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Next step in combating concussion: Recognition

To keep injured and potentially injured players from greater peril, new laws have shifted responsibility from coaches to primary-care physicians and athletic trainers, who must perceive danger signs.

High school football is again at full tilt and Dr. Stanley Herring, who has treated sports injuries for 30 years, is cautiously optimistic. Here’s why:

Canfield, a risk-management company that insures schools against tragic events, reported that in 2010, for the first time in five years, Washington state’s gridiron players experienced no devastating brain injuries.

“I don’t know if that's us or good luck, but it was exciting to hear,” said Herring, UW Medicine director of spine, sports and musculoskeletal medicine.

“If every young athlete we see at our clinic has a concussion, we're not seeing enough young athletes,” Dr. Stanley Herring said. The “us” to which he referred is the coalition that advocated for the Zackery Lystedt law, a mandate to protect Washington’s youth athletes from devastating brain injuries like the one that befell Lystedt, then 13, in a prep football game. UW Medicine’s Seattle Sports Concussion Program, which Herring co-directs, was created in 2009 as part of that effort.

In two years, the law has galvanized the nation: 28 states have enacted similar legislation and all but a handful of the rest are on that path. Meanwhile, the concussion program’s practitioners, based at Harborview and Seattle Children’s, have raised risk awareness at 60-plus seminars nationwide attended by thousands of coaches, parents, administrators and primary-care physicians (PCPs).

Attendees often are alarmed to hear that the concussion rate in high school girls’ soccer is nearly as high as in boys’ football. In sports that both sexes play, girls’ concussion rates are higher.

In determining players’ fitness to return to play, the Lystedt law shifted the burden from coaches to athletic trainers and PCPs. Their recognition of danger signs is crucial.

“You often can't stop the first concussion. It’s how you treat it that makes a difference,” Herring said. “If it’s a child’s second or third concussion, if symptoms linger more than two weeks or if they have modifiers – learning disabilities, migraine headaches, ADD or ADHD, anxiety or depression – outcomes tend to be worse.

“Even if an athlete has had just one concussion but severe, longstanding symptoms, or starts to have concussive symptoms with smaller taps to the head, these are the cases that we’d hope primary-care physicians would refer and try not to solve,” he said.

Herring thinks the incidence of concussions is unchanged; rather, the reporting has increased – a trend he hopes will continue.

“If every young athlete we see at our clinic has a concussion, we're not seeing enough young athletes. They should be referred even with suspected symptoms.”

“Primary physicians and athletic trainers can remind parents to be involved and engaged in their kids’ sports,” Dr. Rich Ellenbogen said. Parents whose kids play contact sports should champion the culture change, too, said Dr. Rich Ellenbogen, UW chair of neurological surgery and the concussion program’s co-medical director.

“Primary physicians and athletic trainers can remind parents to be involved and engaged in their kids’ sports. I’m so proud when I hear a mom tell me about being at a soccer game and a girl takes a knee to the head and the parent is running to the sidelines to get the girl taken out of the game. This type of advocacy needs to be pervasive.”

Since March 2010, Ellenbogen has co-chaired the National Football League’s head, neck and spine committee. It just issued a more stringent cognitive evaluation for players suspected of having a concussion, in which the player is walked off the field and his helmet taken away.

“Kids pay attention to what pro players do. At the end of the day, this is about the kids.”

To refer a patient or learn more, contact UW Medicine’s Seattle Sports Concussion Program at 206.744.8000.

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