may be, it cannot be left up to (parents) to decide when our children are free to return to the field.
Why? Because a concussion hides a potential life-threatening entity.
Somebody hits their head, and they have all these concussion signs. Is it a concussion? We’re not sure, we’ll tell you in one week if it was.
If you survive the next 20 or 30 minutes, you’re okay.
The next timeline is the next 3 to 4 hours; you’re okay.
The next 24 hours? You’re okay.
This continues for up to 4 to 5 to 6 days.
These guidelines, he mentions, are in place for anyone, over the age of 25.
For anyone younger than that, the wait period extends to two weeks because the frontal area of the brain only matures between the ages of 20 and 30.
It is imperative that parents and coaches are able to identify the signs and symptoms of a concussion in children.
There are 22 of them:
- Headache - Nausea
- Balance Problems - Dizziness
- Fatigue - Sleep more than usual
- Drowsiness - Sensitivity to Light
- Sensitivity to Noise - Irritability
- Sadness - Nervousness
- Feeling more Emotional - Feeling slowed down
- Feeling "foggy" - Difficulty Concentrating
- Difficulty Remembering - Visual Problems
- Getting confused - Clumsy
- Answering questions more slowly.
Of course, John Boulay explains, it's important to understand how these symptoms compare to your child's baseline behavior. If your son or daughter normally gets headaches in a moving car, or has a habit of being a little clumsy, you would look for these signs to be worse than usual.
So, you child gets tackled heavily, or is the recipient of some other form of head trauma on the field, and they exhibits any of these signs or symptoms for only a day or two, Boulay warns against shrugging it off and saying "Oh, they're fine. They can play again on Sunday."
Your job as a parent is to recognize these signs and symptoms of a concussion. If they abide within 15 minutes, don’t worry about it (they don't need to go to a hospital). But they’re still off for two weeks. Even if he’s fine after 15 minutes.
We don’t know if it’s an evolving catastrophe or not. And we don’t know if those symptoms are going to pile onto each other.
The new protocol is to have an asymptomatic week, and it is now "Return to Learn" before "Return to Play".
"Return to Learn" is a return to cognitive function. (After one week) you have to be able to read, you have to be able to focus, you have to able to do homework assignments, and exams (symptom free).
There’s another phenomenon, which is outside the concussion realm, it’s called “Second Impact Syndrome.”
It’s not a bleed, because bleeds are what we usually die of. You don’t die from a concussion, except for this rare phenomenon.
What happens is, when a child hits their head a second time while they still have symptoms, there is a great amount of swelling to the point where it’s pushing so hard it’s herniating the brain and causing extreme congestion….intracranial pressure.
The second impact only happens if you play with symptoms.
IGNORING THE SYMPTOMS, OR HIDING THEM FROM PARENTS OR COACHES CAN BE FATAL
I’ve been a therapist at judo camp for 22 years. In my 22 years we’ve had 2 deaths—a 14-year-old and a 16-year-old—exactly for the reason I’m talking about. Not a second impact, but rather going back and not being monitored. The 16-year-old in Manitoba hit his head, told his parents, but never told the coach. He went back, hit his head again two days later and died. An epidural bleed.
The second one, in Alma, Quebec in 1997, hit his head, told his parents, but never told the coach. He went back. He didn’t hit his head again, he just started jogging to warm up for judo, and the clot dislodged and he died.
In those two cases, if they had been withheld, they would have been alive. So that’s why we only know after a week.
It used to be, since 2001, a six to seven day layoff. As of last year, more literature is coming, it’s changing all the time. It’s now two weeks for anyone under 25-years-old. One week "Return to Learn" before "Return to Play."
If the symptoms continue to worsen within the first fifteen minutes, or the child vomits three times within the first twenty-four hours, he or she should be taken to the hospital.
Otherwise, they can be kept at home, and monitored. But, even how parents should monitor their child has evolved. No more waking them up every hour or two overnight.
At the time of injury, you take the signs and symptoms. If they’re okay 2 or 3 hours later, they’re probably okay to go to bed. Two hours later you go and see that they’re okay, that they’re not seizing, that they don’t have one eye open. Or, if they’re awake, you’ll know why they don’t feel well the next day; because they didn’t sleep well all night.
For now, you leave them be, you go and check on them in two hours, and then you go and check on them in four hours.
Then 24, 48, and 72 hours. It takes six or seven days to find the evolution. What you want is to see the symptoms (improving). If they’re not doing well, then you have to get yourself to a concussion clinic.
BUT WHAT ABOUT PARENTS WHO SAY, "BUT LOOK AT HIM, HE'S FINE!"
There’s two things. If he has active symptoms, he could dislodge a clot; he could recommence a bleed. So you can have an acute evolving catastrophe. Or you’re adding more sub-concussive hits to an already accumulating problem. After they’ve had two or three in a row, it doesn’t take much; the threshold decreases. The next hit they have, instead of having a little concussion, they’re going to have a big one, and this can throw a kid’s life out of whack for weeks, for months, for years.
DO HELMETS PREVENT CONCUSSIONS?
Helmets can help reduce the impact, but there is no helmet that will help reduce the incidents of a concussions. You can still get skull fractures, too. If you're skiing at 30 km/h and hit a tree (with a helmet), you’re going to get a concussion. Maybe it helps with a reduction, but is won’t prevent it 100%. With the mechanisms of injury, you don’t have to hit your helmet; you can hit your chin, you can fall on your buttocks. It’s the brain hitting against the inside of its cell.
John mentions a frightening statistic: two out of three concussions are not properly diagnosed and treated. Which means those children are returning to play before their brains have healed.
It's one thing to be your child's cheerleader, it's another to push them past the point of what is safe and logical.
Listen, concussions happen. We’re not going to put the kids in a padded room. Play rugby, and football, and all that. But, play by the rules. And the rules are: you cross the line, you’re out. You have concussion signs? You’re out for two weeks. It’s only 2 weeks! It’s only a game.
Especially elite athletes. Why are they going to school? You want to leave with a degree, right? You want to leave with more intelligence than you came in with.
It is not worth it. I’ve worked at the professional and the Olympic level. I will pull my kid out. It’s an Olympic Games? I don’t care. People will look at me, “You can’t. This is so important.” I’m the advocate for the kid, I should protect the kid; I should be sued if I don’t do that.
Parents should be even more careful than I am.