Concussions in Basketball Marc Richard Silberman, M.D.
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Transcript of Concussions in Basketball Marc Richard Silberman, M.D.
Concussions in Basketball
Marc Richard Silberman, M.D.
Has the game changed?
Wilt “The Stilt” Chamberlain7-1, 250
Tiny Gallon 6-9, 290
The game has changed
“Now everyone looks like a sumo wrestler” - North Carolina Coach Roy Williams
Your Brain
“This is your brain. This is your brain on drugs.”
This is your brain
The Brain
Freely floating within the cerebrospinal fluid Moves at a different rate than the skull in collisions Collision between the brain and skull may occur
On the side of the impact (coup) On the opposite side of the impact (contracoup injury)
Acceleration-deceleration may result in stretching of the long axons and in diffuse axonal injury
Lies, headlines, and statistics Headline: “Concussions in basketball are on the rise in teens” Study: Retrospective review of ER visits from 1997-2007 Truth: “Emergency room visits diagnosed as concussions are
on the rise for teens playing basketball” 2.6% = overall concussion percentage of basketball injuries Percentage doubled in boys, tripled in girls from 1997-2007 Does not tell us if more concussions are being suffered The real story: 1/3 did not recognize or report symptoms to their ATC 28% continued to play with symptoms
Pediatrics, McKenzie, October 2010 issue
High School Concussions 1995-1997
Concussion 5.5% of total injuries
Football 63.4% of concussionsWrestling 10.5%Girls Soccer 6.2%Boys Soccer 5.7%Girls Basketball 5.2%Boys Basketball 4.2%Softball 2.1%Baseball 1.2%Field Hockey 1.1%Volleyball 0.5%
JAMA. 1999 Sep 8;282(10):989-91
Ligament sprains 44% Muscle/tendon strains 17.7% Contusions 8.6% Fractures 8.5% Concussions 7.0%
H.S. Basketball Injuries 2005-2007
Am J Sports Med December 2008 vol. 36 no. 12 2328-2335
H.S. Basketball Injuries 2005-2007
Rebounding caused the majority of injuriesJumping/landing caused the majority of sprains
Am J Sports Med December 2008 vol. 36 no. 12 2328-2335
H.S. Basketball Injuries 2005-2007
Am J Sports Med December 2008 vol. 36 no. 12 2328-2335
Girls
Boys
5 %
14 %5 %
3 %
Females Greater proportion of concussions Greater proportion of knee injuries Knee was most common injury requiring surgery
Males More frequently sustained fractures More frequently sustained contusions Contact sport
H.S. Basketball Injuries 2005-2007
Am J Sports Med December 2008 vol. 36 no. 12 2328-2335
Concussion Cause Collision with another player 65% Contact with the floor 13% Personal opinion this is not the truth
Concussion Activity Rebounding 30% Defending
20%
Illegal Activity Total number of injuries 13% Concussions 35%
H.S. Basketball Concussions 2005-2007
Am J Sports Med December 2008 vol. 36 no. 12 2328-2335
Soccer, lacrosse, basketball, softball, baseball, and gymnastics 14,591 injuries in male and female athletes 5.9% classified as concussions Males Game Injury Rate / 1000 exposures
Soccer 1.40 Lacrosse 1.46 Basketball 0.47
Females Soccer 2.10 Lacrosse 1.05 Basketball 0.73
Collegiate Concussions 1997-2000
J Athl Train. 2003 Jul–Sep; 38(3): 238–244
Females more likely than males to suffer concussions Games 3.4X riskier than practices for females A finesse sport has become a contact sport Concussions in Women Basketball
4.7% total injuries sustained in practice 8.5% total injuries sustained in games
Concussions in Men Basketball 4.1% total injuries sustained in practice 5.0% total injuries sustained in games
NBA game injury rate 2X the NCAA
Collegiate Basketball Concussions 1997-2000
J Athl Train. 2003 Jul–Sep; 38(3): 238–244
This is your brain
What is a concussion?
Complex pathophysiological process affecting the brain induced by traumatic biomechanical forces
Functional disturbance of the brain with no structural injury
Typically short lived impairment that resolves spontaneously
Direct blow to the head
Indirect blow with a force transmitted to the head
Classification of concussions
A concussion is a concussion
There is no such thing as a mild concussion
No grading system
Most symptoms resolve in a short period of 7-10 days
Post concussive symptoms may be prolonged in children
Concussion diagnosis
There is NO test to diagnose a concussion Clinical diagnosis based on the following:
Symptoms Physical Signs Behavioral Changes (cry, irritable) Cognitive Impairment (slow reaction time, memory) Sleep Disturbances (drowsiness)
Symptoms
Headache is the most common Feel dazed, cobwebs, or in a fog Light and sound sensitivity, visual disturbances “Everything seems slow” “My colors changed” Teammate, “Eric’s not right, coach” Appearance can be delayed several hours
Physical Signs You do not have to lose consciousness Amnesia (“Doc, I don’t remember the first half”) Emotional labile (crying, talkative) Poor balance Difficulty concentrating Difficulty remembering
On-Field Evaluation
Standard emergency management Exclude cervical spine injury Return to play determined by a physician “When in doubt, sit them out” No player shall return to play the same day Sideline assessment of concussion (SCAT2) Monitor for any deterioration over time
Syracuse
Post-Standard
Jan 16, 2005
Concussion Management
Complete physical and cognitive rest until symptom free
No sports No horseplay No school, if necessary No texting, video games, internet, TV, driving
Graded program of exertion prior to full return to play
Exertion effects
Symptoms are worsened by physical activity mental effort environmental stimulation emotional stress
Academic Accommodations
Excuse from school if necessary Excuse from homework Excuse from quizzes and tests Rest breaks during school in a quiet location Avoid re-injury in crowded hallways or stairwells Avoid over-stimulation (cafeteria or watching games)
Provide reassurance and support
Most recovery in 7-10 days.
About 95% recover in 3 months
Post-concussion syndrome is the term used to describe prolonged or incomplete recovery
Non-injury factors often play a role in the persistence of symptoms
Recovery from Concussion
a ‘miserable minority’ experience persistent symptoms
Risk factors for complicated recovery
Re-injury before complete recovery Over-exertion early after injury Significant stress
Unable to participate in sports Medical uncertainty Academic difficulties
Prior or comorbid condition Migraine Anxiety ADHD, LD
Post-concussion syndrome
Multiple Concussions Second Impact Syndrome
A concussion within 2 weeks of one Athlete is still symptomatic Mostly males < 21 years old Rapid increase in intracranial pressure Rare but almost always fatal
Cumulative effects
Risk of concussion is 4-6 times greater after one concussion
Risk is 8 times greater after sustaining two concussions
Prolonged or incomplete recovery
Increased risk of later depression or dementia
How many is too many ?
Return to activity
No symptoms at rest Neuropsychological test
returns to baseline Balance testing
returns to baseline Consideration of concussion modifiers Graded return to play protocol
Neuropsychological Tests
Neuropsychological testing is an additional tool May assist in return to play decisions
Need a baseline Perform the follow-up test when symptom free
Cognitive recover most overlap symptom recovery may precede symptom recovery may follow symptom recovery
You can be fooled!
Concussion modifiersSymptoms Number, Duration (>10 days), Severity
Signs Prolong loss of consciousness (> 1 min), amnesia
Sequelae Concussive convulsions
Temporal Frequency – repeated concussions over time
Timing – injuries close together in time
“Recency” – recent concussion
Threshold Repeat concussions occurring with progressively less impact
Repeat concussions with slower recovery after each one
Age Child and adolescent
Comorbidity Migraine, depression, ADHD, LD, sleep disorder
Medication Psychoactive drugs
Behavior Dangerous style of play
Sport High risk activity, contact collision sport, high sporting level
Graduated return to play protocol
Day 1 Light aerobic exercise
Light jog/stroll, stationary bicycle
Goal: elevate HR
Day 2 Sport-specific exercise
Running drills in basketball
Goal: add movement
Day 3 Non-contact training drills
Passing and shooting, light resistance training
Goal: coordination, cognitive load, valsava
Day 4 Full contact practice only after physician clearance
Day 5 Return to competition
Any symptoms at any stage, return to complete rest
Consensus Statement on Concussions in Sport reference
2001 1st International Conference on Concussion in Sport, Vienna
2004 2nd International Conference on Concussion in Sport, Prague
2008 3rd International Conference on Concussion in Sport, Zurich http://www.sportconcussions.com/html/Zurich
%20Statement.pdf Sport Concussion Assessment Tool (SCAT2)
Concussions in Basketball
Thank you.
Marc Richard Silberman, M.D.
Gillette, NJ
(908) 647 6464