TPM #319: A Short Guide To Managing Head Injuries In Youth Athletes.
The story of the great Kelly Catlin reminds us that concussions can happen in any sport and the consequences, if not treated properly, can be tragic.
Head injuries are a risk of sport participation.
We might think of football, ice hockey, rugby and boxing as the only sports with head injury risks. The reality is that cycling, soccer, volleyball, basketball, gymnastics, skiing, just about any sport has risks.
Losing our balance and falling backwards with head snapping back is not confined to the hockey game but can happen anywhere, so can collisions.
The risks are mostly uncontrollable, to a degree, but awareness is.
There is a rising awareness of consequences of head injuries in sports like bobsled, soccer and baseball as evidence of how common and serious they are, especially if undetected or minimized.
Hearing the stories of undetected, misdiagnosed or minimized head injuries and their impact can assist organizations, coaches, parents, athletes and volunteers in recognizing how serious they can be.
Kelly Catlin was a world champion cyclist.
4 years after taking up cycling, she won Olympic Silver at 20 years old. She was also won the 2016, 2017, 2018 UCI Track Cycling World Championships. At the same time, she was a concert-quality classical violinist and an artist, was graduated summa cum laude from the University of Minnesota with a Bachelor’s degree in mathematics, spoke fluent Chinese, and was in the exclusive graduate school in mathematics at Stanford University when she committed suicide at age 23, on March 7, 2019.
In October 2018, she crashed during a training ride and broke her arm, but as was expected from her, she continued to train and race. On January 5, 2019, she crashed on a training ride in Malibu, California, but she finished her ride. On the next day, she left for the U.S. national team training camp in Colorado Springs. There she told her family that she was dizzy and felt like throwing up, so she left the camp early and flew back to school in California. Her brother believes that these were probably signs of a concussion.
This was the beginning of a downward spiral that led to one unsuccessful suicide attempt in early 2019, before taking her own life a few months later.
Her family had tracked the training ride crashes and recovery to changes in her personality. It is suspected that a second crash so close to the first one led to onset of Chronic Traumatic Encephalopathy CTE. CTE is a progressive degenerative disease which afflicts the brain of people who have suffered repeated concussions and traumatic brain injuries. It can only be found in the testing of brains after death. *
As significant as head trauma can be, repeated head trauma is obviously worse. Athletes returning to play before fully healed is a major factor in ongoing and permanent damage.
CTE is a disease of the brain, whose symptoms are often problems with impaired judgement and reasoning, impulse control and aggression. It is a documented precursor to multiple mental health issues.
What is CTE? : Chronic Traumatic Encephalopathy, or CTE, is a progressive degenerative disease affecting people who have suffered repeated concussions and traumatic brain injuries, that may occur in some athletes and others who have been exposed to concussions and repetitive head impacts. One theory about the cause of CTE is that repeated injuries to the brain causes a buildup of an abnormal form of the tau protein which may interfere with the function of the brain’s neurons. Not everyone who has a brain injury or who has been exposed to repetitive head impacts develops CTE.
What We Can Do:
Steps that sport organizations, coaches as well as parents and athletes must be educated on:
· Understanding signs of a concussion.
· Using a concussion recognition tool as part of coach’s certification (most youth sports do not have first aid professional onsite during practice and competition).
· Have a return to health protocol and process.
Do you see sudden changes in your young athletes’ personality?
Changes in mood or sudden difficulty in tasks that were not difficult?
Coming back from competition or practice where there could have been contact or jarring or head and neck?
Signs of a Concussion
A concussion can cause difficulty speaking, thinking, remembering, recognizing people, seeing, walking, balancing, staying awake, and concentrating; confusion, nausea or vomiting, irritability and other mood changes, numbness or loss of feeling, loss of coordination, feeling sleepy or inability to sleep, severe headaches, and any other change in nerve function.
The below information courtesy of Shift Concussion Management
How do I know if a concussion was sustained?
Concussions can be difficult to properly recognize given the wide range of symptoms & individual responses (especially for the lay person). Symptoms such as headache and dizziness are common yet can also occur in a variety of other sport-related issues (eg. dehydration, heat-related illness). To complicate things further, the appearance of symptoms may be delayed for several minutes or even hours after the initial injury.
Use this rule of thumb: If you, or your son/daughter is displaying one or more of the symptoms listed previously and there was an incident or trauma involving direct contact to the head or a “jostling/whiplash” effect, treat it as a concussion. It is important to realize that the mechanism of injury may be subtler and not as obvious as a “big hit.” An individual who is not acting normally, having difficulty remembering events or words or following instructions may have sustained an injury several hours previously. For athletes, there should be absolutely NO return to play on the same day as the injury regardless of the level of athletic performance.
Parents, coaches, and trainers should be taught that a symptom scale/checklist is a good method for identifying symptoms that may be indicative of concussion. For the team coach or trainer who knows the athlete well, it may be obvious that the athlete is struggling with simple questions and/or is acting unusual or different. Other cases are less apparent. Sideline concussion evaluations, which assess orientation, concentration, and memory, help to determine how well the athlete's brain is working. The Pocket Concussion Recognition Tool is a valuable sideline assessment tool that can be used to evaluate the domains above, however it is not designed to take the place of a more comprehensive evaluation by a medical professional.
What the return to play process looks like:
Once symptom free, it is recommended that each athlete undergo a graduated program of exercise testing. Similar to weight training, athletes recovering from a concussion should not skip to 100% exertion from 0% in a short time frame. Physical exertion testing is important not only for physical re-conditioning, but to guard against symptom relapse and help prevent premature return-to-sport. Even though you may feel well, running, jumping, or stick handling are things that may cause your symptoms return.
The return-to-play process is gradual.
The first stage typically involves light cycling or jogging to elevate your heart rate a moderate amount. If no symptoms are aggravated either during or for 24 hours after this exercise session,
you may progress to a more difficult workout routine.
Eventually you may advance to on-field or on-ice practice and finally full game play (with proper medical clearance).
At any time if your symptoms return, you must return to a lower level exertion (or modified activities) depending on the advice of your health professional.
More Frequently Asked Questions on concussions here courtesy of Shift Concussion Management.
The incidence of brain injuries, mental health and suicide issues with bobsledders.
The majority of soccer related concussions in female athletes are a result of athlete to athlete contact.
Did You Know?
Concussion and Whiplash:
The details of Kelly Catlin’s story courtesy of :
* https://www.drmirkin.com/histories-and-mysteries/kelly-catlin-concussion-depression-and-suicide.html
https://www.washingtonpost.com/sports/2019/07/29/kelly-catlin-death-cyclist/