Looking at concussions in high school sports

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A crushing helmet-to-helmet blow. A quick whipping of the head and neck caused by a jolting hit. A devastating face-plant into the sometimes-unforgiving turf. These are just a few of the ways high school football athletes can fall victim to head trauma and suffer a potentially harmful concussion.

With the fall high school sports season now underway on Long Island, it’s essential athletes are protected from the possibility of brain injury that sometimes accompanies head trauma. Unfortunately, concussions in high school football are sometimes all-too-common.

Concussions occur from a violent jarring or shaking that results in a disturbance of brain function, according to the U.S. National Library of Medicine. Simply, the brain ricochets off the skull. While many concussions are considered minor traumatic brain injuries, its symptoms range from mild (confusion, headache, light-sensitivity) to severe (loss of consciousness, convulsions, coma). And maybe even death.

“In younger players who are not as muscular, the neck muscles supporting the head may not be as strong, which can worsen the effect of head injuries,” said top-rated Long Island pediatric neurologist Dr. Robin Smith. “The short-term consequences include post-concussion syndrome -- significant, persistent and often disabling headaches which can be difficult to treat. Other problems include difficulty with concentration, which impacts their academic performance and mood; sleep difficulties with anxiety and even depression. These can persist for weeks or even months.”

Dr. Smith, who works for NRAD Medical Associates in Woodbury and is affiliated with Cohen Children's Medical Center of New York, said repeated concussions can have long-term consequences, including cognitive impairment. “There is evidence to indicate that even supposedly minor head injuries cause injury to the brain at a microscopic level -- interruption in normal metabolic processes and contusions (bruising) of the brain tissue,” he said.

Each year, emergency rooms across the country treat an estimated 173,285 sports- and recreation-related traumatic brain injuries, including concussions, in people age 19 and younger, the Centers for Disease Control reports. Of those reported injuries, 55,007 are related to football.

While those at the helm of Long Island‘s football and athletic programs, recognize that concussions are an inevitable risk, preventative measures have been put in place.

“The safety of all our student-athletes is paramount,” said Tom Combs, Suffolk’s Section XI Football Chairperson. “Unfortunately, concussions are a part of all sports, including football. Through proper equipment, techniques and knowledge of what a concussion is, the players are as safe today as they have ever been.”

Patrick Pizzarelli, Nassau County’s Section VIII football coordinator, said though there’s been an increase in reported concussion injuries, he attributes it to a higher level of awareness and education among coaches and parents.

The New York State Public High School Athletic Association’s aggressive approach to increase concussion awareness started on July 1, 2012 when it initiated the Concussion Management and Awareness Act, requiring all public and charter schools to comply, beginning with the 2012-13 school year. The mandate requires coaches, physical education teachers, nurses and athletic trainers to complete an approved course on concussion management, and sets standards for the care of athletes who have suffered even minor brain trauma.

“There have been rule changes, [such as] not using your head to block or tackle,” Pizzarelli said. “Also, athletes are taken off the field if suspected of head trauma. I believe we are ahead of other areas in the country.”

The state requires athletes that have suffered head trauma to remain out of play for 24 hours. Dr. Smith said he requires his patients to be symptom-free for approximately one week before he clears them for return to sports.

“There is a rare and somewhat controversial entity of second-impact syndrome where the athlete has a concussion and then returns to play while still symptomatic, and sustains a second -- apparently minor -- head injury,” he said. “This leads to a cascade of events with swelling of the brain and sometimes catastrophic consequences, and even death.”

Moving forward, Dr. Smith offers proactive advice for high school football programs and the further recognition of concussions: “From a public health point of view, it’s important to recognize concussions -- in terms of the frequency -- so that the scope of the problem can be identified and also to enable further studies into the long term consequences,” he stated. “[But] athletes with recurrent concussions should seriously consider not participating in contact sports.”

Brian Dessart answers your health and fitness questions

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Q: I have looked all over to find some kind of relief for muscle cramps in my legs. Since this has been happening, I have found how prevalent this is even in younger adults. I have been to doctors and an acupuncturist with no results. I started taking magnesium with the hope that it would help, but it didn‘t. Do you have any suggestions?
-Celia Sanchez, Lindenhurst, NY

A: Muscle cramps are very common among the general population and can affect athletes, those moderately active and the sedentary. These painful contractions, which are also referred to as a charley horse, can be caused by a nerve malfunction, dehydration, muscle overuse/strain, lack of blood flowing to the muscles or not getting enough electrolytes/minerals in your diet.

When the cramps occur there are several self-remedies you can take advantage of, such as gently massaging the cramped region, stretching, and applying ice to sore muscles and heat to tight muscles.

The American Academy of Orthopedic Surgeons makes specific recommendations in regard to stretching:

Calf Stretch: Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds.

Hamstring Stretch: Sit up tall with both legs extended straight in front of you. Your feet are neutral -- not pointed or flexed. Place your palms on the floor and slide your hands toward your ankles. Hold for 30 seconds.

Quadriceps Stretch: Hold on to a wall or the back of a chair for balance. Lift one foot and bring your heel up toward your buttocks. Grasp your ankle with your hand and pull your heel closer to your body. Hold the stretch for 30 seconds.

Keep in mind -- you should never stretch to the point of pain, and each stretch should be preceded by a warm-up, such as lightly jogging in place or walking briskly.

If the muscle cramps are happening often or if there’s no obvious cause, you should see your doctor, as this could be a sign of an underlying medical condition and may require different treatment.

Q: Say you've had a long day at work and feel exhausted. But you've managed to make it to the gym. What strategies do you use to get yourself in the right mindset for a great workout? Is there a particular exercise or kind of exercise you choose? A warm-up? An energy drink? Back squatting a relatively heavy weight works for me, but I'm hoping for a secondary strategy.
-Newsday’s Adam Fusfeld, New York, NY

A: It's definitely difficult to get in the right mindset after an exhausting day of work, but I would recommend some type of light cardiovascular warm-up preceding your resistance workout. The bikes and elliptical gliders work very well and are relatively low impact on the joints. The warm-up doesn't have to be anything too aggressive -- its purpose is to increase blood flow throughout the body's muscles, which is normally achieved when you begin to reach a light sweat. But keep the resistance on the cardio machines low. Turn it up enough to add a light amount of tension, so you're doing the work and the machine isn't in motion by itself. You don't want to be exhausted, even further, after finishing your warm-up.

If you don't want to use cardio machines, another idea would be to do a round of body weight calisthenics -- jumping-jacks, push-ups, sit-ups, etc. Either way, make sure you bring your body to a light sweat before beginning your resistance workout.

You should warm-up before every resistance training workout. This will help to make your muscles more fluid and allow for less chance of injury. If you decide to stretch, do this after your warm-up and never before. Stretching cold can actually tear muscle fibers.

Stay away from energy drinks. They are loaded with sugars and caffeine-like ingredients, and can provide a large energy crash, as well. I'm not a fan of any type of unnecessary nutritional/dietary supplementation. Been there, tried that. I’ve even ended up in the hospital, from the ingestion of creatine monohydrate, which was considered a "safe" supplement.

Q: Is there a way to prevent RLS -- Restless Leg Syndrome?
-Lorraine McDonnell Dessart (AKA my mom), North Ft. Myers, Fla. (formerly of East Rockaway, NY)

A: To my wonderful mother: Even though you know my phone number very well, I will be more than happy to answer your question.

The National Institute of Neurological Disorders and Stroke (NINDS) defines RLS as a neurological disorder characterized by throbbing, pulling, creeping or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them.

Symptoms occur primarily at night when a person is relaxing, or at rest, and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful. Restless Leg Syndrome affects as many as 10-percent of the U.S. population, according to the Institute.

According to NINDS, Restless Leg Syndrome is generally a lifelong condition, with no cure, and in most cases its cause is unknown. But there are lifestyle changes and activities that may help to reduce symptoms in those mildly to moderately affected by RLS.

NINDS recommends the following: decreased use of caffeine, alcohol and tobacco; correcting deficiencies in iron, folate and magnesium; changing or maintaining a regular sleep pattern; a program of moderate exercise; and massaging the legs, taking a hot bath, or using a heating pad or ice pack.

Note: A trial of iron supplements is recommended by NINDS, only for individuals with low iron levels. Although many people find some relief with such measures, rarely do these efforts completely eliminate symptoms. Medications are usually helpful but no single medication effectively manages RLS for all individuals.

Trials of different drugs may be necessary, and your doctor will help in prescribing common drugs used to treat RLS. In addition, medications taken regularly may lose their effect over time, making it necessary to change medications periodically.

Q: My 14-year-old son wants to weight train this summer, and he’s in puberty already. Will this affect his growth?
-Peter Cullen, Huntington, NY

A: If resistance training is done correctly, with good form and under proper supervision, your son shouldn’t have any problems. In fact, resistance training at an early age can help your child’s sports performance, increase his resistance to sports-related injuries and help in the development of motor skills.

There’s always been the worry of stunting growth if resistance training is started at an early age. While this is a reasonable concern, it’s not as common as many are led to believe. The National Strength and Conditioning Association notes that a growth plate fracture has not been reported in any youth resistance training study that adhered to established training guidelines.

Of course, you should consult with your family doctor before your son starts a training regimen. For further information on this topic, please refer to Newsday’s Daily Apple post: Is resistance training a safe option for children?