Sports Law Handbook

** SPORTS MEDICINE / FITNESS News **

End Of Summer Means Football Season: Prevent Potentially Tragic Head And Neck Injuries
http://www.medicalnewstoday.com/articles/161545.php

Every year, there are tragic stories about athletes who suffer life-altering football-related injuries to the brain and spine. According to the American Association of Neurological Surgeons (AANS), in 2008, football contributed to the second highest number of sports-related head injuries, behind cycling. Of the nearly 41,000 people treated for football-related head injuries at U.S. hospital emergency rooms, 16,900 were age 14 and younger. As far as spinal cord injury, football comes in as the third leading sports-related cause after diving and cycling.

While football is a collision sport with inevitable risks, most serious neurological injuries can be prevented by following a few safety measures,” stated Brian R. Subach, MD, FACS, a Virginia-based neurosurgeon who is a team spine surgeon for the Washington Redskins. “Although data indicate a reduction in the number of cervical cord and brain injuries with incomplete neurological recovery when compared to data published in the early 1970s, basic rules need to be followed and injury prevention taken seriously by the players, parents and coaches,” added Dr. Subach.

Injuries to the cervical spine are usually associated with high-velocity collisions between players, causing acceleration or deceleration of the head on the neck. Acceleration often causes a whiplash type of extension force on the neck, while deceleration often results in forward-bending (flexion) forces. Spear-tackling or spearing, banned in American football since 1976, occurs when a player uses the top of the helmet as the first point of contact with another player. Spearing was banned secondary to the high number of associated cervical spine injuries and quadriplegia. Advances in the construction of helmets and shoulder pads, as well as proper coaching from an early age have combined to dramatically reduce the number of serious injuries.

The National Center for Catastrophic Sport Injury Research tracks a number of neurological injury statistics related to football. Statistics from 1977-2008:

Football Neck and Head Injury Statistics and Cases

– Cervical-spine injuries are estimated to occur in 10-15 percent of all football players, most commonly in linemen and defensive players.

– During the past 32 years, there have been a total of 295 football players with incomplete neurological recovery related to cervical spinal cord injury (SCI): 243 high school players; 33 college players; 13 professionals; and six sandlot players.

– From 1984-2008, there have been 121 traumatic brain injuries with incomplete recovery.

– A 17-year-old high school football player was injured in a preseason scrimmage. He was assisting on a tackle from the linebacker position. He flipped over and landed on his head on the turf. He is now quadriplegic.

– A 20- year old college football player suffered a cervical spine injury during a game, causing transient paralysis. He made a full recovery but was advised that his football career is over.

– A 16-year-old high school football player was injured while tackling during a game after a helmet-to-helmet hit. He underwent surgery to remove a blood clot from the brain and has recovered, but was advised to never play football again.

– A 14-year-old high school football player was hit on the left side of the head four times during a practice drill. He underwent surgery to remove a blood clot from the brain, was in a medically induced coma, had surgery, and was scheduled for another surgery in three months. He has not fully recovered.

Concussion

A concussion is an injury to the brain that results in temporary loss of normal brain function. A blow to the head is a common cause of concussion. Cuts or bruises may be present on the head or face, but in many cases of concussion, there are no external signs of trauma. A “Second-impact” syndrome results in acute, often fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. The impact is thought to cause vascular congestion and rapidly increasing intracranial pressure, which may be difficult or impossible to control.

According to the AANS, the annual incidence of football-related concussion in the United States is estimated at 300,000. At the high school level, studies show that while 10 to 15 percent of athletes playing contact sports sustain concussions each year, only a fraction receive proper treatment. Some team physicians and trainers evaluate an athlete’s mental status by using a five-minute series of questions and physical exercises known as the Standardized Assessment of Concussion (SAC). More recently, teams have employed ImPACT, a 25-minute computer based testing program specifically designed for the management of sports-related concussion. A player who has sustained a concussion is three to six times more likely to sustain another one. “While the decision on when an athlete is ready to return to play isn’t straightforward, every player should receive baseline neurological testing before the season so that the results can be used for comparison in the event the athlete receives a blow to the head,” said Dr. Subach.

Football-Related Head and Neck Injury Prevention Tips

– All players should receive preseason physical exams and those with a history of prior brain or spinal injuries, including concussions, should be identified.

– Football players should receive adequate preconditioning and strengthening of the head and neck muscles.

– Coaches and officials should discourage players from using the top of their football helmets as battering rams when blocking, hitting, tackling, and ball carrying.

– Coaches, physicians and trainers should ensure that the players’ equipment is properly fitted, especially the helmet, and that straps are always locked.

– Coaches must be prepared for a possible catastrophic SCI. The entire staff must know what to do in such a case, because being prepared and well informed might make all the difference in preventing permanent disability.

– The rules prohibiting spearing should be enforced in practice and games.

– Ball carriers should be taught to not lower their heads when making contact with the tackler to avoid helmet-to-helmet collisions.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,600 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.

Source: American Association of Neurological Surgeons

Brain Damage In Amateur Boxers Detected By Blood Test
http://www.medicalnewstoday.com/articles/161475.php

A blood test can now be used to detect brain damage in amateur boxers. Deterioration of nerve cells seems to occur even after a two-month break from boxing. This is shown in a new study from the Sahlgrenska Academy.

The results of the study conducted by researchers at the Sahlgrenska Academy and the Erciyes University Medical School in Turkey are published in the current issue of the scientific journal Brain Injury.

The findings constitute further evidence that repeated blows to the head may damage the brain.

‘The blows seem to lead to a deterioration of nerve cells that lasts for a relatively long time. It is important that this is made known to participants in sports that involve kicks and blows to the head and to parents who let their children participate’, says Henrik Zetterberg, Reader at the Department of Psychiatry and Neurochemistry at the Sahlgrenska Academy.

The study included 44 Turkish amateur boxers, whose blood samples were collected in the beginning of a training camp after a two-month break from boxing. The results were compared to those found in a healthy control group. The researchers analysed several proteins that can be used to identify brain damage, and found that the levels of one protein, called NSE, were higher among the boxers than in the control group.

‘Their levels were high even after two months off from boxing. This indicates that the harmful processes in the brain continue even if the boxers have not recently experienced head trauma’, says Zetterberg.

The same team of researchers has previously been able to show that amateur boxing leads to increased levels of brain damage markers in spinal fluid.

‘A blood test is much easier to take, and it would be interesting to test athletes repeatedly following matches and while they recover from knockouts to see how the levels of NSE change over time. These types of biomarkers could be useful in sports medicine to help decide when an athlete should abstain from training and competition. But the method must first be evaluated further’, says Zetterberg.

Source:
Henrik Zetterberg
University of Gothenburg

Young Athletes At Risk For Heat Illness As Fall Sports Begin
http://www.medicalnewstoday.com/articles/161222.php

As the start of another school year looms and practices for fall sports begin, young athletes – and not just football players – are challenged by the hot weather and face significant heat injury and illness risks, say experts from the American College of Sports Medicine (ACSM).

Education, planning, acclimatization, modification, and monitoring are all key to keeping heat injuries and illnesses at bay – effective prevention strategies that coaches supervising practices often don’t implement, says Michael F. Bergeron, Ph.D., an ACSM Fellow and Trustee and one of the nation’s most highly regarded youth sports heat stress experts.

“Teaching coaches the warning signs of heat illness would be a huge step toward prevention,” said Bergeron, who co-wrote the ACSM Roundtable Consensus Statement on Youth Football Heat Stress and Injury Risk. “But it’s not enough. Coaches need to progressively introduce practice duration and intensity, as well as the uniform and any protective equipment, so that young athletes can safely adapt. Regular fluid breaks should be mandatory and practice should be appropriately modified for safety as the heat and humidity increase. Long gone are the days of refusing players water or using heat as a strategy to ‘toughen up’ a player. Unless the coach wants a collapsed athlete – or worse – on the field, it’s just not acceptable. All athletes need to be closely monitored for signs and symptoms of developing heat illness, and participation should immediately stop and medical attention should be promptly sought at the earliest point of recognition.”

The National Center for Catastrophic Injury Research, commissioned by the National Federation of State High School Associations, says that “heat-related deaths continue to be the cause of a majority of indirect deaths” in high school sports. In the report, heat stroke and other heat illnesses were experienced in variety of sports, including cross-country running and wrestling, with wrestlers working out in heat-holding rubber suits to try to “make weight” for events. Even marching bands should be concerned and take precautions – a study at the 2009 ACSM Annual Meeting showed band participants had heat illness risk and levels similar to those of athletes.

“I’ve attended numerous junior tennis tournaments where kids were competing from morning to dusk in excruciatingly hot summer conditions,” Bergeron said. “Football might get the most attention for severe heat-related injuries and illnesses, but the risk in other sports is very real.”

The ACSM Consensus Statement provides helpful prevention guidelines that can be applied to all outdoor sports, not just football:

- Avoid holding practices between 12 and 4 p.m., typically the hottest hours of the day (although later hours can also be as hot or hotter).

- When heat is extreme, hold practices indoors or use outdoor practices as lighter walk-through sessions.

- Increase the frequency and duration of rest breaks in the shade during practice, and give plenty of opportunities for sufficient fluid consumption.

In addition to promoting these proven heat illness prevention strategies, ACSM is developing new initiatives to educate not just coaches and schools, but also sport governing bodies and policymakers on heat illness prevention.

Source
The American College of Sports Medicine