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Injured Athletes: The Risk of Returning to the Game Too Soon

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Some pediatricians who treat student athletes for head injuries fail to properly instruct them about when it is safe to return to the playing field, a study out last week concludes.

Resuming activity too soon after an injury poses grave risks, the researchers say. What appears to be a minor head injury can damage the brain or harm its functions, and repeated concussions produce cumulative effects.

"We are concerned that inadequate precautions are being taken with these young athletes," the University of Alabama at Birmingham researchers write in this month's issue of the journal Pediatrics.

In some cases, the authors write, athletes have died following a seemingly minor second impact when the symptoms for an earlier concussion remain.

In what is apparently the first study of its kind, the authors examined the instructions given 33 child athletes upon their hospital discharges. The youths were treated for sports-related closed-head injuries, or concussions, at the Children's Hospital of Alabama between 1987 and 1991.

The researchers found that 23 of the 33 patients--70 percent--received inadequate instructions about returning to sports participation. Three of the 23 were given recommendations allowing too quick a return to the field, and no instructions on returning to play appeared on the medical records of the other 20.

All but one of the patients studied, who ranged in age from 7 to 17, were boys. Football accounted for 18 of the 33 injuries. Most of the other athletes were baseball, basketball, or soccer players.

Physicians should follow the accepted medical guidelines for return to competition after a sports injury, and "must insist that these guidelines be followed regardless of whether the player will miss the 'big game,"' the study says.

One expert, who did not participate in the Alabama study, said its authors identified only "the tip of the iceberg."

"Very few pediatricians have received in their normal pediatric residency adequate instruction in terms of return to play after head injury," said Dr. Robert C. Cantu, the chief of neurosurgery and director of sports medicine at Emerson Hospital in Concord, Mass.

About 90 percent of concussions are mild and do not require a hospital stay, said Dr. Cantu, who wrote 1986 return-to-play guidelines for child athletes who have had a concussion. Therefore, he said, "if there is a problem with proper instruction for the individual with the most severe concussion...you would almost certainly expect in the mild cases there would be an equal if not bigger problem."

The American Academy of Pediatrics last week endorsed sexual abstinence for teenagers, but urged doctors to encourage the use of condoms by adolescents who do have sex and said schools are appropriate places to distribute them.

Barriers to condom availability should be removed because of the spread of sexually transmitted diseases, including AIDS, and teenage pregnancy, says the policy statement in the February Pediatrics.

Schools are an appropriate place to make condoms available because they reach large numbers of adolescents and they often provide young people with an array of related educational and health-care resources, the academy says in its statement.

No single approach can eliminate the high rates of sexually transmitted diseases and pregnancy among adolescents, the academy said. It called on parents, health professionals, and schools to work together in comprehensive, community-based alliances.

In addition, the academy's communications committee called on the television, movie, video, and music industries last week to broadcast public-service announcements promoting both abstinence and the use of condoms.

The committee also said broadcasters should air advertisements for non-prescription contraceptives on television and radio.

State health and education departments often duplicate each other's work and fail to communicate, says a report showcasing successful partnerships on the state level.

The resulting inefficiencies contribute to bloated bureaucracies and limit their effectiveness, according to the recently released study by the National Health and Education Consortium, a Washington-based alliance of groups concerned with child health and education.

As health and education have become increasingly linked in the public debate over school reform, a few states have moved to reconfigure the structure of their agencies.

The report reviewed successful partnerships between the two sectors in four states--Florida, Maryland, New Mexico, and Texas.

"In a time when states are increasingly called on to provide more services for less money, we must all work to maximize our resources," Tamara Lucas Copeland, the N.H.E.C.'s director, said in a statement.

"Successful collaboration can be the key to improving state services for families and children," Ms. Copeland added.

Copies of the report, "Putting Children First: State Level Collaboration Between Education and Health," are available for $2 each from the N.H.E.C., 1001 Connecticut Ave., N.W., Suite 310, Washington, D.C. 20036; (202) 822-8405.

--Millicent Lawton & Jessica Portner

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