Hello I'm dr. Randall SI crees your host free orthopod TV today we'll be talking remotely with dr. William seeds dr. C's is an orthopedic surgeon who practices orthopaedic in Ashtabula Ohio hunter seeds is also the medical director for the great Center in Geneva Ohio thanks for joining us today dr. C thank you for having me Randy I'm excited to be here today dr. seeds what I thought we would.
Discuss today is is is a very common problem amongst athletes that are involved in contact sports and that's head and neck injuries i think is we're starting to see in the news today this has become more of a problem as we're seeing our football players especially using techniques wear the helmet is used as somewhat of a device to to do some type of aggressive moot motion on the.
Field that is either a block or a tackle or something like that that puts the the alley at risk for a head injury or a neck injury I think we can also see this in some of the other lesser contact sports like soccer and rugby but it's become a real problem in football what I'd like to discuss today with you is is in your role as a sports medicine physician on the field when you see.
These injuries occur at the time we've got several different questions one is is you know what what what's going on with the athlete what's the injury like to is how do you assess the athlete and determine whether they can go back into the game because all these athletes once they wake up from these problems they want to go back into the sport and it may or may not be safe for them to do.
That so I guess the other piece is how you counsel these athletes coaches and parents in these younger athletes about the risk and the benefits of going back in so start by sort of giving us the scope of the problem what are you seeing as you are on the sidelines especially in football games how how big a problem is this well Randy I think this is an excellent topic in lieu of all of the.
Information that's coming out right now in the NFL how they're trying to improve the control of head injuries specifically in football and I will tell you that we're definitely seeing an increase in the number of injuries head injuries that were able to identify at this time I think a lot of it is due to we're doing a better job of educating the players.
The families and the coaches and so were I think as a group we're better at it trying to identify these these these problems and I think with concussions it there there are also some some I think we have to understand with concussions there there are some controversies over is it a concussion is it a traumatic brain injury I think there's some play on words but basically we're looking at.
It at brain injuries and and I think that's what we have to we have to all agree on that there is an injury to the head that that is causing an injury to the brain and we all need to know that this can have long-term effects on these individuals within a few years or down to 20 to 30 years down the road so knowing this I think it's important that we also realize that on the field you.
Have to be very attuned to what's happened it possibly at the time of injury because I'll tell you that a lot of the players you know when they come off the field they're not going to tell you they got hurt they're not going to tell you that they that maybe they might have had some type of injury to their head they're going to get up there going to come off the field or they're going.
To get back in the huddle and I think we're still missing possibly up to maybe a third of those injuries so you've got to be attuned to watching the player and trying to identify those problems initially in helping these players with these injuries now when you see a player come off the field who's had a head injury who may may have had a brief loss of consciousness maybe even not what are.
You doing to assess that patient what sort of questions are you asking the patient to get some idea of how serious this is well I'm defining with with my trainers and and what we try to educate the the coaches and so forth with is that loss of consciousness doesn't essentially mean that they've that they've blacked out it could be as much as an injury to the head where we're.
Looking for the the player coming off the field and having a sense of immediate fatigue a fogging of what they may feel is is there they're kind of living in a fog problems with vision as far as light sensitive or even sound sensitive nausea type of symptoms lightheadedness dizziness and I think dizziness is the is probably the the initial thing I hear the most doc I feel.
A little dizzy and those are things that you need to start when you hear that then you need to start looking a little bit further and questioning that that patient what is their speech pattern like are they able to focus their attention on what you're saying and if I see any of those symptoms that's it for the game I mean to me at that point in time they've had sub type of injury.
That's affected their brain and until those symptoms resolve and and you follow those symptoms for over 24 hour period and and so forth you you you've got to be responsible in that that players got to come out of the game well I think we ought to explain for parents and coaches and even players what what constitutes a head injury I think you've mentioned some of the symptoms you see.
But I think there's a misperception out there that if you if you didn't lose consciousness you didn't have a concussion or you didn't have a brain injury clarify that for me is that true Randy that's absolutely true and I think that's where we we've run into problems in the past and i think the NFL is has really come to to the table also identifying that hey.
A concussion is not just a loss of consciousness before we used to we used to kind of blow off any of those symptoms if if that patient didn't lose consciousness where they blacked out for a few seconds or a few minutes then they were ok to continue to play that that's not true if a player is having some aspects of what I just discussed you know altered consciousness as far as.
Lightheadedness fogginess blurred vision slurred speech inattentive unable to to follow commands well dizziness not off balance you know you can do some initial balance testing and I mean you can hold in on these things very quickly you can't hide them and I think we're very attentive to those to those aspects now and and I'll tell you on the flip side now that the players know we're looking.
For it I think some of them are definitely hiding those symptoms are trying to stay away because they don't want to be taken out of the game now in terms of the brain injury that that occurs with a concussion what do you think's going on with the brain can you explain that so that patients and coaches and and and and parents can understand what's actually going on in.
The brain sure Randy what we we've actually there have been studies that that have have looked at the you know what potentially could be occurring in the brain where they've done studies such as functional MRI evaluations of the brain after acute injuries and they've been able to show that there are certain areas in the brain that are definitely affected by.
The the trauma and that can have that that trauma to the brain can show up as subtle changes on the MRI suggesting that there were alterations in in blood flow to a certain area of the brain that that can have long-term effects on that brain as as we age so I think and there's a lot of exciting data that's coming out now where we're doing more to follow these patients and look at these.
Type of injuries but there is there's absolutely evidence that there are alterations in in what we see functionally on an MRI and also physically as far as impairment to the brain well in terms of treatment I mean you've mentioned that if you see a an athlete come out of the game with any of these symptoms that you're going to take them out of the game at that point what.
Else do you advise those patients to do in terms of treatment what are they going to do the next step well it's very important to continue to do a neurological assessment and get an idea of how this patient is progressing with this injury and it's very important to educate the family that you want to do a neuro a neuro assessment what we try to do is is follow that patient every.
Couple hours initially and it depends on the severity of the symptoms again and and kind of make sure where we want to make sure that those symptoms do do stop and that there is some improvement within that 24 hours if it goes beyond that 24 hours then we'll do some more of an intense observation some of these patients we may admit it to the hospital to follow.
It just depends again on the severity of the symptoms and and some of these patients with with mild concussions can have symptoms that can last weeks and those symptoms could just be dizziness or lightheadedness and and the problem is is that if you let players play with any of these symptoms we're doing harm to that brain the brain is not that the brain is very fragile and will not if.
They're playing with any of these symptoms all we're doing is making that situation worse for them well it seems like we're also putting them at risk because if some of the symptoms that you just suggested you know balance problems inability to think quickly actually puts them at risk of another injury of the same sort if they're not playing up to a hundred percent you know it's just like.
When you get tired you're more likely to be injured obviously if you're if you've lost some of your cognitive abilities or some of your balance you're more likely to be injured whether it's a brain injury or some other injury I would assume is that what you're seeing yeah absolutely Randy and and I think it's important also to understand that we've seen some new studies that have come out.
Recently where they've actually been able to track high school football players and they've put they've put sensors in the helmets and they've actually been able to follow a group of football players football players that have had mild concussions football players that that were supposed to be normal with no no brain injury at all where they followed all these players.
With with the sensors they followed them with functional MRIs they followed them with neuro in cognitive type of testing and they found some very interesting aspects of this study where it showed that that continued head trauma where there are no symptoms are sequelae of injury where someone's had a continued injury to the head or or continued let's say tackling with the head.
That those people have the same functional change can have the same functional changes on the MRI and the neural and cognitive testing they can show impairment just the same as the concussive patients and that's pretty alarming because those are people that you know that they show no signs of concussion or symptoms but in retrospect that looking you know looking back at.
These players they found that these players had an increased amount of head contact and that that's very concerning because we know that we've seen this what we would call a traumatic neuro encephalopathy of these NFL players that you know in their 50s and 60s that are developing these symptoms of impairment with the use of their brain and so I think that all of this information is is.
All is very important in what we're trying to do to help these players continue to play the sport but be very very concerned about what's what's happening you know as you're as you're beginning to watch these patients to three days down the road and maybe they're still having symptoms when do you make the decision that it's time to do some sort of imaging like an MRI scan.
Of the head or a cat scan of the head when is that Randy I have a my rule is is pretty much it's a very I don't know if you call it aggressive but it's it's a it's a rule of I would say 24 hours of where I if I have players that continue to have symptoms within a 24-hour period I don't hesitate to to move forward with the CT and further testing of the of the brain and I think it's you know there's.
A lot of relevance to that with the concern of the parents and not sometimes not seeing the injury at the time it occurred I mean there's a lot of things that that really sometimes can fog that presentation where you don't you do not want to be caught from behind with with not properly assessing this and so within 24 hours if if these patients are having.
Continued symptoms will will move forward with that now if I have patients that have immediate loss of consciousness on the field then there are times that we will immediately do a CT that same night so it just really again depends on the presentation and I think we're very aggressive with it but I think you need to be well what about treatment I mean other than just.
Watching the patient and making sure that the situation isn't getting worse and maybe there's no bleeding into the end of the skull or something like that or no skull fracture that needs to be addressed is it really any treatment that you can provide to patients who've had a concussion and may be exhibiting some of these symptoms over a period of several days anything active that you do.
To try to help that situation to resolve yeah I think that education is is absolutely the best thing you can do with the family and the individual I have found that and we found in our experience that there I would say the number one complaint or or question that that has come up in the past is that the family or the players notice they notice a change in their behavior they're more.
Irritable they may even show some depressive signs or symptoms that they don't even know our depression and and these things can happen right away and it's very it's very disturbing where I'd say in the past maybe people weren't aware of these things are they weren't educated about looking at these things in and just those those behavioral things can make a big difference in how.
The family approaches this and the players understanding that hey there are some things that can occur here that that can be very relevant the other things are you know we try to we try to help them with the visual and sound cues as far as you knows maybe being more in arrested area where they're not getting a lot of a lot of other a lot of environmental things that can affect it.
You know bright lights and sounds and things like that again it depends on the symptoms and so those those are some of the early initial things will do but but no medications that you're you're recommending or anything any sort of special diets or anything that the patient should be actively doing other than then the thing the behavioral.
Things you're talking about no not in the not in the acute onset we do try to we do try to limit you know their appetite somewhat it but most of them aren't hungry when these things occur so no there aren't any we don't tell them to take aspirin we don't tell them to take a tylenol or anything like that because I want to know what these symptoms are I don't want to mask them I.
Want to know if they're having headaches if they're having these complaints and i forgot to mention you know headache along with dizziness headaches are the other thing that are that are very relevant and significant and the headache tends to show up a little bit later it's not an initial complaint it goes dizziness and then headache is that is the thing that the patient will.
Complain up down the road well you know it seems like that that prevention is is is part of the key to this i mean i think that when you're playing football you're doing some of these things you just simply can't avoid the possibility of a head injury but it seems to me that that clearly the discussion today is is that we're putting our athletes at risk because they're specifically doing.
Things that that increase the risk of a heading head injury so how do you work with the athletes in a preventative way to try to teach them skills that reduce their risk of head injury well I think that is a continuing educational process that's happening right now not only in high school and collegiate athletes but also in the NFL I mean we're trying to change now that you know back striking.
With the head as far as direct contact changed many years ago now we're trying to change the zone and where you can strike we're trying to show the proper techniques and it and it's it's still interesting to me today to see the the techniques of tackling of where some some people aren't properly educated on on the aspects of tackling and the appropriate approach which now.
You can now that the NFL is is producing videos on just that on the proper technique the strike zone all these things I think play an important role in that let's talk for a moment about the athlete that's had a head injury and the risk of additional head injuries down the road and and sort of how you advise that athlete if you have an athlete a young athlete with a significant head.
Injury what do you tell them about their sport I mean do you tell them not to go back to the sport what kind of risks are they taking when they go back to the sport those sorts of issues well I think it's important now with the information that we that we are gathering more of specifically with these these type of injuries that were aware now that there are long-term problems with just a.
Single concussion so it's very important to educate these families that there there can be repercussions with this this brain injury in and my rule of thumb is if if player has had a second concussion I usually recommend that that that they need to seriously consider not participating in that sport again because we know that multiple brain injuries such as this can can absolutely.
Have a long-term effect and again our role is to educate and to let these people know that hey we're trying to we're trying to improve your your quality of life as you age so it I'm not a I'm a realist in giving the family and the players that information and I will I'm very stringent on the on those type of problems as far as if a player's had a second concussion they need to.
Seriously consider what they're doing and I won't clear them to play if if they're able to you know have further opinions and recommendations I'll certainly look at that but that's kind of my stance I take you know on the lower level of high school and and collegiate athlete well I think there's been a very good discussion for the young athlete especially but but.
Athletes of all ages that are involved in contact sports is there anything that we haven't discussed that you feel like that patients or coaches or parents need to know about head injuries and how to how to manage a head injury once it's occurred I think the family what what we discussed as far as just trying to just being aware you know again it's it's very interesting to me that the the.
Families sometimes the the mother or father that are out there in the stands they know something's happened to their child before the coach or the physician knows because they know what their kid typically is doing out there they know that the kid usually Sprint's or he's hustling or he's doing they can recognize problems right away and I encourage the families to come to us.
Come to the trainer and say hey something's just not right with my kid I don't know what it is but those kinds of things can really help in in getting that player the proper attention and and I've found that to be invaluable with with evaluating and treating these kids earlier well I want to thank you for this information and and I want to invite parents players and coaches to.
Continue watching a second segment where you and I are going to discuss a little different topic but something that's very close to this and that's neck injuries in contact sports you know it goes by different names sometimes burner stingers or sometimes just just injury to the neck but it's a another problem that we're seeing in conjunction with the head injury so thanks for this.
Discussion and and I would invite the viewers now to find the second video on the neck injuries because I think that's very complimentary what we just discussed so thanks again for the information Thank You Randy you