What Everyone Should Know about Concussions: An Interview with Stanley A. Herring, MD

10 April 2013
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An Interview with Stanley A. Herring, MD

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What Everyone Should Know about Concussions: An Interview with Stanley A. Herring, MD

Dr. Herring is a UW clinical professor in the Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery. He is the director of Sports, Spine and Orthopaedic Health for UW Medicine and co-medical director of the Seattle Sports Concussion Program. He is a team physician for the Seattle Seahawks and the Seattle Mariners. Dr. Herring specializes in non-operative musculoskeletal and sports medicine, with a particular interest in disorders of the spine and sports concussion.

Concussions: An Overview

G4: Thank you for taking the time to talk to us Dr. Herring. You are an authority in the area of concussion. How prevalent are concussions in the United States?

Dr. Herring: Concussions are common in the United States, perhaps as many as 4 million sports and recreation concussions occur every year.

The good news is that there are not 4 million people who have persistent problems, because a great majority of concussions improve — in young athletes, 80% of concussions are improved in 10 to 14 days.

However, that means that 20% are not, and if there are 4 million sports and recreation concussions a year, that means there will be some people who struggle.

Struggles can mean a 2-week injury becomes a 4-week injury, if you don’t rest enough and do the proper treatment.

But sometimes there can be tragic consequences, particularly for young people. Mismanaging a concussion, for young people, can have life threatening consequences; it’s rare, but it’s tragic.

G4: What should parents, coaches, and athletes do when concussion occurs?

Dr. Herring: The beauty here is, unlike so many things in medicine where no matter what we do we can’t stop something terrible from happening, with a concussion, if you manage a concussion, appropriately and acutely, you can prevent tragedies in young people.

Concussion is a preventable problem. 

For coaches and parents, the idea is to understand that concussion is a brain injury. All brain injuries are potentially serious. And they all deserve appropriate treatment.

When In Doubt, Sit Them Out

G4: What is appropriate treatment?

Dr. Herring: Appropriate treatment means as parents and coaches, we must recognize the signs and symptoms of concussion in our young athletes.

If you know the athlete and the athlete seems different after a blow to the body or the head, if there is a change in their physical well being, their thinking, their balance, or their emotion, then you need to think that this could be about a concussion. Dizziness, lightheadedness, confusion, loud noises and bright lights bothering them can be signs. Additionally, headache, nausea, being unsteady on their feet, or perhaps being unreasonably sad or giddy are indicators.

If you recognize a change after a blow to the head or the body, it’s pretty simple — the job of the parent and the coach is to recognize the potential concussion and just take the athlete out.

When in doubt, sit them out.

If we do that, we will prevent tragedies. Remember, a decision about return to play after a concussion is a medical decision. It’s not a decision for a coach, a parent, or a teammate to make. We ask the coaches and the parents to be our front door, to be our eyes on the field. If you suspect a blow to the head or body that results in changes, just take the athlete out of practice or play.

G4: If an athlete experiences a concussion, what should he or she do to treat it?

Dr. Herring: Now the only treatment for concussion is rest initially. So if you rest the athlete, you’ve begun the rehabilitation. And then it goes to a healthcare provider, someone who is knowledgeable in the diagnosis and management of concussions to decide what to do. How much rest? When to return to play?

If you take an athlete out of play, and you see worrisome signs: increase in sleepiness, asymmetric movement one side of the body to the other, repeated vomiting, or just a dense confusion or being dazed that does not change at all, call 9-1-1. Because there is the rare, but potentially tragic situation where there is an epidural hematoma, a subdural hematoma or a brain contusion.

So watch the athlete, continue to watch them — don’t leave them alone, and if they deteriorate, they are not moving symmetrically, or they are increasingly tired or they vomit more than once, just pick up the phone and call 9-1-1. Save a life.

On Recovery

G4: Great insights on diagnosing the potential life threatening concussion symptoms. What about the non-life threatening concussions? What is the treatment for those?

Dr. Herring: Once a concussion is diagnosed, and there’s no life threatening injuries, each athlete recovers at a different pace. Most athletes improve in 7-10 days but remember, each athlete’s concussion experience is unique. And each concussion within the athlete is unique. So they don’t always present the same in both ways. The younger the athlete, the more conservative the treatment.

After rest, and the athlete is back to base line, meaning that he or she can do homework, can text, can use the internet, and do everything that is normal. Then, we ask for a graduated exercise challenge — a little bit of aerobic activity, then rest for 24 hours. If the athlete doesn’t have any symptoms, increase the aerobic activity the next day, add a little bit of weight lifting and rest for 24 hours. This is a 5 to 7 day process.

So remember, if an athlete is concussed, and he or she feels normal in 7-10 days, you’re still looking at another 5 days or so before they return to practice or play — and that needs to be medically supervised. This phase can be longer. Some athletes, if they have had more than one concussion, concussions close together, or their recovery is prolonged, can take weeks not days.

G4: Are there any rules or regulations in place to keep our young athletes safe?

Dr. Herring: Luckily, in the State of Washington and now in 41 other states, there are laws that help protect our youth athletes due to the heroism of the Zack Lystedt family.

There is a Lystedt law in Washington and it’s pretty simple, that parents, coaches, and athletes must be educated about concussion. If there is a suspected concussion, the young athlete must be removed from practice or play at that time, and there’s no return to play without medical clearance from a licensed healthcare provider knowledgeable about concussion.

Remarkably, that was not a law in any state. It’s now a law in 42 states, and we hope to see at least 3 to 4 more states this year.

G4: What does the Lystedt Law mean for young athletes?

Dr. Herring: It means that management of concussion is where it belongs — in medical hands. But it also means that athletes, coaches, and parents need to be a part of this by understanding the potential seriousness of a concussion and reporting robustly when they have symptoms.

Further Resources

G4: Are there available materials for parents, coaches, and athletes to become educated on concussion?

Dr. Herring: There are many materials available, many are linked to our website at uwmedicine.org/sportsconcussion or the CDC website on concussion. There are educational materials for parents, coaches, and athletes. There are educational materials for healthcare providers. The resources are there. The awareness is there.

No one likes sports more than me. I do not think that our young people need to stop playing sports. I think most concussions do get better. But we have a chance here to prevent tragedies and also disability.