Lately, the long-term risks of concussion have made headlines, inspired movies and changed the way we think about contact sports like football. But apart from chronic traumatic encephalopathy (CTE), the degenerative brain disease caused by repeated head trauma, there’s a concerning new risk that parents and coaches should know about.
According to a new study, adolescents who suffer a concussion have an increased risk of developing multiple sclerosis (MS) later in life. After one concussion, teens were about 22 percent more likely to develop the disease, while multiple concussions led to a striking 150 percent increase.
MS is a debilitating disease that causes the body’s immune system to attack the central nervous system, affecting the brain and spinal cord. Doctors do not know its cause. Overall, the chances that these teens will develop MS are still low, and much research is still needed. Still, with this news and everything we are learning about CTE, it’s crucial to keep your kids protected during sports and other physical activity.
We had a conversation with Michael Dougherty, a certified athletic trainer and the Florida Hospital Sports Concussion Program’s clinical coordinator, about these new findings and the general risks of adolescent concussion. Dougherty’s team provides concussion testing for 27 Central Florida high school sports programs, as well as designs and implements cutting-edge education strategies for coaches and parents.
Q: Physiologically, why might it be that teen concussions are linked to MS?
A: I think this, along with several other studies, are pointing in the direction that the youth and adolescent brain, where it’s still developing and not mature until upwards of age 25, is more susceptible to stress and injury than the fully developed adult brain.
The adult brain actually heals faster than the developing youth brain. If 12-year-old Johnny sprains his ankle, and his dad sprains his ankle, everybody would expect that the child would heal faster. But with the brain, adults heal and recover sooner, which goes against our thinking.
The ongoing research is going to be extremely important in how we continue to change and manage, diagnose and treat concussions in the future...we know a lot more about concussion than we did 20 or 30 years ago, but we still don’t know what we don’t know.
Q: The study showed that teens run a higher risk than younger kids. Could you explain why that is?
A: From other research, it seems to be the stages of development in the brain – the amount of developing and changing and growth that is going on in those mid-range adolescent years (11 to 21) versus the younger ages, under 8 to10 years old.
Q: How common are concussions in adolescents?
A: Concussion in adolescents and kids is very common, and it’s probably more common than a lot of studies are reporting. It’s widely known that there’s an underreporting of symptoms and lack of proper management. That’s where education comes in.
With our youth athletes, the risk is much greater because they have more exposures to a possible injury because they’re playing contact- and collision sports a lot more than adults are. With the amount of exposure there is, the number of injuries is going to go up.
Q: I feel like in the past, concussions weren’t always viewed as a big deal – just something that happens when you’re a kid. With all this new research, do you think that perception is changing?
A: It is absolutely a common perception that getting a concussion is ‘just a ding’, ‘getting your bell rung’, or a ‘badge of honor’. Then the expectation was “get back in there,” and “be tough.” But I think with the prominence of concussion in the media and new research, people are starting to understand the seriousness.
If somebody breaks their arm, they know they’re going to be in a cast for six weeks, and they don’t think twice about it. With concussions, you can’t cast the brain, and if you tell an athlete they’re going to be out for two weeks, they’ll have a fit. The difference is, a bone versus your brain. There seems to be a disconnect in that thinking. There needs to be ongoing education. I do believe that old-school mentality is starting to wane.
What I’ve seen over the years is an improvement in the teammates looking out for one another. They don’t want to ‘turn somebody in’, but they are more likely to say, “you need to go see the athletic trainer” or coach or let the athletic trainer or coach know that their teammate “took a big hit” or “doesn’t seem right” to have them evaluated. It’s coaching, parents, teammates, education – so many components to player safety regarding concussion.
Q: What about adults who suffer a concussion? Are they at increased risk?
A: I’m not aware of any studies that have shown a correlation between concussions in adults and MS, but we worry about and don’t know enough about what long-term problems you can have – more data is needed to know what predisposes an individual to MS, CTE, early cognitive decline and emotional and behavioral changes like depression.
We just don’t know what chain of events causes this person to have these problems and another person not to. That’s why it’s so important for a concussion to fully recover before exposing the patient to risk again. Serious and long-term issues have a much higher rate if you sustain a second concussion before the first one is resolved.
Q: What other diseases or conditions can arise as a complication of concussion?
A: Common risk factors that may either increase susceptibility or sensitivity to a concussion or have a longer recovery, include a history of past concussions, including how many concussions they’ve had, how long it took to recover and how long it has been since the last concussion. All of these factors affect the recovery process, along with other things like comorbid and confounding factors.
Q: Could you explain what you mean by comorbid and confounding factors?
A: Studies are showing that people who have a history of anxiety and depression, ADD or ADHD, headaches and migraines may be more susceptible to having a concussion in the future, or maybe a concussion that occurs with less force or one that takes longer to recover.
We don’t know the exact mechanism, but we’re seeing these correlations, much like they saw the correlation with MS in the study. The brain is an amazingly complex, integrated system that we still know very little about, but we know more than we did, and we’re constantly looking for better ways to evaluate, test and manage head injuries.
Q: Tell us about how you and your team work with concussion patients.
A: We see patients of all ages, although the majority are youth athletes in middle- and high school. We see patients in sports such as football, soccer, lacrosse and cheerleading; in lesser numbers, you might see cross-country and track. You also have patients who get concussions that aren’t sports-related: recreation, horseplay or random accidents.
We are a multidisciplinary team, and our program is based on an initial assessment that uses neurocognitive assessment, balance testing, and visual/ocular screening to help assess and objectify how the brain is functioning. From that, we use different clinical trajectories to create a treatment plan that may include vestibular therapists, speech therapists, neurology, and neuro-ophthalmology, depending on what is found in that initial evaluation.
Our main goal is to try to get the patient feeling better and set them up for success. In adults, to get them back to work and their normal activities, and with athletes, to set them up for academic success and get them back to their sport safely.
Q: What can parents, players and coaches do to help prevent concussions?
A: There are a couple of things that come to mind. Number one is education – educating all parties on the signs and symptoms of a concussion.
There are four categories of symptoms: physical (headaches, dizziness, light sensitivity, nausea, balance issues); sleep disturbances (sleeping more or less than usual, restless sleep, drowsiness and fatigue); emotional and behavioral changes; and cognitive ability (concentration, focus, memory, processing speed). In those four categories, you can have some, a few, a little or a lot of the symptoms. Each concussion is unique and individual.
Besides education is coaching. Coaching techniques are probably even more important than equipment, because a helmet, a mouthguard or a headband cannot prevent concussion. Those things are important, and they can prevent skull fractures, dental injuries and other injuries, but they’re not going to prevent concussion.
Getting coaches to teach proper techniques and mechanics – whether that’s a football player wrapping up and tackling with their head up, or teaching a cheerleader proper techniques for basing and catching the flyers. Proper coaching goes a long way in the prevention of concussions.
Q: Do you still think it’s important to encourage teens to play sports and be active, even in light of these new findings?
A: I think that organized sports and physical activity have a lot of benefits and should be encouraged. We certainly don’t want to discourage anybody from participating, but understand the risks and make sure you stay healthy, fit and educated.
This is why we have our youth athletes go through pre-participation physicals, to make sure they’re fit enough for the sport they’re choosing. Use your medical advisors and physicians to help make an informed decision, weighing risks and rewards. Have fun, play hard but play smart.
Have more questions about teen sports and the risks of concussion? You can schedule a consultation with Michael Dougherty and Florida Hospital Sports Concussion Program by calling (407) 303-8012 or visiting FHSportsMed.com/concussion.