Feb 23, 2010 8:55:55 AM

Ron Courson, director of sports medicine at Georgia and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, provided testimony at a February 1 forum in Houston held by the U.S. House of Representatives Committee on the Judiciary. Courson, a past chair of the National Athletic Trainers' Association College and University Athletic Trainers Committee and former medical liaison to the American Football Coaches Association, also has been trained as a physical therapist and emergency medical technician. Following is a summary of his statement to the committee.

As a former intercollegiate athlete, a health-care provider in intercollegiate athletics, and a parent of four young children who participate in sports, I have a strong interest in concussions.  I feel that efforts in this area should focus on: 1) prevention, 2) recognition and treatment, and 3) education and research.

Prevention

We must focus on prevention strategies encompassing both safe techniques and equipment. An example is the "Spearing and Head-Down Contact in Football Task Force," cosponsored by the NCAA, NATA and AFCA in 2005 and charged with preventing head and neck injuries through rule changes and education. In 2005 and again in 2008 the NCAA Football Rules Committee changed the college football rules regarding spearing and head-down contact. In 2009, new rules were added to protect the defenseless player being struck in the head. Rule changes and proper enforcement of rules can help reduce concussions in sports.  Prevention also encompasses protective equipment. Further research and development is needed, particularly in the area of football helmet design.

Recognition

Concussions are unique in the fact that many times symptoms may be underlying and difficult to observe.  Unlike an ankle sprain where the athlete may limp noticeably, the athlete with a concussion may have significant symptoms that are not apparent, such as headache, nausea, dizziness, blurry or double vision, sensitivity to light or noise, concentration or memory problems, and sleep disruption.

Sports participation helps to instill values such as discipline and physical and mental toughness. Particularly in the sport of football, an athlete may be recognized for his toughness, his ability to take or deliver a blow, or the ability to never quit. Unfortunately, this same recognition can at times be detrimental by creating an environment where the athlete is self-conscious or embarrassed to discuss symptoms of a concussion and instead hides them from health care providers, parents, teammates and coaches. Likewise, an athlete may be reticent to discuss concussion symptoms with health care providers due to fear of being held from sports participation.

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, noting the importance of concussion recognition, made recommendations in December 2009 that included a proposed playing rule that would mandate removing from competition a student-athlete "who exhibits signs, symptoms or behaviors consistent with a concussion." That student-athlete would not be permitted to resume competition until cleared by a physician or another health-care professional designated by the physician to provide clearance. If the symptom is a loss of consciousness, amnesia or persistent confusion, the athlete would not be permitted to return to play that day.

Treatment

Concussions are unique in the fact that treatment is sometimes different from other athletic injuries. For example, an athlete with an ankle sprain may receive treatments to decrease swelling and relieve pain. He may perform rehabilitation exercises as well as strength and cardiovascular training to maintain his fitness level while recovering from injury. He may spend additional time watching film to prepare from a mental standpoint while his injured ankle is healing from a physical standpoint. This aggressive injury plan of care is commonly accepted as a standard by many athletes, parents and coaches.

In contrast, an athlete who has sustained a concussion is treated quite differently. There is typically no treatment or rehabilitation exercises for an athlete who has sustained a concussion. The athlete may be held from any type of strength or cardiovascular training. In fact, the athlete may be prohibited from scholastic work or watching film to avoid exacerbating his symptoms. The cornerstone of concussion management is physical and cognitive rest until symptoms resolve. Activities that require exertion, concentration and attention may exacerbate symptoms and possibly delay recovery. In comparison to the aggressive injury plan of care associated with orthopedic injuries, such as an ankle sprain, this concept of physical and cognitive rest is often difficult to understand by many athletes, parents and coaches.

Education

Concussion education and research may be our most important undertaking. We must educate not only athletes, but parents, coaches and health care professionals.  The NATA "Head's Up" educational video was produced as a result of the "Spearing and Head-Down Contact in Football Task Force" and distributed to every college and university as well as every high school in the United States. The NCAA has additionally developed posters and a football education player safety Web site to help educate student-athletes, coaches and officials. Other educational actions include a revision of the NCAA Sports Medicine Handbook guideline addressing concussions and scheduling of a summit meeting in midyear 2010 to review NCAA policies for medical management of concussions and prevention strategies appropriate to the collegiate environment.

Further educational initiatives are needed in concussion management. New concussion research studies should be commissioned to continue to expand the body of knowledge, which in turn will impact our quality of care.