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Concussions in Basketball

Concussions in Basketball. Marc Richard Silberman, M.D. Has the game changed?. Wilt “The Stilt” Chamberlain 7-1, 250. Tiny Gallon 6-9, 290. The game has changed. “Now everyone looks like a sumo wrestler” - North Carolina Coach Roy Williams. Your Brain.

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Concussions in Basketball

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  1. Concussions in Basketball Marc Richard Silberman, M.D.

  2. Has the game changed? Wilt “The Stilt” Chamberlain 7-1, 250 Tiny Gallon 6-9, 290

  3. The game has changed “Now everyone looks like a sumo wrestler” - North Carolina Coach Roy Williams

  4. Your Brain “This is your brain. This is your brain on drugs.”

  5. This is your brain

  6. 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

  7. 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

  8. High School Concussions 1995-1997 JAMA. 1999 Sep 8;282(10):989-91 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%

  9. H.S. Basketball Injuries 2005-2007 • Ligament sprains 44% • Muscle/tendon strains 17.7% • Contusions 8.6% • Fractures 8.5% • Concussions 7.0% Am J Sports Med December 2008 vol. 36 no. 12 2328-2335

  10. H.S. Basketball Injuries 2005-2007 Rebounding caused the majority of injuries Jumping/landing caused the majority of sprains Am J Sports Med December 2008 vol. 36 no. 12 2328-2335

  11. H.S. Basketball Injuries 2005-2007 Girls 14 % 5 % Boys 5 % 3 % Am J Sports Med December 2008 vol. 36 no. 12 2328-2335

  12. H.S. Basketball Injuries 2005-2007 • 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 Am J Sports Med December 2008 vol. 36 no. 12 2328-2335

  13. H.S. Basketball Concussions 2005-2007 • 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% Am J Sports Med December 2008 vol. 36 no. 12 2328-2335

  14. Collegiate Concussions 1997-2000 • 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 J Athl Train. 2003 Jul–Sep; 38(3): 238–244

  15. Collegiate Basketball Concussions 1997-2000 • 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 J Athl Train. 2003 Jul–Sep; 38(3): 238–244

  16. This is your brain

  17. 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

  18. 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

  19. 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)

  20. 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

  21. 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

  22. 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

  23. Syracuse Post-Standard Jan 16, 2005

  24. 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

  25. Exertion effects • Symptoms are worsened by • physical activity • mental effort • environmental stimulation • emotional stress

  26. 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

  27. Recovery from Concussion • 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 a ‘miserable minority’ experience persistent symptoms

  28. Post-concussion syndrome 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

  29. 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 ?

  30. 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

  31. 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!

  32. Concussion modifiers Symptoms 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

  33. 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

  34. 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)

  35. Concussions in Basketball Thank you. Marc Richard Silberman, M.D. Gillette, NJ drbicycle@njsportsmed.com (908) 647 6464

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