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Treating a concussion

This is the second of a four-part series on concussions and their impact on youth sports in the area.

Former New England Patriot running back and 2012 NFL Hall of Fame inductee Curtis Martin had his own method of dealing with concussions.

“When I would get hit, (my teammates) knew that I popped up just like that, every time I get hit,” he said in a recent interview.

“Any time that I didn’t pop up, my fullback knew to come pick me up, because I was probably either dazed or knocked out.”

That tough but short-sighted mentality used to seep all the way down to the level of youth football.

But with the light recently being shed on the dangers of head injuries in the sport of football, protocol for dealing with concussions has changed dramatically, including at the high school level.

Dr. Darius Greenbacher knows all too well how dangerous head injuries can be. Greenbacher is the program director of sports medicine at Baystate Franklin Medical Center in Greenfield. The Minneapolis, Minn., native and current Northampton resident has been in the area for some 10 years, working first as an emergency room doctor. Four years ago, Greenbacher pitched the idea of a sports medicine program to the hospital, and it’s since taken off. He has added head athletic trainer Tom O’Brien to his staff, and is in the process of bringing in two more physicians.

One reason for the increased traffic going in and out of his door has been the increase in head-injury awareness and the recognition of the importance of diagnosis and treatment of head injuries as quickly as possible.

“Just like all other injuries, if we can see the athlete and get them in the right direction as soon as possible, they’ll be back out there playing strong,” Greenbacher said.

“The sooner the concussed athlete does what he or she is supposed to do — shutting everything down, resting, letting the brain have the energy to heal — the sooner they will be back on the field and in the classroom at 100 percent.”

According to Greenbacher, there has been a lot of research done to find out more about concussions, but despite this, diagnosing them can be tricky. Perhaps the biggest step in helping with the diagnosis has been the advent of neurocognitive exams like the ImPACT Test, which has been around for about 12 years, but has really only been introduced to the local community in the past three or four years. ImPACT tests are given to athletes prior to the season, and give doctors a baseline against which they can measure a person in the event of a possible concussion.

“It’s extremely useful when I have the baseline,” Greenbacher said. “It makes it that much easier to know when a person is cognitively back to normal.”

The ImPACT is far from perfect, however. While a number of local high schools do have students take the ImPACT before the season, the test takes anywhere from a half an hour to 45 minutes per person. And the test is administered over the computer, which means an administrator must be on hand in order to answer any questions. Plus, Greenbacher admitted, most exams are done in a room full of teammates, and some athletes do not take the test seriously.

Inaccurate baselines are of no use.

Working the system

There is also the issue of students gaming the tests. Because students diagnosed with concussions are typically held out of school and not allowed to take any tests, some administrators worry that students can purposefully fail a concussion test in order to avoid having to take an exam.

Greenbacher said that there are ways to pick up on any attempts at this, and that he feels if there is any gaming going on, it’s in the other direction.

“Is there gaming? There sure might be,” he began. “But there can be with any injury. And it is nearly impossible to game the ImPACT. What I’ve seen is that most students want to be in school, want to be engaged, and want to continue to play their sports.”

And then there is the issue of teenagers being teenagers. According to Greenbacher, in order to heal from a concussion, a person is supposed to do as little as possible to stress the brain. Most doctors suggest sitting in a dark room, which allows the brain to rest and recover.

But this is in stark contrast to the average teenager’s life, which can be filled with texting, phone calls, computers and video games. It is not easy to try and get an athlete to stop any of these things, but failure to rest the brain can lengthen the recovery time.

“I think probably, in the past, the stressors were much less,” Greenbacher said.

“For sure, our multi-tasking culture, our digital culture, doesn’t help at all. Technology is not great for concussion recovery. You can’t just turn off from it, and it’s a huge part of a teenager’s life — that social interaction.”

Concussions’ cause

Experts agree that t here is never going to be a way to entirely prevent concussions as long as people are playing sports. Better equipment, proper tackling technique, and making certain hits illegal only go so far as to lessen the likelihood of suffering a head injury.

But as Greenbacher points out, concussions happen for a number of reasons. There are, of course, those that come from an impact to the head, but concussions can also occur from hits that have no impact on the head. These collisions are the ones that cause the head to jerk around, and the whiplash effect is what causes the concussions. It’s these that are most difficult for researchers to understand and quantify.

“Researchers have had a lot of difficulty finding the bottom limit for impact as far as causing a concussion,” Greenbacher began. “There are times where we see people have these massive hits and they don’t have a concussion, and then there are times that there are hits that don’t look like they should cause a concussion, but players are getting serious concussions.”

And it’s for this reason that even the smallest signs are being taken more seriously by players, parents and coaching staffs today than ever before.

“We for sure know that people continuing to play with concussion very well will lead to prolonged symptoms, and some types, often, of long-term issues,” Greenbacher said. “Football players are good examples of playing week-in, week-out with concussions that are not completely healed, and that can cause long-term issues.”

So is football safe? It seems to be the million-dollar question at the moment for what has become the most popular sport in the United States. Greenbacher admitted that there is a lot of research left to do to try and find the answers.

The National Football League, having admitted that there is a problem, has helped raise the awareness, but there are no concrete answers. Greenbacher, himself an ice hockey player, said that until more is known, all impact sports, including those like hockey and soccer, will be scrutinized.

“It all makes you wonder if just that repetitive contact, even if it’s not causing concussions, is having a deleterious effect on our brains,” Greenbacher concluded.

“We don’t know right now. Unfortunately, our knowledge of concussions and brain impact is minimal. We are learning more all the time, but we need to know a ton more. We need to know the impact of multiple concussions, and when they are appropriately healed. And we for sure need to know about the subclinical impacts.

“It’s all starting to make everyone question impact sports.”

Saturday: A first-person account of what it means to suffer a concussion.

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