Over the last few years more and more former NFL stars have come forward stating the hits they took and the concussions they experienced while playing have affected them long into retirement. Just last month NFL great and Super Bowl winning quarterback Jim McMahon disclosed he is suffering from early onset dementia caused by concussions.
According to an interview WFLD TV conducted with the star athlete who commanded the 1986 Chicago Bears to a Super Bowl victory and the classic “Super Bowl Shuffle” now has problems remembering people’s names two minutes after meeting them. And sadly, he is not alone. While more research needs to be conducted on the long-term affects of concussions, many student athletes are also prone to head trauma and concussions.
The American Osteopathic Association recently conducted a survey with 1300 people to see how informed they are on the symptoms and treatment of concussions. Dr. Jeffrey Bytomski an osteopathic family physician and head medical team physician at Duke University Medical Center, in Durham, North Carolina joined me recently to discuss the results of the survey and talk about concussion symptoms, when parents should seek medical treatment for their children, if it’s possible to prevent a concussion, and much more.
Dr. Jeffrey Bytomski, osteopathic family physician and head medical team physician at Duke University Medical Center, in Durham, North Carolina
Candace Rose: Can you tell us about the recent survey the American Osteopathic Association recently conducted?
Dr. Jeffrey Bytomski: “The American Osteopathic Association did an online survey with 1300 people to see what their awareness was of the seriousness of concussions. The main thing was we were trying to see if people know what a concussion was and if they should get follow-up for it or not and to see where we’re at with education. About half the respondents who thought they had a concussion were diagnosed by a medical professional. We still have a ways to go in getting people to understand what the symptoms are (with a concussion) and whether they should go in or not.”
Candace Rose: What typically happens to a person during a concussion?
Dr. Jeffrey Bytomski: “This is a hard one because usually a headache is a symptom of a concussion, but not every headache is a concussion. It’s one of the symptoms, but usually you don’t just have a headache, you’ll have lights bothering you (what we call photophobia) are more sensitive to light, become nauseous. Dizziness is a big factor too. You can have neck pain (depending on how it happens). A headache depending on where you got hit, whether you were wearing a helmet or not; or if you fell and hit the concrete, you obviously would have some symptoms with that. So the main things are the dizziness, nausea and light bothering you, feeling in a fog or confused. If you fall and hit your head and have a little headache, that’s one symptom but you have to watch for other symptoms that develop or if your headache gets a lot worse- that’s a reason to think is there something else going on?”
Candace Rose: According to the survey more than eight in 10 parents said their children were evaluated by a medical professional, coach or event personnel when they obtained a head injury during a sporting event. Why don’t more parents seek treatment for accidents that happen at home?
Dr. Jeffrey Bytomski: “I think probably like all of us, they think the other ones aren’t as serious compared to when they happen at a sporting event. They may just think it’s a headache. Again, I don’t want to downplay the headache because a headache is definitely a symptom of a concussion, but I don’t want parents to think any time their kid gets a headache after getting hit in the head it’s a concussion. But parents know their kid and if symptoms are worsening or they’re not acting like themselves and there are some other things going on besides the headache, then yes you need to get evaluated. But I think like most of us, if the kid runs around and bangs their head on the coffee table, you don’t think it’s quite as serious as if you’re watching their baseball game and a baseball hits them in the head, everybody equates that to more seriousness than not.”
Candace Rose: Former NFL great Jim McMahon recently stated that he’s suffering from early onset dementia due to head trauma. With more and more former NFL athletes coming forward and speaking out about head trauma, why isn’t the public more concerned?
Dr. Jeffrey Bytomski: “It’s interesting they’re coming more with CTE (Chronic traumatic encephalopathy) and we’re really in the infancy stage of knowing who’s going to get that; how’s it going to happen; what do we even use for the diagnosis. As we get more and more information, and if they’re going to biopsy the brains of when these men die and those kinds of things to see where we’re at. Really it’s more of an education of the public beginning to understand – can multiple repeated head trauma cause early dementia? I think in the study we should ask NFL players if they’d play in the NFL again if they knew this was the consequence or not. I bet you most of them would say no, they’re still going to play.
I think the public thinks “that’s the NFL players, that’s not me or my kid”. That’s something they don’t equate to the same thing. And what we’re trying to do, especially with a lot of education programs coming out is starting at the youth leagues and youth levels- do we start education programs to understand the seriousness of concussions so to speak, so kids don’t get as many concussions when they’re younger? It’s also different when kids play for a recreational sport or something else. It’s different than having a 15 year NFL career, playing four years of college football, and the four years of high school football. It’s a much different set of head trauma than what the concussions that happen in day-to-day life. So maybe that’s why there hasn’t been a public outrage or outcry to get things done.
As far as the longterm stuff, I couldn’t tell you now if a 15-year-old kid has two or three concussions, what are they going to be like when they’re 45? Nobody knows that answer right now. I think people just equate NFL players differently than themselves or their children right now.
I’m on one of the NFL committees for concussions for the players association, and 20 years ago they looked at you and sent you right back. You also have to understand that at the NFL level, if they don’t play, they don’t get paid. Also, athletes aren’t going to tell the doctors they have a concussion because they want to play. So that’s a whole real complicated issue at the NFL level with concussions. Even the recognition and treatment is getting much better at that level. Before it was just everybody playing with concussions. It’s going to be interesting when these older guys that played in that era, they might have more problems and hopefully we can get that to lessen over time once we understand it better and get better policies in play for concussions now.”
Candace Rose: You mentioned some of the longterm dangers of concussions, but what are some of the immediate dangers?
Dr. Jeffrey Bytomski: “The immediate dangers and the main thing everybody worries about is, you’re usually not going to die from a concussion per say but it’s where you can have a subdural hematoma (a head bleed) which you can get sometimes with the same force that you can get a concussion. That’s where people go to the ER and need a CT scan to look for more serious injury. Standard imaging of a regular CT scan or an MRI will not show a concussion. We’re looking for other things with especially the CT scan to ensure it’s not a skull fracture or a bleed in the brain. And that’s the immediate or short-term thing that can happen.
Candace Rose: When should parents of student athletes seek treatment?
Dr. Jeffrey Bytomski: “They should if those symptoms are worsening after they get hit within the first hour or two. Again, worsening headache or the quote on quote ‘worst headache of their life’ is happening; more sensitivity to light; more nausea; numbness or tingling in the limbs. Again, they’re just in a fog and just aren’t answering questions appropriately or those things are happening, then their parents should take them to the ER or if it’s during the day- call their physician.”
Candace Rose: Is there anything student athletes or professional athletes can do to prevent head trauma on the field or on the court?
Dr. Jeffrey Bytomski: “Helmets help by preventing skull fracture more than anything. There’s really no football helmet that prevents concussion. Mouthguards do not prevent concussions. There’s some out there that say they do, but there’s been no specific data to say that they.
Neck strengthening programs can help because your neck is not going to move as much when you do get hit, so definitely that’s more helpful, they have a stronger neck. Also for them, taking care of themselves. Getting good rest and staying hydrated. Those kinds of things if they do get a head injury can help with that. The main thing is really strengthening your neck.
There’s an interesting study with youth hockey players. The coaches would teach them how to anticipate or how to take a hit. Sometimes players can anticipate, but sometimes you can’t anticipate when you’re going to get hit. There’s shown to be a decrease in concussions with this study on youth hockey.
People rely too much on equipment. They think the helmet is going to protect them. It can somewhat but it’s more marketing of these equipment people trying to sell things. A lot of the data hasn’t been shown that there’s been a lot of prevention of concussions.”
Candace Rose: Many states across the country have adopted youth concussion laws over the last few years. Can you talk to us about that?
Dr. Jeffrey Bytomski: “About 40 states have youth concussion laws. I’m in North Carolina, and we do have one here that was just enacted about two years ago. Mostly it was driven from media or parents or people getting together and finally making the lawmakers aware of it to get something done. We’re up to about 80% which is good. We’re getting there, and most of them have been within the last year. Most of the states have adopted these so we just have about 10 to go. The one in North Carolina will not let an athlete return to progression or back to the field without physician authorization. So they have to be seen by a physician before they can get back on the field.
A lot of leagues in high school are having standardized concussion evaluations which you have to do on the field to help with that too.”
Candace Rose: Do you think more states will adopt the laws?
Dr. Jeffrey Bytomski: “Yes. I think as more media and education, and things like this where people are made more aware, that’s coming down the pipe for sure.”
Candace Rose: Do you have any additional information you’d like to share with us?
Dr. Jeffrey Bytomski: “Another good resource and interesting book that just came out is by Robert Cantu. He’s a neurosurgeon who has been a big name in concussions forever. He has a new book for kids on education and here’s the interesting thing, he kind of says (just to throw it out here more for controversy than anything) maybe we shouldn’t have contact sports under 14 years of age, because again, some of those neck muscles and their body is just not aware of that. While some other people will say ‘no maybe we should educate kids more on how to play, how to hit and how to do things at a younger age so there’s less of a risk’
The main thing is we’re just trying to educate the public and Osteopathic.org has the links to the CDC and the Heads Up program. Football USA is also linked to those sites too. They have some great information for parents and youth coaches. They can take quizzes; coaches can get certified in concussion education and those kinds of things. We need everybody to be aware what the symptoms are and when to seek treatment.
I equate it to when I do talks on hydration back 30 years ago. Coaches used to hold water out and not let kids have water breaks if they’re having a bad practice. Well, that would never happen today. They would be sued. Nobody would ever do that these days because they know that would be unsafe in the heat and those sort of things. And that’s where concussions at the kid level and pop warner and those kinds of things really need to get it so that culture changes in the NFL.
Education and culture change are the two big things we can really do.”