Remember the days of "You just got your bell rung, get back in there!" and "Shake it off!"? Times have certainly changed, and concussion practices continue to evolve from professional sports all the way down to youth leagues. See how concussion awareness has changed from then to now.
If you took a hit to the body or head and wobbled back to the bench, odds are your coach took a look at your pupils, gave you a thumbs up, and yelled from behind you, "Wrong way!" as you stumbled back onto the field.
"Coaches should be pulling athletes out of the game if a concussion is suspected and then keeping them out until they are cleared by a medical professional. Pennsylvania and New Jersey Laws both require school athletes to have a clearance note from a medical provider before returning to contact sports, so it's important that youth leagues are following this model when possible," says Dr. Robert Franks, Medical Director of the Jefferson Comprehensive Concussion Center. Most high schools now employ athletic trainers, with many middle schools bringing on AT's to their staff when funding is available. "We educate our athletic trainers to manage sideline concussions. We use assessment tools like the Balance Error Scoring System (BESS), the Sports Concussion Assessment Tool (SCAT III), and a Vestibular/Ocular-Motor Screening (VOMS)," says Meghan Mattson, Manager of Athletic Training at Rothman Institute. "This is the same information collected by our sports concussion physicians during an exam. It has evolved into a team approach."
The mentality of hitting your hardest and at all costs was celebrated.
Today we see the rules changing in waves across sports. Pop Warner was the first to officially limit contact during practices, and now some divisions within the NCAA have banned tackling in football practices. U.S. Soccer recently instituted a massive change by banning ball heading in athletes under 11. Football players are now taught to tackle with their heads up, and we see rule changes almost yearly from the NFL that include defenseless player protections and bans on direct crown hits outside of the tackle box. While there is a need for research on how these rule changes ultimately affect concussion outcomes, it's clear that sports are evolving.
Physicians encouraged parents to wake their children every hour.
If an athlete does not meet the warning signs of a serious trauma such as a brain bleed, and they have been safely cleared by a doctor, there is no need to wake an athlete every hour for a concussion. "It's best to get an athlete back on a normal sleep schedule with minimal napping. We want athletes back to their usual patterns as soon as possible to support their recovery," says Franks.
Concussions were graded on a scale.
Concussions are no longer graded, rather, physicians' document details such as loss of consciousness, amnesia (trouble remembering events before or after the injury), medical history, and symptom type and severity. Objective scores from tools like ImPACT, SWAY Balance, and the King-Devick test can also be used during an exam to help guide the treatment plan.
In the not too distant past, many providers recommended extended periods of complete cognitive and physical rest for the treatment of concussion-sometimes at months on end.
New research is revealing that this extended rest can be detrimental to recovery, and physicians are moving toward a more proactive model of care. "Options exist for treatment now that weren't available 5 or 10 years ago. We can isolate the symptoms now that we better understand the mechanisms of injury, and we are able to tailor treatment to the source. We look at the neck muscles; we look at sleep, balance, vision, stress, and cognition. Treatment has come a long way," says Franks.
The medical information in this article is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.
The Jefferson Comprehensive Concussion Center is a collaboration between Rothman Institute, Jefferson, and Wills Eye Hospital, centrally located at The Philadelphia Navy Yard. To schedule a sports concussion appointment with the Jefferson Comprehensive Concussion Center, or at a Rothman Institute Sports Concussion location, call 1-800-JEFF-NOW or visit Jefferson.edu/Concussion.