By Mike Zhe April 17, 2011 2:00 AM
KITTERY, Maine — Dr. Patricia Wentworth of Sport, Spine and Rehab knows that when dealing with sports concussions, a quick response is critical. Symptoms should be reported and signs should be observed.
That’s one reason the lack of response she’s gotten lately is so troubling to her.
Maybe no health issue in sports has exploded in recent years like concussions, which are brain injuries suffered from blows or impacts to the head. from the professional ranks to the high schools, the rate of reported incidents has risen — in some cases, dramatically.
As the NFL owners and players try to find common ground to prevent a work stoppage, the concussion issue has slid into a front-row seat. Hall of Famer Terry Bradshaw said this week that he links his memory loss to the at least six concussions he suffered in his playing career.
There was the February suicide of former Chicago Bears safety Dave Duerson, who in a final text message to his family before he shot himself in the chest stated that he wanted his brain donated to research, apparently to study the effects of a career filled with brain trauma.
“On a national level, it’s really exploded,” said Exeter High School athletic director and football coach Bill Ball, “between (former Patriots linebacker) Teddy Johnson and some other notable people that have had some problems.”
In 2000, the occurrence of concussions in high school football was 5.6 percent, according to a study published in the American Journal of Sports Medicine. in 2010, that number was up to 8.9 percent, according to the National High School Sports-Related Surveillance Study.
The National Federation of State High School Associations has estimated that more than 140,000 high school athletes suffer concussions each year.
“I would say,” said Wentworth, “that’s an epidemic.”
But Wentworth also feels it’s a problem that needs a more proactive approach, that the focus needs to be more on prevention than just determining when it’s safe for an athlete to return to the field.
And she feels she can provide that approach.
“Experts have made a correlation between neck strength and concussion prevention,” said Wentworth. “How do you test it? there are no other machines in the area that can test that. We can test it. We can find out how strong you are.”
In football, developing stronger neck muscles can absorb the potentially damaging changes in momentum that are associated with mild traumatic brain injury, studies have shown.
In the past year, Wentworth has reached out to 16 local high schools and two colleges, offering tests on a MedX machine that specifically measures neck strength. she also offers a 12-week program where athletes can improve neck strength and, by extension, reduce their risk of concussions.
“Three-quarters have totally ignored me,” she said. “I’ve beaten down people’s doors, I’ve contacted them, and the response that I get from the ones that do respond is that we have an athletic trainer or we do ImPACT.”
“We get people offering stuff all the time,” explained Portsmouth High School athletic director Rus Wilson, who said he typically defers to athletic trainer Nicole Spaulding on medical matters. “We usually keep things in-house because we have what we need here.”
Many schools in the area, including Portsmouth and Exeter, employ full-time athletic trainers through Access Sports Medicine. Those trainers are present from the beginning of the first afternoon practice to the conclusion of the final game.
But Wentworth feels that with concussions a growing problem, teams aren’t doing enough to protect their players.
“Unfortunately, we’ve got a small community here,” she said. “It’s territorial. But who are we doing this for?”
At Marshwood High School, there were 24 reported concussions in 2009-10. This year, with spring sports just getting underway, there have already been 26.
It’s only been in recent years that the school’s kept track, said athletic director Rich Buzzell. Most have come in “collision” sports like football and hockey, but athletes have also suffered concussions in basketball and even cheerleading.
“You expect to get a concussion here and there,” said Buzzell. “But if someone had asked me before I’d really started keeping track, I’d say three or four (a year).”
As the awareness has grown, so has the reporting of instances. Trainers are paying closer attention to hits to the head, and making sure they err on the side of caution when determining when a player can return to action. The inclination to “shake it off” and get back in the game — long a badge of honor among athletes in contact sports — is becoming archaic.
The experts agree on this: The safest way to prevent concussions is to avoid blows to the head. But, like abstinence is the only surefire way to prevent pregnancy, not playing sports is the only way to remove the risk completely.
“We’ve cut back a lot of the things we did 15 or 20 years ago,” said Ball, referring to the amount of live hitting during football practices. “And, as a (lacrosse) referee, there’s a real emphasis on head-to-head contact. It’s a point of emphasis for both the (national high school) federation and the NCAA.”
Equipment has improved, though medical people are quick to point out that helmets are designed more to reduce the risk of fractures and lacerations, not concussions.
Part of the increase may be societal. from YouTube clips to ESPN’s “SportsCenter,” the plays that get viewed the most are often the ones that show the most violent hits.
Studies have shown that repeat concussions can lead to brain damage, depression and memory problems. Because the brains of young athletes are still developing, they’re more susceptible to lasting damage.
Many local schools have or are allocating money in their budget to join ImPACT, or a similar online program, HeadMinder’s Concussion Resolution Index. What the programs do is help determine when an athlete who has suffered a concussion can safely return to the field.
Before taking the field, athletes involved with ImPACT take a 20-minute online questionnaire that explores and documents both their health history and cognitive ability. in the event of a suspected concussion, they would then return to the computer (within 24-72 hours after the injury) and answer more questions, with the interpreted results providing indicators about the injury and treatment strategies.
“It’s been beneficial,” said Ball, who estimated his department has been using ImPACT for five years. “It’s something you can measure. it can certainly help determine return to play dates, if any.”
“I think it’s great,” said Wentworth, “but it’s not preventative.”
The MedX machine at Sport, Spine and Rehab that measures neck strength involves a 10-minute test. it can then determine where a person’s strength level is compared to other subjects of various ages.
The results, said Wentworth, have been eye-opening.
There was the case of a former women’s hockey player at UNH, who’s now in her late 20s. a healthy woman, at that age and with that athletic background, might be expected to produce results higher than the norm, but that wasn’t the case.
The only local high school team to take Wentworth up on her offer for testing is the Marshwood boys lacrosse team. Coach Ralph Ruocco has two of his players getting evaluated, and their results aren’t significantly different than what would be seen in any other segment of the sample, which measures people between the ages of 18 and 78.
“I would want an athlete to be at least three or five times stronger than a 78-year-old man,” said Wentworth.
Wentworth is certified as both an athletic trainer and a chiropractor — one of fewer than 100 people in the country to hold both designations, she said — and has served as an athletic trainer at a high school, a prep school, a college (Maine Maritime) and for elite teams (U.S. Women’s Lacrosse and the Boston Renegades).
In addition to the testing, she offers through her company a 12-week neck strengthening program. she thinks the timing is right for athletes to begin a program like hers now, and reap the benefits once football seasons begin in August.
She counts among her influences Dr. Robert Cantu, a Boston neurosurgeon who, last year, was appointed senior advisor to the NFL Head, Neck and Spine Committee. Cantu, the co-director of Boston University’s Center for the Study of Traumatic Encephalopathy (CTE), was one of the first to correlate neck strength with concussion prevention.
And while there’s still a lot that’s unknown, even high school athletes are starting to appreciate how serious the outcomes of a concussion can be if they ignore it, or return to action too quickly.
Wentworth said she had a lacrosse player from a local high school come to her see her with her mother recently, and state, matter-of-factly: “I’ve had two or three concussions already. if I have another one I’ll have brain damage.’”
Much progress has been made in safety and awareness in just the last five years. now, Wentworth would like to help local athletes get ahead of the curve.
“As a parent I would think I’d want to be proactive,” she said. “I don’t want to wait four or five or six years for studies to come out.”
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