Concussions in football: The short-term impact

Updated: August 19, 2011 7:57PM

A typical day for Dr. Elizabeth Pieroth might have her see a Chicago Bears lineman in the morning and a high school linebacker in the afternoon.

And frankly, if they show up at her office presenting similar symptoms, they might not get the same professional recommendation.

“When it comes to concussion management and the big return-to-play decision, it’s a risk-benefit analysis,” Pieroth says. “If you are a professional athlete, the benefits of the equation are significantly higher than for some 15-year-old, 125-pound kid who just likes football.”

But don’t mistake Pieroth, one of the leading concussion experts in the sporting world. She’s not some doom-saying prude bent on ridding the world of contact sports. Quite the opposite, actually. She wants your kid to be back on the field, to be strapping on that helmet and dishing out hits again.

She just wants to make sure he’s really ready to do so.

And in the nebulous world of concussions, that’s not easy to ascertain.

“Concussion treatment needs to be individualized,” Pieroth says. “Meaning, that the kid with three concussions and a learning disability is very different than the college kid with his first concussion. Or the kid who has a psychiatric issue in his family. All of these things have to go into the equation.”

One thing Pieroth doesn’t enter into the equation is the so-called “grade” determining the severity of a concussion. The way she sees it, when a kid’s better, he’s better.

“I see it as counterproductive,” she says. “We have 19 different grading systems. And there’s a lot of overlap if you look at them. And none are empirically based. They’re a snapshot of how someone functions right at the time of the injury. They’re not helpful when it comes to looking at how the injury recovers. Someone might have a quote-unquote Grade 1 concussion and be symptomatic for a long time. Versus someone who has a Grade 3 concussion and is fine in three days. I don’t ever say to a patient, ‘This is a Grade 1’ because it gives a false impression of the severity of the concussion. Let’s look at this individual injury, this individual case, this individual history.”

That’s the primary reason why the IHSAA hasn’t set any kind of rigid guidelines for handling a player with a concussion. The state last month passed a law saying players who are removed from a game by an athletic trainer or official can’t play again without a doctor’s note, but the IHSAA already has been using that policy since last season.

For one thing, sometimes a person is fine after a few days of rest. For another, putting a timetable on a recovery might allow hyper-competitive kids to get back on the field before they’re healthy.

“If I say to a 15-year-old kid that he’s out for two weeks no matter what because he has a concussion, and in two weeks his rival team is coming up and he’s not wildly symptomatic, just a little bit, he’s not going to tell anybody,” Pieroth says. “You’ve given him a free pass. And that’s completely counterproductive to what we’re trying to do. We’re trying to educate kids to come forth. We respect the value of sports in their lives and we’re going to get them back to play as quickly and as safely as possible. If that means three days, we get them back out there. If that means three weeks, then you’re not going back out there.”

And yes, in rare cases, it means never returning to the field again.

Four years ago, Hobart athletic trainer Mark Leto took one of his players — a senior — to see Pieroth after his post-injury ImPACT test differed wildly from his preseason baseline test. The symptoms were lingering long after the injury, and Pieroth never signed off on his return.

“The parents understood,” Leto says. “They said, ‘We appreciate your expertise.’ Sometimes it doesn’t go that easy.”

But as players and coaches become more educated on the subject, they’re becoming more realistic about their injuries. They know that they’re at a greater risk of suffering another concussion after the first one — especially if they’ve yet to recover from the first one.

And even if a kid might hide his symptoms to avoid being benched, his teammates often are savvy enough to know better.

“It kind of surprises me how many kids say, ‘Hey, Mr. Leto, you’ve got to take a look at so-and-so, he just doesn’t look right,’” Leto says. “Which, to me, is great. Because the message is getting out. They’re frustrated, they’re upset, they’re disappointed and a kid that’s concussed can get pretty emotional and irrational sometimes. And they try to hide it. But their teammates are looking out for them, and that’s great to see.”

And coaches are getting that message, too.

“There’s not a coach or player in the country that’s going to try to send in a kid still dealing with a concussion,” Wheeler coach Dan Klimczak says. “Our jobs do depend on winning and losing, but I’ve never coached with or against someone that would put a kid’s health at risk for the sake of a win. I’ve never met anyone like that, and I hope I never do.”

So the players get it, the coaches get it, and obviously the medical professionals get it. The key is getting parents to get it — to understand the risks, yes, but also to understand that eventually, when handled properly, these injuries heal. And it’s OK to play again.

“There’s so much bad information out there,” Pieroth says. “This is why I spend so much time in neuro-education. Let’s find a reasonable center based on science, so we’re not pulling people out of contact sports. We’re throwing the baby out with the bathwater. Parents are freaking out and saying their kids can’t participate in sports for an injury they may never have, or one they can fully recover from. Let’s be reasonable.

“After you know the real science, not the crazy stuff, then you can be an informed participant in the decision, then you can decide what to do. Because it is your decision. I have authority with the Bears and Blackhawks, but I don’t have authority with your kids. That’s your decision. I just want you to be armed with the facts before you make it. We should not be pulling these kids out of contact sports out of a fear of concussions. We should be managing these injuries in the proper way.”

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