Tua Tagovailoa of the Miami Dolphins suffered injuries in successive weeks with the last injury diagnosed as a concussion.  The neurologist who was part of the process to evaluate and clear Tagovailoa to return to the game the day of his first injury and allow him to play 4 days later where he was injured again has been released as per the NFL.  The issue at stake is that athletes with a concussion can more easily suffer a second concussion and the effects of cumulative injuries can leave lasting effects.  

In light of recent events in the National Football League, it is prudent to consider the effective evaluation and management of head and neck injuries in athletes as the fall season moves along. The correct diagnosis and evidence-based management of head and neck injuries is imperative to the safe participation and return to sport of all athletes at every level of competition.  As athletic pursuits become more ubiquitous in our nation and across the world, we as physicians that care for athletes make every effort to effectively and efficiently assure that each patient is identified and treated correctly and cleared safely.

It has been found that 1.7 to 3.8 million traumatic brain injuries occur each year in the United States. Furthermore, 300,000 head injuries will occur each season in football alone.  Recently, the CDC has estimated 5 to 10% of athletes will experience a concussion in any given season.  As we consider these statistics, it is ever more important to be able to identify those athletes that need to be removed from the field and even more so, those that need intensive management of their post-concussive symptoms.

The diagnosis of concussion is not simple, and requires the consideration of multiple signs and symptoms that may or may not be easily identifiable. We know that a concussion is a complex process that is induced by forces to the head or body, leading to a myriad of symptoms including headache, dizziness, sensitivity to sound or light, nausea, vision changes, fatigue, and feeling of “fogginess,” among several others.  The signs of concussion, which are observed by others can include slowness to respond, personality changes, a stumbling gait, and even a short loss of consciousness.  It is important to know that these signs and symptoms can occur in other, more serious, head injuries but the diagnosis of concussion requires the absence of those, such as multiple episodes of vomiting, worsening headache and seizures.

The on-field evaluation should always include the consideration of a neck, or cervical spine injury, as this often occurs in conjunction with head trauma.  These neck injuries cannot be missed, as certain types can be catastrophic for future participation in sport, but also for normal daily function.  In the unfortunate circumstance of a cervical spine or head injury that leads to a neurologic problem, the athlete will be transported to the nearest emergency department without delay for the appropriate management that may include surgical intervention.

A cervical spine injury can mimic some symptoms of concussion. So it is important to consider this as a source of the athletes problem.  Accordingly, when both the head and neck are involved after an impact, it is imperative that both areas be treated, as one generally cannot recover without correction of the other.

Another aspect to consider is the phenomenon of second impact syndrome (SIS).  This can occur when an athlete returns to sport before the symptoms from a prior concussion have resolved.  If the symptomatic athlete sustains a repeat injury to the brain, the normal regulatory processes of the body can fail, and an increase in intracranial pressure may occur that can be catastrophic.  Fortunately, SIS is a rare occurrence, and very few cases have ever been reported. Nonetheless, it is of the utmost importance that clinicians, athletes, trainers, parents and coaches be aware of this entity, so no person ever has to experience the outcomes of such a case.

In conclusion, as the fall athletic season continues, we as physicians, athletes, coaches, parents and fans should all be aware of concussion in sport.  While the benefits of sports have been shown to far outweigh the risks in numerous reports, we still need to remain vigilant and understand when the pressures of victory are outweighed by the risks of early return to the field.  The sports medicine team at Total Orthopaedics takes every variable into account and works tirelessly to assure you can get back to competition safely and efficiently.

Written By Dr. Brett Spain, DO