Home Concussion Treatment Scanlan: For sports concussion treatment to be effective, the culture needs to...

Scanlan: For sports concussion treatment to be effective, the culture needs to change

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Over the years, Dr. J. Scott Delaney has learned a thing or two about collecting concussion data.

A Montreal Alouettes team doctor, and a professor of sport medicine at McGill University, Delaney released a study last week that raised concern because more than 80 per cent of CFL players who responded to the survey (454) admitted they had hidden concussion symptoms in the previous year (the data was collected in the summer of 2016).

Practitioners will take their victories where they can. At least a significant number of players responded, and copped to the fact they did not report to team staff what the player deemed to be concussion symptoms.

Twenty years ago when Delaney sent out a similar survey, he received a curious response. Only the star players admitted having suffered a concussion. Almost to a man, the rank-and-file members of the team said they had never experienced a concussion.

“I though, well, that’s strange,” Delaney says in an interview between seeing patients at the McGill University Health Centre emergency room.

“You see more concussions than that in amateur sport.”

 This was in 1997. A member of the CFL Players Association whispered to Delaney that instead of requiring players to put their names on the surveys, he should try making them anonymous. Players were worried, the PA guy said, about being branded as “damaged goods.” So, Delaney did just that a few weeks later and the numbers were vastly different – 46 per cent of those no-name responders admitted to a likely concussion, although many at that time didn’t know much about concussion symptoms.

Twenty years later, players are vastly better informed. Posters in locker rooms outline concussion symptoms and care, and before each season, they are instructed on the importance of concussion reporting and protocol.

The NFL, CFL and NHL all hire independent concussion spotters to ensure that a player who receives a head hit goes through concussion protocol, including an immediate examination in a quiet room. A perfect example of this took place Sunday evening during the breathtaking last-second NFL playoff victory by the Minnesota Vikings over the New Orleans Saints. In the third quarter, Vikings free safety Andrew Sendejo was knocked out cold in a collision with Saints wide receiver Michael Thomas. Sendejo was taken into the dressing room and did not return to action, a scene that has become routine for stakeholders in the game, from players to team officials and fans.

And yet, while the official approach to assessing and treating concussions has evolved, players continue to view a concussion as something akin to a scarlet letter. It can be ostracizing, and in a player’s mind, career limiting to acknowledge a brain injury. Stigma is such that players can willingly, even somewhat proudly, admit to knee, ankle and shoulder injuries, but still don’t want anyone to know about a potential concussion history.

Delaney is calling for a culture shift, similar to what happened with smoking, seatbelt use and drinking and driving. Education only goes so far. Attitudes have to follow suit.

Dr. Vincent Lacroix, the Alouettes head physician, suggested to Delaney that teams change the use of the term concussion to “brain injury,” helping underline the significance of the matter. (Clinicians already use the term traumatic brain injury or TBI for damage to the brain).

“Maybe that pushes the culture a bit by taking it more seriously,” Delaney says. “There is this stigma with concussions … but instead it should be, I injured my brain. If I injured my knee I’d be telling you about it … sometimes you have to save the athletes from themselves.”

Football and hockey are team games, and there is something to be said for making concussion reporting a team concept. At McGill, student athletes, as well as their parents and coaches all sign concussion “contracts,” the terms of which include telling someone if he or she believes ANY player on the squad might have suffered a head injury.

“You can’t always expect someone with altered brain activity to act responsibly,” Delaney says. “Recruit others around them. Coaches, teammates.”

It may be as simple as a player on the soccer team telling the trainer that “Sally isn’t acting like herself.”

Interestingly, those amateur athletes, Delaney has found through research, are just as likely to conceal a head injury as CFL players. The competitor in them wants to remain “in the game.”

The message from Delaney and others in the trade: use caution now and it can pay off long-term.

“On average, the third concussion takes longer than the second concussion, and the second longer than the first,” Delaney says. “Let’s deal it with it. Get it better. Get back to 100 per cent and you can go in again.

“You get another one quickly, I can pretty much guarantee you it’s going to take even longer to heal.”

Players aren’t blamed for concussions, any more than they should be faulted for suffering a knee injury. Slowly, the message is getting through. Everyone gets on the same page — player, trainer, doctor, coach, GM. Teams are discovering that a supportive environment with full disclosure works best for all involved.

This article originally appeared in the Ottawa Citizen on January 15th, 2018. Reprinted with permission of the author Wayne Scanlan. www.ottawacitizen.com

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