Sports Medicine

Concussions In Sports: Knowing When To Stop Playing

High school student Mikyla Croul played soccer most of her life. Even though she was noticing changes in her vision and having headaches that felt like a drill into her head, she kept returning to the field.

It was not until her sixth concussion that she sought help. R. Robert Franks, D.O., Assistant Director of Sports Medicine at Cooper Bone & Joint Institute, recognized the athlete had a serious problem and ordered tests. He eventually diagnosed Croul with postconcussive syndrome and told her she could never play competitive sports again because of the severity of her present symptoms and the increased risk of severe brain trauma.

Like Croul, many young players dismiss their symptoms and get back into the game too soon. In Croul’s case, she recalls telling her coaches she was OK even though she felt like her head was in the clouds.

About 300,000 sports-related concussions occur in the U.S. each year, according to the Centers for Disease Control and Prevention. Dr. Franks believes an additional 750,000 to 2.25 million cases go unreported. The groups at highest risk for injury are children between ages 0 and 4 years old and 15 and 19 years old.

Concussion symptoms often do not include loss of consciousness or amnesia and may not appear immediately. Symptoms may include headache, dizziness, confusion, nausea, vomiting and vision changes. Later symptoms of concussion may include memory disturbances, poor concentration, irritability, sleep disturbances, personality changes and fatigue. Studies show the effects of subsequent concussions, or postconcussive syndrome, can be damaging over time.

“There is very little education concerning concussions and their effects upon athletes available to the general public,” Dr. Franks said. “We developed the Cooper Concussion Program to educate people on all levels about prevention, evaluation, diagnosis and management of mild traumatic brain injuries.”

The Cooper Bone & Joint Institute Concussion Program is the only one in South Jersey that offers credentialed experts who evaluate, diagnose, treat and manage minor traumatic brain injuries.

“The Cooper Bone & Joint Institute is recognized by the Brain Injury Association of New Jersey as a referring institution for concussion care and management,” said John Salvo, M.D., Director of Sports Medicine at The Cooper Bone & Joint Institute.

The Institute is a credentialed provider of ImPACT™, a computerized test that measures cognitive function and is used to evaluate concussion symptoms. Insurance companies are starting to cover these tests. Dr. Franks recommends all athletes receive baseline testing and measurements prior to the season or at least immediately post injury. The baseline test helps athletic trainers, parents, physicians and coaches determine when players should return to the game by comparing it to post injury-test results.

For athletes without baseline testing, it is important to take an ImPACT type test after a concussion injury to compare findings with national norms.

“This test compares post results with the baseline to determine changes in brain function,” Dr. Franks said.

With rest, time and decreased activity, athletes can eventually recover. The problem, however, is when athletes return to play too soon and do not allow the brain to completely heal.

For Croul, recovery has been slow but good. Nearly eight months later in December 2005, Croul began light weight training and jogging several times a week. She now works out four times a week.

“Every suggestion Dr. Franks made was well researched. I did everything he said and it worked,” said Croul, who is now a senior at West Chester East High School in Pennsylvania. That meant taking time off from school and temporarily stopping all physical activity. Last fall, as part of her recovery, Croul saw a sports psychologist to help her cope with depression and the fact that she could not be on the field.

Croul admits she misses playing soccer. She wants to try tennis someday, but for now she is enjoying being a teenager.

Croul suggests young athletes take concussions and their effects seriously. “I know teens who have had them and say they are OK. But it’s not worth the risk,” she said. “Don’t dismiss a concussion. Get help and see a doctor.”

A leading shoulder and knee specialist, Lawrence S. Miller, M.D., is Head of the Division of Orthopaedics, Director of the Cooper Bone and Joint Institute, Director of Sports Medicine and a Top Doc (Philadelphia Magazine, South Jersey Magazine, New Jersey Monthly and SJ Magazine). Dr. Miller also performs shoulder replacements.

Cooper’s other physicians are:

Eric L. Hume, M.D., hip and knee specialist and a Top Doc (Philadelphia Magazine, South Jersey Magazine and New Jersey Monthly)

David H. Clements, III, M.D., spine specialist and a Top Doc (South Jersey Magazine)

David A. Fuller, M.D., hand and upper extremity specialist and a Top Doc (South Jersey Magazine and SJ Magazine)

Robert F. Ostrum, M.D., trauma specialist and a Top Doc (South Jersey Magazine)

Eric D. Farrell, M.D., trauma specialist

John P. Salvo, M.D., sports medicine, shoulder, elbow and knee specialist. Also performs shoulder and knee replacements.

Mark A. Pollard, M.D., sports medicine, shoulder, elbow and knee specialist.

Robert Franks, D.O., sports medicine and medical orthopaedics specialist and a Top Doc (SJ Magazine)

David Gealt, D.O., sports medicine and medical orthopaedics specialist

The physicians see patients in Cherry Hill, Voorhees and Camden, New Jersey and in Newtown Square, Pennsylvania. The Cooper Bone and Joint Institute has rehabilitation facilities in Haddonfield, Voorhees, Camden and Cherry Hill.

To make an appointment with a Cooper University Hospital physician at an office near you, please call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.