Play ‘Til It Hurts

This week’s guest columnist is Dr. James Hyatt, a family practice resident at the University Hospital and Clinics here in Lafayette.

“Winning isn’t everything, it’s the only thing.”  This quote, made famous by Vince Lombardi, is a mantra for generations of athletes.  This attitude permeates all sports, even at the youngest level.  If you watch Esquire Network’s “Friday Night Tykes,” you’ll understand how intensified kid sports and sport-related injuries have become commonplace.  You’ll see football coaches yell at children like they’re college phenoms, and then watch the kids get seriously hurt.

Every year, more than 3.5 million children under age 15 require treatment for sports injuries.  This evolution from mere games to full-on quests to turn kids into tomorrow’s superstars has caused a rise in injuries.  What are the perils of youth sports today, and how can we avoid sports-related Emergency Department visits?  One peril is concussions, particularly when kids are charging at each other with extra zeal.

Bailey was a 14 year-old soccer player.  In one tight game she came head-to-head with not another player, but her greatest opponent, the ball itself.  She took her eye off of it for a split second and it struck her in the forehead.  As she lay on the ground, all she remembered was the brightness of the lights and the hush of the crowd.  She tried to stand up but felt too dazed, and began having a headache and nausea.  The coaches were worried she had a concussion, so her parents took her to the ER.  Hours later, after a CT scan of her head, she was discharged with instructions to not play or even work out for at least a week.  Intense play resulted in a long time on the DL.

The American Academy of Pediatrics recommends kids who sustain a concussion be evaluated by a doctor before returning to play.  They need “brain rest,” to resolve the symptoms and let their brains heal.  This means physical rest and “cognitive” rest, relieving the thinking part of the brain.  Cognitive exertion, like homework, video games, or school work may worsen headaches, nausea and fatigue, and make them last longer.  Some kids need weeks or months for these to go away.

12 year-old Bradley was at bat.  Bases loaded, bottom of the ninth, he envisioned his  hit sailing over the outfield wall.  Instead he took the pitch to his ring finger.  He missed the post-game festivities, finding himself in the Emergency Department getting x-rays.  The finger was broken.  

Besides broken bones, or concussions like Bailey’s story above, kid sports injuries often happen less dramatically.  While Bailey and Bradley’s mishaps could happen in sports at any level, the intensification at youth level often leads to overuse injuries we used to see only in college or professional athletes.

Take Little League Elbow.  This didn’t exist when I was young, but now happens to kids who throw too much.  It mostly affects pitchers, but anyone who throws baseballs or softballs a lot can get it, stressing the ligament on the inside of the elbow.  The ligament becomes inflamed, swollen, and hurts.  In extreme cases the underlying bone can come apart, or kids can develop arthritis.

To prevent Little League Elbow, everyone’s now aware of the pitch count.  There’s tables to tell how many pitches children are allowed by their age, but coaches need to be careful.  The school coach may hold his pitchers under their counts, but does he factor how many pitches the kids are throwing at private lessons, or with a select team?  The sum of all those should be under the safety number.

Better prevention of overuse injuries, and more fun, is to vary children’s sports.  If a kid loves sports, she should do a variety- soccer one season, running another, baseball another, etc.  Also, parents and coaches need to dial back the intensity.  The science is clear- too much training is more likely to lead to an injury, rather than to a college scholarship. Kids should learn injury prevention skills like hydration, warm-up exercises, warm-down stretches.  They shouldn’t be pressured to play hurt, but instead encouraged to speak up when in pain.  Then they need adequate rest and rehab.

Preserving young athletes’ health is everyone’s responsibility: coaches, teammates, parents, and physicians.  It’s a balance between keeping kids out the ER, and heeding the call to ”Put Me In Coach!”

Concussion- When Can I Go Back In, Coach?

Now that football season is on again, we are seeing a lot of head injuries in the ED.  Usually the concussion is obvious- the player was knocked out, or obviously confused after the hit.  Last week though, I had a player come in for a wrist injury.  Then he told me, “by the way,” that he had had a tackle the night before where afterward, he could not remember plays or even what his own position was!  Now he had a headache- was this a problem?

I asked him why he did not tell his coach about his head injury.  He told me that the coach was “crazy” about kids slacking off and did not want to upset the coach and not be put back into play.  I told this teenager and his mom about the dangers of a second hit while concussed, where brain swelling and even death are real possibilities.  Fortunately for this player, his arm had a minor fracture and his season with this coach and his head injury was over anyway (fortunately, except of course for the broken arm).

Concussions are being recognized by the NFL, the NCAA, LHSAA, and other sports as a big problem.  This year the NFL has much more strict rules about putting players in after a concussion.  Watching last Sunday’s Saints game,  I noticed that after a head injury, players were being given neurological exams on the sidelines.  The Arizona quarterback, Max Hall,  was taken out for a time after a head injury, even though he wasn’t knocked out (he looked pretty dazed though, I’m surprised they let him back in).

What is a concussion?  A concussion is a head injury where you have certain symptoms afterward, like confusion, headache, nausea, poor concentration, and poor coordination.  In the next few days kids with concussions can have sleepiness, depression, and poor school performance.  Repeated concussions can lead to long term problems with thinking ability and mood.  Some people with a career of head injuries, like boxers and pro football players, can have syndromes like Traumatic Encephalopathy, which is akin to early Alzheimer’s disease.  A kid with a second head injury while having concussion symptoms can end up in Intensive Care with serious brain swelling.

As always, prevention is important.  Football equipment needs to be up-to-date.  Players need to be taught to tackle safely, where the player tackles with their arms and shoulders with heads up,  not “spearing’ with their heads.  The new rule is “see what you are hitting.” 

Coaches and trainers need to know to watch for which players might have a concussion, do a quick sideline exam, and take out players with any concussion symptoms, no matter how minor.  No need to take a chance with tragedy!  Finally, players need to return to play only when they are free of concussion symptoms.  Then they need to return to play in a step-wise fashion.  This means that after a week of healing, they return only to running and calisthenics.  If they are still symptom-free, then they can go back to running plays in practice, without contact.  Then if that is okay, they can go back to full contact.

Coaches, families, and players need to be aware of concussion.  Football, soccer, basketball, hockey (ice and field) and baseball and softball players, be careful!  Cheerleaders too- cheering is now considered a full contact sport, what with cheerleaders being stacked and thrown higher and higher into the air, and occasionally dropped back onto the ground.  There is no good reason to take chances with your brain.  I know this is Louisiana and we are talking about football, but again, isn’t it only a game?