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New state law tackles concussion problem
(by Sue Reid - April 27, 2013)
New state law tackles concussion problem
By SUE REID
When Jack Krienen got his first concussion playing soccer as a Solon High School sophomore in 2009, he doesn’t remember much about the experience, except everything that led up to it.
He had worked diligently to make the team, which was a competitive one and required a great deal of time and effort to prepare. Being selected was a “pretty big deal,” he recalled, as the 16-year-old was thrilled. Sports always had been the biggest part of his life for as long as he can remember.
It was mid-season in a game against Hudson when Mr. Krienen went up for a header. The result was the first of five concussions, each of which resulted in longer recovery times and eventually ended his soccer career.
“I’m done playing competitively now after I got so many concussions, including three in two years,” the now 20-year-old said. “I was starting to get them a little too easily.”
Mr. Krienen, who coaches a recreational soccer team at the Solon Community Center, said that not playing soccer competitively any longer “is the worst feeling in the world.”
“It is something I have done close to 15 years, and it’s been taken from me,” he said. “There’s nothing you can do to get it back now.
“I have always been able to come back and work hard and get back at it,” and at this point, I can’t. It’s an awful feeling.”
Increased awareness
Education and awareness surrounding concussions, which are transient injuries to the brain that usually occur as a direct or non-direct blow to the head, have come to the forefront in recent years. As a result, the injury is subject to different guidelines than were in place 15 years ago.
Gone are the days when a player comes to the sideline, a coach holds up two fingers, the athlete says “three,” and the coach says “close enough” and sends them back on the field, said Dr. Richard Figler, head team physician at Solon High School and primary care sports medicine physician at the Cleveland Clinic.
“It has taken years to realize, and the education has kind of lagged behind, but this is the brain. You have one, and it’s the only one you will have for the rest of your life, so why not protect it?” he said.
Football by far has the highest incidents of concussion and accounts for about 47 percent. Hockey is second, with one in five injuries a concussion. There also has been a significant rise in concussions in girls’ soccer because of increased aggressiveness and stronger players. Boys’ soccer has a relatively high rate of concussions, as well. The numbers are rising in lacrosse and rugby leagues in Northeast Ohio, according to Dr. Figler.
Legislative support
A new return-to-play law Ohio law based on House Bill 143 addressing how concussions and return-to-play protocol are handled for athletes at the youth and recreational levels takes effect Friday.
The law has two components, Dr. Figler explained. The most important, the educational component, raises awareness for parents of signs and symptoms of concussions and requires coaches and referees to go through a formal training program. The second component requires the player who exhibits signs, symptoms and behavior consistent with a concussion to be taken off the field by a coach or an official.
Further, that player is not permitted to return to practice on the same day as the condition must be assessed by a physician or licensed health care provider prior to the athlete returning.
“The purpose of the bill is to educate those closest to the athlete to recognize the signs and symptoms of a concussion and to safely pull these athletes off the field, whether they have a team physician on the sidelines or if they are 8 to 10 years old competing in a youth basketball league where there may not be one present. It’s about protection,” he said.
In speaking to the benefits of the new law, City of Solon Recreation Director Don Holub said that with youth sports, the tendency is to cut corners, whether by parents or coaches.
“That is very worrisome,” Mr. Holub said. “With this new bill, it does not allow you to cut corners. If a player is taken out with a concussion, he or she cannot be put back in.”
Symptoms and treatment
At the time of Mr. Krienen’s first concussion, he was taken to the hospital to make sure he was OK and sent home, where his parents checked to be sure he was responsive. He eventually played the last two games of that season, but with a bit more caution.
“I was nervous and timid when I came back to play,” he said.
Mr. Krienen continued playing, making the varsity team his junior year. It wasn’t until his senior year that he got his second concussion, which occurred during a varsity game on Senior Night, when he was hit from behind with the ball.
“Right when I got hit, I knew right away it was the same feeling, like I had an instant headache and wasn’t steady on my feet,” he recalled. “It’s a distinct feeling once you get a concussion. You know right away you have one.”
Outward signs and symptoms of a concussion include a player “not looking right, having glossed-over their eyes and slow to answer questions,” Dr. Figler explained. Other signs include stumbling and being a bit off balance.
Common symptoms include headaches, dizziness, neck pain, irritability and sensitivity to light and noise. Student athletes can have difficulty concentrating or focusing in the classroom and experience changes in their sleep patterns, Dr. Figler said. About 80 percent to 90 percent of concussions get better within a week to 10 days.
“We treat concussions pretty aggressively,” he said.
The first step is to remove the athlete from the competition no matter what is happening at the time. “We think that instituting rest is the most important thing, similar if someone were to come up with a torn ligament in the knee or badly sprained ankle,” he said. “Because it’s the brain, it’s more important to allow it to heal without risking another injury.”
Also key to the treatment of concussions is identifying and avoiding triggers, Dr. Figler said. For example, if sunlight poses a problem, the student should wear glasses.
“When in doubt, sit them out” has become the tag phrase, Dr. Figler said. “It’s much easier to err on the side of caution with a concussion,” he said, adding that while some get better in a week after a concussion, others suffer symptoms for months after.
Solon School District has pushed concussion education, Athletic Director Mark McGuire said. His coaches, long before it was a state mandate, took part in concussion courses.
“I think that reflects the attitude of our coaching staff on how serious this issue is,” he said. “It’s a huge part of sports now, and we all have to be aware of the implications. We always want to err on the side of caution for the kids. We don’t want to put anyone in harm’s way.”
Solon’s athletes in contact sports do baseline testing, including football, boys’ and girls’ soccer, ice hockey, boys’ and girls’ basketball, lacrosse, baseball and softball.
“They take the baseline test, and if they are suspected of having a concussion, we have something to compare with,” Mr. McGuire said.
Warrior mentality
Some athletes who have a “warrior mentality” go back in a game after suffering a concussion and suffer additional injury, prolonging their recovery.
“The ones whose symptoms last the longest seem to be the players who sustain another hit to the head after they were already symptomatic from a prior hit,” Dr. Figler said. “Whether it’s neglect or a warrior mentality, if they are pulled and start to recover, they typically get better soon. The ones to me who are worrisome are the kids missing months of school and falling behind because of their symptoms.”
That warrior mentality has permeated the sport of football, he said, adding an athlete who has a concussion has an altered sense of the ability to judge his or her injury. “That’s where it becomes even more important for coaches, parents and the athlete’s teammates to make sure they are educated of the signs and symptoms and that the player is pulled off right away to be evaluated. It becomes important that everyone’s aware. We are not trying to punish athletes, but protect them.”
Even after his second concussion, Mr. Krienen was determined to get better and play again. “Doctors told me to rest and see what happens.” The second concussion took longer to recover from, but he still managed to play a bit in the district finals during the last game of his high school career.
The brain is more vulnerable to subsequent injury following a concussion, Dr. Figler said. “If the brain is allowed to heal itself without interrupting it, it does a much better job. If there is another trauma to the brain at this point, which we don’t see as often with our diligence and education, the brain actually swells and that is when there is a trauma on top of a trauma. Although the swelling is rare, it can be catastrophic.”
When an athlete takes a direct blow to the head, “the brain gets jostled in the skull,” he said.
After a concussion, signs and symptoms manifest themselves due to trauma in the brain and the subsequent healing process. “We see a healing cascade that goes on, which is a very complicated cascade where the brain is attempting to heal itself right away,” he said. “We should give it a chance to do that.”
Recurring problems
It was Mr. Krienen’s passion for soccer that led him to continue playing in college, even after two concussions. He attended Defiance College in Toledo, where he made the team as a freshman.
His third concussion occurred during the offseason. During his sophomore year while going up for another header, he experienced his fourth concussion. His last and final one was right before finals, when he was elbowed in the back of the head.
“It was a struggle to go back home for winter break and go back to school to take my finals,” he recalled. “The timing of it was really bad.”
Mr. Krienen went home to see his doctor and missed his finals. “I had a constant headache for longer,” he said.
MRIs, CAT scans and X-rays showed that everything was OK, which is one reason he continued to play. Another reason is he loved the game of soccer. “I have done it for so long,” he said.
Mr. Krienen eventually transferred to Kent, which wasn’t easy. “I wasn’t doing too well in any of my classes,” he said, “so I just made the decision to take a semester off and get back on my feet.
Mr. Krienen said he will continue coaching and pursuing his degree in exercise science and will spread the word and educate others about concussions.
“If I didn’t play sports, I would not be in this situation,” he said, “but everything happens for a reason.”
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