Effective Sports Risk Management
Effective Sports Risk Management
If you have watched the movie, Concussion, starring Will Smith, you might have some concern about whether you or your child should participate in sports activities or stay inside with your heads wrapped in bubble wrap. These questions are at the heart of risk management, which is the process of keeping athletes safe and protecting organizations from lawsuits.
Despite concussion risks, the value of the free play of sports in our society is significant. This has become even more clear during the pandemic as kids and adults have been prohibited from engaging in their usual activities and many sports and recreation activities were limited or shut down for many months. The world’s reaction to Covid-19 is an excellent example of risk management. The consistent message has been masking, handwashing, social distancing, and vaccination. With concussions, there is a need for consistent risk management messaging as well.
In the sports world, a mild traumatic brain injury is referred to as a concussion. According to the Center for Disease Control (the CDC), concussions are a bump, blow or jolt that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
The most common way a concussion is sustained in sport is through collisions. Think about two players colliding in mid-air when going for a header, or a basketball player being hit in the head during an aggressive rebound. As you know, collisions in sport are common occurrences. Concussions can be an unfortunate by-product of these collisions.
Young athletes are at risk of harm from concussions because their brains are still developing up until around age 25. An added challenge is that kids might take longer than adults to recover. Concussions can impact the way kids think, act, feel and learn. Unfortunately, in youth sports medical personnel are usually not on site to conduct an evaluation. It is often up to the coaches, officials, parents and athletes to know what to do if a concussion is suspected.
According to a 2017 study, 2.5 million U.S. high school students reported having had a concussion from a sports or recreational activity over a 12-month time period. (DePadilla L, et al.). Another published study from 2019, indicates that 12.1% of youth athletes sustained concussions, with an 18-year-old twice as likely to get a concussion than a 13-year-old. Most research has concluded that the riskiest youth sports for concussions for boys are tackle football, lacrosse, and ice hockey. It’s notable that the three boys’ sports with the largest occurrence of concussions are contact sports in which helmets are worn. While helmets may reduce the risk of head trauma, it does not eliminate the risk of concussions.
When it comes to comparable sports, a 2019 study concluded that girls are one and a half times more likely to sustain a concussion than boys. For the girls, soccer was identified as the riskiest sport for sustaining concussions.
Soccer is classified as a non-contact sport in which no helmets are required. Think about how often players collide with one another or how often a header is used to play the soccer ball. But players do not even need to hit their heads to get a concussion. Remember a concussion is a bump, blow or jolt that shakes the brain. This means there does not even need to be actual contact with an athlete’s head for a concussion to occur. For instance, two players’ bodies colliding with no head contact can still shake the brain and cause a traumatic brain injury. If there is no head contact, this makes it more difficult to identify a resulting concussion.
Now we have to be concerned with how COVID-19 has complicated concussion identification and recovery. Many sports took a backseat during the pandemic so concussions were the furthest thing from the minds of most people. Although understandably the priority has shifted to preventing transmission of COVID-19, as we have returned to play, now coaches, athletes and parents need to be concerned with both COVID-19 and concussions.
For instance, it is important to understand that both conditions have shared symptomatology. So let’s say that an athlete exhibits the symptoms of fatigue, headache, nausea, gastrointestinal issues, or a change in or loss of taste. Does the athlete have COVID-19, a concussion, or something else? While it may be a good idea to rule out COVID-19 with a simple test, you cannot dismiss concussion as the cause of these symptoms.
One of the most challenging things about COVID-19 is that we are still discovering all the short-term and long-term harm the virus causes to a body. Think about all the things we may not yet know. We need to question whether COVID-19 can have an impact on concussions or vice versa. Consider the following questions:
Since a concussion is not visible on a CT, MRI or x-ray, medical professionals must use other means to diagnose a concussion. Generally,, a medical professional will look for the signs and symptoms of a concussion. These symptoms may be physical (blurred vision, dizziness, fatigue), cognitive (confusion, slurred speech, amnesia), emotional (anxiety, depression, personality changes), or related to sleep (increased or decreased sleep).
Perhaps one of the few positive consequences of COVID-19 is it it likely gave athletes who were suffering from sport related concussions sufficient time to rest and heal from their traumatic brain injuries. The break from play followed by the slow return to play protocols that focused more on skills and drills and less competitive play was also a benefit to concussion prevention and recovery.
Ever since COVID-19 has turned our world upside down people were and are anxious to get back to sport. Similar to concussion protocol, a COVID-19 gradual return to play protocol was put into place to ensure the health and safety of others. However, the singular focus on managing the risk to reduce the spread of COVID-19 has left little time, thought or energy towards the physical and mental readiness of those returning to play. This singular focus may provide a gap, which could lead to increased concussions.
Consider gymnast Simone Biles who withdrew from competition at the Tokyo Olympics because she was not in the right state of mind to compete. Her awareness of her lack of medical readiness to compete likely saved her from injury. In fact, it is possible that she avoided getting a concussion because of her ability to determine it was unsafe for her to continue. This is an example of Risk Avoidance. Every time an athlete gets on the field, the court or the ice they make a risk management decision
Approximately, 15% of athletes sustain concussions. So what can be done to prevent them? Ultimately, there are two ways to minimize the risk.
1. Prevent concussions from occurring in the first place; and
2. Follow protocols to avoid worsening of concussion symptoms.
So how do we prevent a concussion from occurring?
Focus on drills, skills and conditioning and minimize full contact during practices. Recognize that following COVID-19’s cancellation of sport, athletes may not have the same physical or mental readiness to resume play at the same level as before. A player that is neither physically or mentally ready to play is more likely to get injured, which could include a concussion.
Neck strengthening exercises are important. For example, in tackle football, strong neck muscles are key to support the head and heavy helmets. Strong neck muscles can help an athlete better control jostling to their head that might otherwise contribute to a concussion.
Upon return to sport from the pandemic, spend extra time reminding players, coaches, and officials of the rules of sport, emphasizing those rules that affect safety and can minimize the risk of concussions. This is particularly important for younger or inexperienced kids.
Use properly fitted helmets that meet safety standards. Helmets should be regularly maintained and inspected. If they are defective, they should be repaired or replaced.
And don’t forget to buckle the chin strap! In the Tokyo Olympics we saw many televised skateboarders and BMX bikers wear helmets with loose fitting chin straps. While helmets may not save all athletes from a traumatic brain injury, a properly fitting helmet that stays in place during a fall can lessen head trauma. Officials should enforce the safety rules and make sure that each athlete is wearing an approved helmet that is not damaged, fits properly, and the chin strap is buckled and tightened so that the helmet will provide the maximum amount of protection in the event of a fall or collision.
Safety rules and consistent enforcement are key. Communication of rules is important. Think about how every time you fly on an airplane, the safety messages are always given even though you know how to buckle your seatbelt.
A good example of safety rules that should be consistently communicated are those designed to keep football players safe. Tackling rules in football include no helmet-to-helmet hitting and leading a tackle with your shoulders, rather than your head. Coaches might consider reminding players of this rule before each practice and game.
Realize that wearing a face mask limits a person’s ability to see well. Many COVID protocols require athletes, coaches, staff and officials who are not in active play to wear a face mask to reduce the likelihood of the transmission of COVID-19. This, however, can increase the likelihood of collisions and trip and falls, which may in turn increase the likelihood of concussions. Young athletes in particular may need to be reminded how to prevent these sideline incidents while wearing face masks.
Even when safety measures are complied with, accidents do happen, and athletes can sustain head injuries. Many athletes with minor concussions can return to play within 2-4 weeks after following proper concussion protocol. But some concussed athletes may never fully recover or may even die. So, what protocols can be implemented post-concussion to best minimize the risk to an athlete?
Concussion training must be provided to coaches, staff and volunteers. Parents and athletes also benefit from this training, which is offered by the CDC and other organizations. Concussion training may even be required in your state.
Many programs require participants to have a pre-play physical examination in order to ensure that the athlete is physically healthy enough to participate. This should be more thorough than a simple COVID-19 test.
For those athletes who have a greater chance of sustaining a concussion, it might make sense before starting a sport to undergo baseline cognitive testing by a qualified medical professional. This baseline test allows for future comparison testing of the before and after concussion conditions of a brain. Medical professionals have completed baseline testing on kids as young as five years old. A medical professional may recommend that a concussion-free athlete repeat the baseline test every couple of years, and that a concussed athlete repeat the test more frequently.
Do not ignore or confuse symptoms of a concussion. For instance, many may attribute anxiety or depression to teenage hormones or to the challenges of living through the pandemic. However, anxiety or depression can be triggered or heightened as a result of a concussion and may be resolved with proper treatment by a medical professional.
An athlete who returns to play before completely recovering from a concussion has a high risk of developing second impact syndrome. This condition occurs when an already concussed athlete sustains a second concussion. Even if it was a minor event that caused the subsequent concussion, the symptoms can be significantly worse, which may increase suffering, prolong recovery, and in some cases can be fatal. Our break from sports during COVID-19 likely saved some athletes from a devastating encounter with second impact syndrome.
If you saw the movie Concussion, you’re probably aware of CTE, which stands for Chronic Traumatic Encephalopathy, which is a progressive and fatal brain disease associated with repeated traumatic brain injuries. This condition can only be diagnosed after death by an autopsy. Awareness of the seriousness of CTE reminds us of the importance of settling time aside before games and practices to encourage athletes to tell you about any possible concussion symptoms that they are experiencing.
Consider posting information about concussions in locker rooms or other places where your athletes practice and compete. Let them know of the risks and the greater risks of multiple concussions, particularly before an athlete is fully recovered.
When a concussion is suspected immediately remove the athlete from play. Inform the athlete’s parents and medical provider. Follow the medical providers instructions for adequate brain rest. Only allow an athlete to return to play when sufficiently recovered and medically cleared.
Ultimately risk management strategies should include concussion prevention and mitigation measures.
The identification and treatment of concussions has to be done from the beginning with youth sports. For any possible head trauma, an athlete should be assessed and it should be determined whether they should be removed from play.
All 50 states and Washington D.C. have laws to reduce the risk of traumatic brain injuries in sport. States may also have laws that outline how and when an athlete can return to play following a concussion. These protocols may outline informed consent of parents and athletes, removal from play, bench times, medical clearance, and training for coaches, parents, and athletes.
Coaches, officials, staff, sports organizations, parents and athletes all have a role in concussion prevention and symptom management. Consistent protocols should be in place before the athlete is allowed to return to play---with no exception. Each athlete’s health is more important than any practice or any game. This assessment may include seeking medical attention, taking time off, and not returning to play when a doctor provides clearance. The recovery process generally means a period of complete rest and then gradual return, first to school, then to limited physical activity, and ultimately to full activity and competition.
These steps are important to keep athletes healthy in order to avoid secondary concussion syndrome, long term physical and mental problems, and so athletes can enjoy many years of healthy play and lifetime success.