Create Safe Concussion Symptom Environment, de Lench Tells National Concussion Conference

Unfortunately, there are still far too many coaches in this country, of youth gymnastics, football, field hockey, soccer, lacrosse, basketball, skiing, who berate and ostracize players complaining of concussion symptoms, who call them “wimps,” who yell at doctors, and athletic trainers for refusing to let a player with concussion symptoms go back into the game, and have kicked kids off of the team for refusing to play for two weeks because of a concussion. I hear these stories all too often.

Parents have a right to expect that, when they entrust their children to a sports program that it will take reasonable precautions to protect them against harm. In other words, parents have a right to expect that the entire team to whom they entrust their children’s safety — including the national governing body for the child’s sport, the state association, the athletic or club director, the athletic trainer (if there is one), and especially the coaches – are part of the concussion solution, not part of the problem.

That they will witness their child suffering a serious injury playing sports is one of a parent’s worst nightmares. The possibility of injury was often in the back of my mind when I watched my children play sports. Two of my sons have received a total of seven concussions. Thank you Hunter–he is my golfer.

But because the signs and symptoms of concussions are not as obvious as a broken leg or a sprained ankle and are often very subtle, because most don’t involve a loss of consciousness, and because self-reporting by athletes is critical to the detection and treatment of concussions, the only way parents can sit in the stands without worrying sick about what might happen if their son or daughter suffers a concussion is if they know the program, and especially the coach, takes concussions very seriously and that every member of the team is using the same playbook.How are parents going to know?

Parents will know that the program and the coach take concussions seriously if the coach has met with parents and athletes before the start of every season to educate them about the dangers of concussions.

Parents will know the program and the coach take concussions seriously if the meeting includes a presentation by a medical physician familiar with the grading and evaluation of concussions and return to play guidelines; a doctor who can educate parents on the important rolethey play in their child’s recovery from a suspected concussion, especially in terms of checking for signs of deteriorating mental statusrequiring immediate hospitalization, ensuring that their child gets the cognitive rest required, and monitoring for continuing concussion signs or symptoms that should absolutely rule out a return to play and may indicate the presence of post-concussion syndrome.

Parents will know that a program takes concussions seriously if it has brought in former athletes from the school to share personal stories about the consequences of continuing to play with concussion symptoms or after a series of concussions, to tell them about their reoccurring headaches, their depression, and their memory problems.

Parents will know that a program takes concussions seriously if it brings in members of their peer group — parents of concussed athletes like me — to emphasize how critical it is that, in making the all-important return-to-play decision, they consider not the here and now, but the entire life cycle of their child: if I let her play now, what will her life be like in ten, twenty, thirty years? Will she be suffering from chronic, major depression, or Alzheimer’s?

Parents will know that a coach takes concussions seriously if they hear the coach at the preseason safety meeting actively encourageathletes not only to self-report post-concussion symptoms, but to inform the coaching staff or athletic trainer about teammates with symptoms if they fail to report them to the staff.

Parents will know that the coach takes concussions seriously if he tells them that if they self-report their symptoms, they will not jeopardize their place on the team, but also that, if they don’t play by the rules, if they don’t report symptoms — their own or a fellow player’s — if they lie about them when asked, if they try to fudge their answers on baseline neuropsychological tests, if they say they are symptom-free so that they can be cleared to play in the next game, they will be suspended or kicked off the team entirely for violating team rules.

Parents will know that the coach and the program takes concussions seriously if they enforce strict penalties for any lacrosse, ice or field hockey player who strikes a blow to another players head in a game or practice.

Parents will know that the coach and the program takes concussions seriously if they know that the athletic director or administrator, the coach, the athletic trainer (if there is one), and the team doctor have, at the very least, agreed upon and adopted a philosophy for grading and managing concussions before the start of the season and use it consistently during the season, regardless of the athlete or circumstances surrounding the injury. In other words, that no double standard when it comes to concussions will be applied — one for regular players, another, more lenient, standard for the “stars.”

The sad fact, and what makes it sometimes hard for parents to truly believe that programs are taking concussions seriously, is that many of the sports programs in which their children participate do not follow any set of return-to-play guidelines, and many clinicians believe that the current return-to-play guidelines are too conservative. When parents are kept in the dark like that, when they have no clue as to how a program treats concussions, their anxiety level naturally goes up. This happened to me when my son Taylor sustained a soccer concussion and his AT told him he only needed to sit out one day.

Some advocate against any rule that would flat out bar players who experience concussion signs or symptoms from returning to the same game or practice. They view such a rule as not only unworkable but counter-productive. Their fear is that such a strict, unyielding rule is likely to be evaded by the very players it is designed to protect, leading players to simply stop telling sideline medical personnel that they have anysymptoms so as to avoid being benched for the remainder of the game. Many parents, either out of ignorance of the risks or out of a desire to see their child achieve athletic success, adhere to this view as well.

Others, myself included, believe that the rule that best protects our children, is the easiest to apply and the one best supported by the available science, is that reflected in the consensus statement of the 2nd International Conference on Concussion in Sport held in Prague in 2004: a rule that recommends no return to play for concussed athletes in the same game regardless of how quickly the symptoms appear — to clear.I strongly believe that, if, as I suggested earlier, the penalty for not reporting symptoms, for not playing by the rules, is to be suspended or get kicked off the team, then players will not, as some fear, try to evade this rule; that adoption of such a rule will not lead players to simply stop telling sideline medical personnel that they have any symptoms so as to avoid being sidelined for the remainder of the game.

All of the recent consensus statements recommend more conservative management of concussions in athletes under the age of 18.

In the face of such evidence, the only reason I can think of for allowing a youth athlete to return to play in the same game after concussion symptoms clear is because it increases the team’s chances of winning. As I write about at length in my book and on the MomsTeam website, our youth sports culture has become so obsessed with winning that not only has fun taken a back seat, but, more dangerously, safety as well.

Winning, at any level simply isn’t worth it, at least when it comes to concussions, which are simply in a league of their own apart from other types of injuries. To the extent our culture teaches that winning is more important for athletes who don’t get paid to have their clocks cleaned for a living, needs to change.