Concussions are back in the news as fall is upon us and with it the return of Friday night lights and the risks that tackle football brings.
But Andrew Peterson, a clinical associate professor at the University of Iowa and founder of the UI Sport Concussion Program, said his clinic is seeing fewer concussions as Iowa laws improve and schools and squads step up their safety and skills game.
Q. What is the average number of concussions you see a week?
A. They’ve gone down quite a bit. When I started the Sport Concussion Program in 2010, we were very full very quickly. We’d typically have 10 to 12 new concussions per week. Now I’d say I have more like two or three new concussions per week. But they tend to be much more complicated cases.
Q. Why the decrease?
A. Most of these regular run-of-the-mill injures have kind of dried up for us because most primary care physicians are doing a good job with those.
Q. What sports pose the most concussion risk?
A. Football epidemiologically has a reasonably high rate of concussions. There are other sports that are similar, but in terms of participation numbers, there are way more people playing football. So the burden of disease is higher, and we definitely get more in the fall.
Q. Iowa updated its concussion law last year. Tell what that change did.
A. One of the changes required “return to learn” and “return to play” guidelines in the schools. Each school had to have their own policy for those things — getting back in the classroom getting back to sports. That was largely being done already. So this kind of codified what was already happening and what should be happening every place. The other things were related more to policy — creating an insurance program for high school athletes who had a sport-related concussion and making sure they could get adequate care if they were uninsured or under insured.
Q. Have those changes had an impact?
A. Most schools had a concussion policy, but a lot of places were scrambling to create a “return to learn” policy and match what they were doing in practice with what the rules require.
Q. What is “return to learn?”
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A. In general, you want to help people get back in the classroom and return to as much work as they can as soon as possible. There is pretty strong evidence now that absolute rest isn’t beneficial. We want people to be doing as much as they can. So now we are encouraging people to return to their school, to return to their classroom, to return to reading, those types of things that maybe we were a little more hesitant to get people back to — and make sure those things are successful — before they ever start returning to sports.
Q. How dangerous can concussions be for athletes?
A. There is clear danger in the second-impact type of a concussion or second-impact syndrome — where someone gets a concussion and gets another one on top of that while they’re still injured. The basic science of that is pretty well understood. We understand why the brain is so vulnerable during that period. Those injuries can be much more severe. They’re usually longer-lasting, their symptoms are usually more severe, and they’re dramatically more likely to lead to long-term disability.
Q. Is that what the policies are meant to prevent?
A. There is a period of vulnerability where you have a concussion and your brain is very vulnerable and susceptible to second injury, and that’s really what we’re trying to do with most of these policies and laws — take people out of play and make sure they don’t return to play until they’re symptom-free and recovered.
Q. What are the symptoms?
A. Headache, feeling in a fog, feeling not right. Dizziness. Nausea and vomiting. It’s actually pretty rare for someone to have really profound symptoms. So things like getting knocked unconscious or having a seizures — those things definitely happen, but they’re much less common than these softer symptoms.
Q. How long can they last?
A. Most are very short. The average duration in high school age boys is about eight days. Most people recover quickly and spontaneously.
Q. What is your opinion of tackle football and whether kids should play?
A. What attracts people to football is the physicality. It’s hard to have a sport like football without the hitting in it. That said, there are important steps of skill acquisition that can be done prior to hitting, and so I do think things like flag football or tackle bar or some of these padded flag leagues — I think they make a lot of sense as a point of entry. I think a well-coached and well-supported league can be a reasonably safe thing. It’s not risk-free. But for the vast majority of kids, they’re going to play a happy healthy season and enjoy themselves and not have too much risk for severe injury that’s going to have long term effects.
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