AFM RSS Feed Follow Us on Twitter       

   User Name    Password 
      Password Help

Article Categories

AFM Magazine

AFM Magazine

Brain Damage

© More from this issue

Click for Printer Friendly Version          

A minor knock on the head can have big consequences

In the past decade, researchers HAVE concluded head injuries, which seem relatively minor and insignificant, could cause permanent brain damage. Due to the potentially serious consequences, even minor head injuries should be a concern to coaches, trainers, and players.

The reasons are obvious: Football players are prone to head injuries. Surveys have shown that roughly 10 percent of all college football players will sustain mild head injuries in any given season and 40 percent will have at least one in their high school and college careers.

The chances of suffering a head injury are slightly greater in a game situation (56%) than in a practice situation (44%). And, of course, certain types of players are more prone to head injuries than others. Special team players run the greatest risk. Forty-four percent of players are injured while tackling or blocking, 32 percent are hurt while they're being tackled or blocked. Over 54 percent of all injuries involve direct impact to the head either by contact with another helmet (21%), torso (12%), foot (9-12%), or knee (12-18%). Being propelled into something, like another player, or making quick stops that injure the neck, and damage the arteries that supply blood to the brain are among the most common cause of neck injuries. They can result in specific damage (focal injuries) and/or damage to many areas of the brain (diffuse injury).

To deal with the injuries, players, coaches and trainers should know how best to evaluate and treat them.

In 1945, football teams commonly employed what was called "Quigley's Rule" to provide a measurement of protection from the cumulative effects of injuries to the brain. According to the rule, a player who suffered three or more concussions in one season was sidelined. Knowing they'd be put on the bench, many players either minimized the extent of their injuries or denied them altogether.

That's who those who still use the rule run the risk of allowing injuries to go undetected. The rule, in part, turned mild head injuries into a silent epidemic. Unfortunately, ignoring head injuries that are accompanied by even a brief loss of consciousness may have long-term cognitive, psychological, and personality effects.

A mild head injury is commonly called a concussion. Concussions are an instantaneous reduction or loss of consciousness. They can range from no loss of consciousness, in which symptoms may be mild confusion and ringing in the ears (tinnitus), to a loss of consciousness for as long as five minutes. Those who lose consciousness may experience confusion, loss of memory about events that took place before the accident (refrograde amnesia), unsteadiness (etexia), and even a mild failure to understand simple instructions (aphasia). Concussions were once believed to be completely reversible, based on the assumption that no structural neurological damage occurred, and that, in most cases, recovery was relatively rapid. However, researchers today believe this may not always be the case.

The term "mild" in mild head injury simply refers to the amount of time a person is unconscious. However, the effects of the injury may be anything but mild. Changes may be immediately noticeable or may appear days or weeks later. In general, people who have suffered a head injury will have difficulty processing information, their reaction time will be slow, and they may have trouble speaking or understanding. The most common symptom is memory disturbance. But, Individuals may also show personality changes, such as irritability. They may complain of headaches, dizziness, and fatigue. All of these symptoms together are sometimes referred to as "post concussion syndrome." These symptoms may result from physical damage to the brain, from a psychological reaction to the injury, or a combination of both.

Due to the nature of mild head injuries and the potential for long-term brain damage, players should be evaluated and treated immediately. Researchers generally agree that the best measure of severity is the length of altered consciousness, memory disturbance, and any physical evidence, such as cuts, scratches, bruises, and swelling.

Players who have suffered head injuries should be asked simple questions to determine how much memory, if any, they have lost. They should be asked about events that occurred before the injury. They should also be asked simple questions, such as how many fingers are raised on a hand or to solve basic math problems. They should also be asked general questions, such as, "Where did you go after you left the playing field?" and "What are some of your plays and assignments?" Another technique in examining memory loss is to use two word pairs such as "crush/dark" or "pin/grocery" at intervals of one, three, and five minutes. A players should be able to remember the word pairs each time. Errors suggest an impairment and injury.

Researchers Jennett and Teasdale developed a rough measure of severity using the length of Post Traumatic Amnesia. It is based on how much a person can remember before the injury occurred. Based on a person's ability to remember, the researchers suggest the following classification scheme:

Less than 5 minutes: Very Mild
Less than 1 hour: Mild
1 to 24 hours: Moderate

It is easy to see that, if memory is not immediately tested on the field, it will not be easy to detect a problem. As a result, an undetected injury may not become evident until days or weeks later. In such a case, a player may initially appear to function normally, however, as time passes, problems may appear. For example, he may not be able to execute a newly-learned play, may ad-lib inappropriately on standard plays, or may become easily fatigued during practice or games. He may forget appointments or other activities. Other notable changes might be vagueness in speech, manipulation of language, irritability and lack of coordination. An injury that goes undetected will cause problems in many other areas of an athlete's daily life.

The football player who suffers a mild head injury may exhibit rapid and perhaps complete recovery within 5-10 days after an injury. However, researchers have demonstrated that the effects of mild head injuries can persist for up to six months. This is complicated even further if the injuries are not assessed rapidly and properly.

Due to the cumulative effects of mild head injury and the possibility of brain damage, coaches and athletic trainers need to be aware of the following: the severity of the initial injury; the number of injuries a player has previously sustained, and the symptoms that develop. It is important that trainers and coaches know assessment techniques so they can quickly and accurately determine if a player should remain in the game. Since time is an important factor in determining the extent of a mild head injury, quick assessment of the athlete's injury is critical.

Since the effects of head injuries are cumulative, trainers should keep a record that provides information of an athlete's past head injuries, the extent of the injury, and the amount of time he was unconscious. Such a record provides a detailed, permanent account of each player's injuries. The record could also be used to determine whether a player should continue in the game.

Like other injuries, prevention is key. But education can help substantially reduce the effects of head injuries and provide for an overall attitude of team welfare.

John F. Doronzo, PhD., and Thomas Van Dillen, B.S. work at the HealthSouth Head Injury Rehabilitation Center, St. Louis, Mo.

Due to the nature of mild head injuries and the potential for long-term brain damage, players should be evaluated and treated immediately.

Evaluation Methods for identifying Severity of Mild Head Injuries

1. Observe the length of altered consciousness

2. Observe memory disturbance following the injury (Post Traumatic Amnesia) through memory evaluation, such as:

Questioning a player's immediate memory by quizzing him about digit recall, simple arithmetic, or reverse spelling.

Questioning players concerning recent events about the game, game assignments, etc.

Questioning player's recall by asking them to remember a pair of words at various time intervals.

3. Observe notable changes in personality, headaches, dizziness, fatigue, vagueness in speech, manipulation of language, and lack of coordination. The evaluator must be aware of the severity of the initial injury, the number of injuries a player has previously sustained, and the symptoms that develop.


AFM Videos Streaming Memberships Now Available Digital Download - 304 Pages of Football Forms for the Winning Coach


Copyright 2024,
All Rights Reserved