At every level, from children’s teams to professional leagues, athletes who suffer concussions are frequently allowed to resume playing too soon, doctors have said.
Returning to sports too early leaves athletes vulnerable to devastating brain damage from a second blow, even a seemingly minor one, the doctors said.
At a meeting of the American Academy of Neurology last fall, speakers said athletes frequently did not know they had concussions or tried to cover up symptoms in order to keep playing. The researchers said some coaches, parents and doctors, failing to understand the dangers, encouraged injured students to play.
About 300,000 people a year in the United States suffer brain injuries from sports, according to estimates by David Thurman of the Centers for Disease Control and Prevention in Atlanta. The highest rate occurs among males between the ages of 15 and 24. Most of the injuries are concussions, and about a third of the victims never consult a doctor. About 500 people a year die from the injuries.
There are no statistics on how many people develop mental problems as a result of repeated concussions. But having one concussion increases a person’s risk of suffering another one by four to six times, and a recent study suggested that multiple head injuries could increase the risk of Alzheimer’s disease.
Hockey player Pat LaFontaine, a center for the New York Rangers, told the group that he had played six or seven games for his previous team, the Buffalo Sabres, without realizing that he had sustained a severe concussion when he was knocked unconscious during a game in October 1996. Even though he had depression, insomnia and headaches, it was only when other players and his coach told him he was behaving strangely that he sought medical help and was told to quit playing for the rest of the season.
LaFontaine came back for the recent season but suffered another concussion in March and was sidelined for the remainder of the season. He has had six concussions.
James Kelly, director of the Brain Injury Program at the Rehabilitation Institute of Chicago and one of LaFontaine’s doctors, described a concussion as a brain injury resulting from the brain being shaken inside the skull.
Symptoms can include confusion, memory loss, blurred vision, headache, nausea, lack of coordination, slurred speech and emotional outbursts. Many people suffer concussions without ever losing consciousness.
Some of the worst injuries occur when a player with a concussion that has not yet healed gets another head injury. The result can be rapid swelling of the brain, which can be fatal.
Last year, the Academy of Neurology issued guidelines to help other doctors, trainers and coaches recognize concussions, judge their severity and determine when a player can rejoin a team.
One of the neurologists’ main concerns is that head injuries in young people, particularly repeated ones, may cause problems later. Even though the injuries appear to heal, they often cause some loss of brain cells.
That loss may go unnoticed until aging or health problems cause additional damage to brain cells. A person with previous injuries may have little reserve and start to show signs of mental decline in middle age or earlier.
In players who seem to recover fully, doctors cannot tell how many concussions are too many.
If there are no detectable symptoms of brain injury, the decision on whether to quit is up the athlete.
“What kinds of risks are they willing to take?” Kelly asked. “Some are foolish enough to want literally to go down doing what they love. They have a romanticized, very immature idea of being immortalized. Some, unfortunately, get their wish.”
Kelly said he wished there were a “face-saving way” for professional athletes who had suffered repeated concussions to retire without being labeled brain-damaged.
“I don’t want them to become the butt of jokes on Jay Leno,” he said, adding that the stigma, even if baseless, could harm their prospects for jobs. “There must be a way to let them go on with their lives without the specter of brain injury,” he said. “I don’t know how to delicately address it and yet put a stop to this.”
