Concussions in American Football
Major advancements in sport-related concussion (SRC) management have been made across time to improve the safety of contact sports, including football. Nevertheless, these advances are often overlooked due to concerns regarding the potential long-term effects of SRC. Although further research is needed, it is critical that current efforts are focused on better understanding SRC in order to recognize and change ongoing factors leading to prolonged recoveries, increased risk for injury, and potentially long-term effects. To reduce risk for these outcomes, future focus must be placed on increased education efforts, immediate reporting of injury, prevention techniques, targeted treatment, and the development of multidisciplinary treatment teams nationwide. Finally, with the progress in understanding concussion, it is important to remain vigilant of additional advances that will help to further improve the safety of contact sports, including football.
Cognitive/Fatigue. A global concussion factor (including cognitive, fatigue, and migraine symptoms) has been identified within 1 to 7 days of injury. Although this factor of symptoms generally resolves during the acute recovery period, it persists in select cases.13 Symptoms typically include fatigue, decreased energy levels, nonspecific headaches, potential sleep disruption, increased symptoms towards the end of the day, difficulty concentrating, and increased headache with cognitive activities.29,30,35 Routine schedule, daily physical activity, exertion therapy, pharmacologic intervention (eg, amantadine), and school/work accommodations are potential treatment options.30
Conclusion
Advancements in SRC management warrant change in the conversations regarding concussion in football. Specifically, conversations should address the current understanding of concussion and improvements in the safety of football through stricter concussion guidelines, detailed sideline evaluations, recognition of risk factors, improved acute management, and identification of concussion profiles that help to direct individualized treatment plans and targeted rehabilitation strategies. The biggest concerns related to concussions in football include underreporting of injury, premature return to play, and receiving routine rather than individualized treatment. Therefore, to further improve the safety of football and management of concussion it is essential that future efforts focus on the following 6 areas:
Education: Improved understanding of concussion is imperative to reducing poor outcomes and widespread concerns.
Immediate reporting: Reporting of concussion must be expected and encouraged through consistent responses by coaches to reduce underreporting and fear of reporting in athletes.
Prevention techniques: Athletes must be taught proper form and playing techniques to reduce the risk for concussion. Proper form and technique should be incentivized.
Targeted treatment: Individualized treatment plans and targeted rehabilitation strategies must be developed based on the identified clinical profile(s) to avoid nonspecific treatment recommendations.
Multidisciplinary treatment teams: Given the heterogeneous symptoms profiles and need for care provided by different medical specialties, multidisciplinary teams are essential.
Remain current: With the progress in understanding concussion, providers must remain vigilant of future advances in concussion management to further improve the safety of football.
Am J Orthop. 2016;45(6):352-356. Copyright Frontline Medical Communications Inc. 2016. All rights reserved.
