I wrote about concussions in my April 3rd sports medicine installment for the Metro Sports Report that was titled "Spring no respite from concussion concerns."

Iowa passed a concussion management law on April 7 (Senate File 367). Interestingly, in February 2011, only 11 states had concussion management laws for high school sports.

Fast forward to August 2011 and 32 states have passed laws, and 10 others have legislation pending to protect student athletes from the dangers of concussions.

What is driving this monumental change across America? Plain and simple: RESEARCH.

In a landmark study published in the journal of Pediatrics this summer, results revealed that between 1980 and 2009 there were 1,827 athletes under the age of 21 who suffered sudden death while participating in high school sports.

About 14 percent of those (261 athletes) were caused by trauma; 57 percent (148 athletes) of those occurred in football. More importantly, 11 percent of those football deaths were trauma to the head and face after sustaining a prior concussion within weeks or days of death.

These numbers highlight the catastrophic results of poor concussion management and the devastating effects on families, communities and high school sports teams. The study concluded that most of these deaths could have been prevented by improved guidelines for concussion management (especially the protocols to determine when an athlete has recovered and is ready to return to football).

These researchers also proposed that a continued push to improve equipment and change rules regarding tackling and blocking should be strongly considered in high school football.

The Centers for Disease Control and Prevention have estimated that up to 3 million sports-related concussions occur in the USA each year. Ten percent of all high school sport injuries are concussion related, and 13 to 16 percent of all high school football injuries are concussion-related.

Unfortunately, 35 to 50 percent of reported severe head injuries in high school football (reported in a national study for 2008) occurred when a player was still recovering from a previous concussion. More specifically, 35 percent of football concussions occur when a player is being tackled, 25 percent while the player is in the act of tackling, and 40 percent
combined while blocking or being blocked.

While symptoms may persist from days to weeks before a football player is ready to return, 15 percent of football players who suffer a concussion will have symptoms longer than a few months.

This type of information has clearly driven sweeping changes and new concussion management laws for high school sports (especially football) across the USA, and Iowa’s law is a breath of fresh air to sports medicine professionals.

The new law in Iowa requires:

• The IHSAA to distribute the CDC education guidelines for concussion management to parents, coaches and student-athletes.

• All athletes participating in sports grades 7-12 to have the concussion and brain injury information sheet turned in to the school prior to participation and signed by both the student-athlete and a parent.

• Any athlete exhibiting signs, symptoms or behaviors consistent with a concussion injury will be immediately removed from participation.

• The athlete removed from participation is then to be evaluated by a licensed health care provider trained in the evaluation and management of concussions (brain injury); the athlete cannot return to participation until they receive written clearance from said health care provider. (The list of health care providers covered under this law includes: athletic trainers, physical therapists, physicians, physician assistants, nurse practitioners, nurses and chiropractors, licensed by a board designated by the state of Iowa.)

Concussions are no laughing matter. Slang terms used such as “suffered a ding” or “got their bell rung” in reality minimize the fact that a concussion is an injury to the brain.

Unfortunately, it is a widely held misconception that you need to lose consciousness (“be knocked out cold”) to have suffered a concussion. The vast majority of sports-related concussion injuries reported do NOT involve a loss of consciousness.

While most athletes who suffer a concussion do heal within a few weeks, an athlete who returns to play before a concussion has completely resolved risks re-injuring an already injured brain, which can have catastrophic consequences.

Although rare, adolescents seem most vulnerable to this rapid brain swelling known as “second impact syndrome” which can be fatal.

Additionally, multiple concussions suffered prior to complete resolution of a previous injury can result in prolonged symptoms lasting weeks, months or years. New research evidence shows that neurological deficits following concussions can even show up later in life.

To learn more about sports-related concussions, I highly recommend that athletes, coaches and parents visit the IHSAA website (http://www.iahsaa.org/Sports_Medicine_Wellness/Concussions/concussions.html). Pay particular attention to the “Heads-Up” educational materials, and note there is a section for teachers, too.

Finally, I recommend that readers take a look again at my April 3rd column “Spring no respite from concussion concerns."

Stay tuned for more updates on concussions and get ready for some football!

(About the Author: John Tomberlin has worked with high school athletes in the Cedar Rapids Metro area since 1995. He was a four-sport athlete in high school and a high school coach for two years in Illinois. John has more than 25 years of experience working with athletes as a physical therapist and a certified strength and conditioning specialist. He has worked with professional athletes in the NFL, MLB, and on the PGA and LPGA tours. John also has worked with elite amateur athletes in alpine skiing, figure skating, and track and field.)