To Your Health
July, 2012 (Vol. 06, Issue 07) |
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An athlete may exit a game reporting a head injury. They are up moving around and may just seem a little dazed. Nonetheless, the report of the head injury, even if it appears minor or is downplayed by the player, must be taken seriously.
Assessment of the player's level of consciousness, orientation to person/place/time, immediate memory (game score), short-term memory (game plan) eye movements, visual function (How many fingers am I holding up?), and balance/coordination (touching the nose, standing on one foot) must be performed.
Head injury cannot be separated from the possibility of neck injury in these cases. Observation for signs of cervical spine injury is also necessary. Neck pain or stiffness, muscle spasm, asymmetrical/abnormal head positioning, respiratory difficulty, numbness, tingling or burning in the extremities, muscle weakness or paralysis, and loss of bladder or bowel control are among the primary signs and symptoms to look for.
If the player is down on the field, but conscious, assessment is even more important. Immobilization of the head and spine is necessary as part of the assessment. In addition to the neurological assessments described above, procedures such as having the player stick out their tongue, wiggle their fingers and toes, and respond to sensory stimulus are required. Transport to a health care facility is usually necessary for further evaluation and observation.
If the player is down and unconscious, then the situation is critical and should be treated as such. Assessment begins with airway, breathing and circulation (the ABCs), and proceeds as the head and spine are immobilized. Neurological screening is also required. In this circumstance, the athlete requires transport to a health care facility for further evaluation and observation once stable enough for transport.
In all circumstances, but especially this last circumstance, it is important to be prepared. Training, equipment, transportation and emergency facilities must be in place. On-field assessment is an art and anyone involved in sideline or team health care should be well-versed and well-rehearsed in it.
That said, there is a drawback to the Pop Warner initiative and clinical information described, and a drawback to all of the knowledge and preparation discussed here. Pop Warner events don't typically include sideline health care personnel. The athletes with brains most sensitive to concussion have the least amount of help available. Keep in mind that Pop Warner is the largest organization of its kind in the world, with over 200,000 participants each year.
This shifts the primary responsibility for success of the new rules directly to the coaches and parents in the league. Doctors of chiropractic can help coaches and parents understand the clinical importance of concussion as it relates to players young and old. This information must then be combined with moderation of the high level of competitiveness seen at all levels of sports today. Competitiveness must not be allowed to deviate the course of the new initiative. Talk to your chiropractor about the danger of concussions and what you can do to reduce your child's risk.
K. Jeffrey Miller, DC, MBA,is an assistant professor of chiropractic at the University of Missouri Orthopedic Institute, a branch of the University of Missouri Health System. He is a graduate of Palmer College of Chiropractic and the author of several practitioner and patient texts.
