Concussions in Young Athletes: Balancing the Risks

Concussions can happen in any sport, even though football usually gets all the attention, says Dr. Michael Koester, whose specialties include pediatric and adolescent sports medicine, as well as sports concussion management at Slocum Center.

“Certainly we see more concussions in football than we see in other sports, but it’s not necessarily by a huge margin,” Koester points out. Even everyday activities like bicycling or tripping and falling while walking can result in concussion.

Dr. Michael Koester

While many sports, including soccer and lacrosse, come with a risk of concussion, Koester says it’s important to remember the vast benefits of enrolling kids in sports.

“My worry is that people are so freaked out about concussion that they don’t want their kids to play football, baseball, soccer, or whatever sport,” Koester says. “When we’re in the middle of an obesity epidemic, it’s not something you want to see.”

The key, Koester says, is to recognize symptoms of concussion quickly and take care of them properly.

Over the past 10 years, new research on concussions has further revealed the intricacies of treating this complex injury. A concussion in and of itself is not a lifelong problem, Koester says, and with proper treatment, concussion symptoms typically resolve. Koester sat down with LCMS and shared his perspective on treating concussions. The interview below has been condensed for length and clarity.

On recognizing concussion symptoms:

“The big thing to know is that you’re not always going to have immediate symptoms. In some cases, kids may try to hide their symptoms, although I find that much less frequent now because of all the knowledge we have with media coverage and discussion from coaches and athletic trainers. If they’re complaining of headaches, nausea, dizziness, or there are mood or behavior changes within 24 to 48 hours of participating in physical activity where they may have received a blow to the head, that’s something to get checked out.

“Now, if it’s been a month since they last participated in physical activity, or if these symptoms are developing when they haven’t done any physical activity at all, it’s not usually going to be from a concussion. As a matter of fact, many concussion symptoms are not significantly different from the daily complaints of teenagers, so it can be difficult to figure out what may be happening.”

On the connection between concussions and anxiety:

“In terms of prognosis, one of the biggest associations we’re seeing in concussions is pre-existing anxiety or a family history of anxiety. With kids who are already anxious, you see this spiral of anxiety and worsening symptoms when they get a concussion, especially if they’re in an academically challenging environment. There were two studies a few years back that found kids who had a history of anxiety actually took twice as long to get better from their concussion than kids who didn’t. And I see it every day.

“If you have an anxious personality, there are many things about the vagueness of concussion systems that may get the brain firing. If you’re anxious and you come to see me because you’ve broken your wrist, we know it’s going to hurt a week or so, and we’ll manage that with ibuprofen. We’ll get you out of the cast in about four weeks. You have this very set plan, so even if you’re kind of stressed about it, you know pretty much what’s going to happen.

“But if you come in with a concussion, I’m going to have to tell you that I can’t really know how long recovery will take.”

On the team approach to treating concussions:

“Everything we do from a concussion standpoint is really a team approach, starting with the primary care physicians sending the patients to me, if needed. I’ll send them back to their physician if I’m worried something other than a concussion may be going on, like anxiety or depression. We utilize athletic trainers at school, if possible, and they’re usually the first step in getting kids to the primary care physician or to me.

“On the other end, they’re helping head up the school side of things for academic accommodations. Neuropsychologists can be huge helpers in the kids with symptoms lasting longer than four to six weeks, or who have pre-existing academic difficulties. We utilize physical therapists locally, counselors at the school, and psychologists, neurologists, and psychiatrists, because concussion tends to ramp up pre-existing tendencies toward anxiety, migraines, and depression, to name a few complicating factors. We work with counselors and psychologists quite a bit to deal with mental health issues.

“The team approach has come into the fore in the past two or three years, especially utilizing neuropsychologists and physical therapists. We’re noticing more and more that kids with vestibular injuries and difficulties with balance respond really well to physical therapy programs.”

On the difficulties parents and kids face during recovery:

“It can be really challenging for parents because they may be seeing me, a physical therapist, a neuropsychologist, and a counselor. You may not have to see everyone every week, but you’d see the counselor and physical therapist every week. Even if you’re in town, that’s more missed school, but if you’re in Coos Bay, that turns into an all-day venture for kids who, in some cases, don’t do well riding in the car, so we have to balance that aspect as well.”

On the importance of playing a variety of sports:

“My number one advice for parents with kids playing sports is to have kids play a variety of sports. We have really good data now that it decreases injury risk. Kids who specialize in one sport are at increased risk for injury, and I think variation goes a long way to decrease burnout. That’s one of the reasons I really like football, because it’s just that one season and kids can go play lacrosse or basketball or baseball, whereas there’s a huge amount of pressure on kids to play soccer or softball or basketball yearround.”

On the complexity of concussions:

 “The take-home message for concussion is that all concussions are manageable, but some are more difficult than others. If a kid has symptoms that last more than a couple of weeks, and if they have pre-existing anxiety, depression, learning or academic issues, significant dizziness, or a history of previous concussions, those are the ones that deserve more attention and a team approach, because those are more likely to have problems. For the kid who has a concussion and the symptoms clear within four to five days, they’ll typically be fine. But those kids with the other red flags will likely be problematic.”