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Ask The Doctor: Concussions

Ask The Doctor: Concussions
Ask The Doctor: Concussions

This month, Dr. Worrel addresses concussions and other common sport injuries.

What are your best tips for concussion prevention?

The only way to truly prevent a concussion is to avoid contact sports or any contact to the head. Concussions are considerably more common in contact sports, with football and rugby having the highest incidence, followed by hockey and soccer. For female athletes, the risk is greatest in soccer and basketball.

Football’s coaches and governing bodies have limited the amount of hitting that occurs at all levels. There have been rule changes in the NCAA and NFL intended to protect vulnerable players on the field of play.

Recognizing the potential for a concussion is the most important thing you can do for the athlete. If the athlete has had a severe blow to the head, remove him or her from play for immediate evaluation.

It is common for the concussed athlete to know they are “not right” but not realize they have a head injury. Once they have been removed from the field of play, it can be determined whether they have indeed sustained a concussion.

There are numerous products in development and in limited use that attempt to reduce the concussive forces to the head. In addition to using large caps over the helmets in practice, there are sensors being used in helmets to determine and signal the severity of a blow to the head. While there is some promising data with these products, there is not a helmet on the market that has proven to reduce the incidence of concussions. Time will tell.

Is there any special or different precaution to be taken by those who have had multiple concussions in the past?

It is most important for them to realize that they are at increased risk.

There are occasionally athletes who are unable to continue to playing their sport due to multiple concussions, particularly younger athletes.

An athlete who has sustained one or more concussions is at greater risk for another concussion. Their greatest risk is in the 10 days following their concussion.

What’s the most important step to take after a concussion?

Immediately remove the athlete from the field of play for assessment and do not return them to contact until they have fully recovered. Athletes recover from concussions at varying rates. Younger athletes tend to take longer.

Many athletes think they did not have a concussion because they were not “knocked out.” Loss of consciousness is actually rare with a concussion.

More commonly, athletes with concussions have:

  • headaches, light/noise sensitivity
  • loss of balance, coordination, reaction time
  • changes in memory, judgment, speech, and sleep

Can you explain your current role as the SMU team physician?

I, along with a team of physicians, provide coverage for all of Southern Methodist University sports. We cover football, basketball, soccer, volleyball, swimming/diving, track/field, rowing, cheer, and equestrian.

What are the most common sports injuries you see on a day-to-day basis?  

I most commonly treat sprains, strains, and overuse injuries.

How can these injuries be avoided?

While some injuries are unavoidable and may even require surgery, the majority of them are managed conservatively.

Knee injuries in soccer players have been dramatically reduced by plyometrics and warm-up exercises that develop balance and agility. The governing body for soccer, FIFA, has endorsed this practice. It is called the FIFA 11+. We know that soccer players, particularly female soccer players, are at increased risk for knee injuries. Most knee injuries are sprains and are treated conservatively.

Occasionally, more severe injuries occur, most commonly to the anterior cruciate ligament (ACL), which generally require surgery to stabilize the knee.

Shoulder injuries can be traumatic. For example, a volleyball player or soccer goalie diving for the ball, a football player getting tackled, or a collision in soccer or basketball.

This can result in a tear to the labrum deep inside the shoulder, a separation of the shoulder involving the joint between the clavicle and the shoulder blade, or even a dislocation of the shoulder. Some of these injuries require surgery in the young athlete, depending on the severity. Most of them are treated conservatively.

Treatment of these injuries initially includes rest, ice, compression, and elevation if appropriate. Bracing or taping, strengthening the stabilizing muscles, and physical therapy can be very effective at preventing re-injury and accelerating the return to play.

Common overuse injuries in athletes include inflammation of the rotator cuff, most commonly seen in swimmers and tennis players. This can typically be managed by rest and strengthening exercises. Back pain and hip pain is common in young rowers. These athletes benefit from core strengthening and training modification.

Many of the injuries I see are preventable. Appropriate management and rehabilitation is multimodal. I frequently collaborate with coaches and trainers at all levels regarding return to play, injury management, and steps to prevent re-injury.


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