Vickroy: Concussion risks give pause for thought
BY DONNA VICKROY firstname.lastname@example.org Twitter: @dvickroy July 10, 2013 9:46PM
Updated: August 12, 2013 11:54AM
Greg Primus remembers the day he got clocked.
“It was my senior year at Colorado State. We’d gone down to LSU (Louisiana State University) to play in front of about 80,000 people,” the former Bears wide receiver said. “My family is originally from Louisiana, so there were lots of family members in the stands, probably the most that had ever seen me play.
“I got hit in the facemask,” he said. “I lost consciousness because I dropped the ball, but didn’t know I dropped the ball.”
He was dizzy and foggy but didn’t want to alarm his teammates and family, so he lay on the field for a few minutes until he regained his bearings.
“The world was on a slant and I could feel a shock going through my head,” he said.
Nevertheless, after spending a brief time on the sideline, he went back into the game.
A lot has changed since those days. Back then, in the early 1990s, Primus said, you could suffer a head injury and resume play if you could demonstrate you’d had a full recovery. Not so anymore.
Today, Primus, who played two seasons with the Bears, is an orthopedic surgeon with the Chicago Center for Sports Medicine in Tinley Park and is an independent member of the medical staff at MetroSouth Medical Center in Blue Island. He volunteers his services on the sideline during football games at Homewood-Flossmoor and Crete-Monee high schools.
He also will be part of the panel for “Head in the Right Direction: Concussion Awareness” from 11 a.m. to 3 p.m. Saturday at the South Holland Community Center. The event is open to the public.
“I still love the game,” he said. “But I want to keep kids safe, too.”
Primus will be joined by Otis Wilson, a member of the Bears ’85 Super Bowl team; Elizabeth Pieroth, neuropsychologist at North Shore Neurological Institute and a consultant to ImPACT and the Bears, Blackhawks, White Sox, Fire and Northwestern University; Timothy McManus, neuropsychologist at Ingalls Memorial Hospital; Brian “Tho” Hang, clinical instructor of pediatrics, division of orthopedics, sports medicine and emergency medicine, at Lurie Children’s Hospital, and a consultant to the Vancouver Olympics and the Chicago Marathon; and Patrick Becker, physical therapist at AthletiCo and Vestibular Physical Therapy, team physical therapist for the Blackhawks.
The panel will address diagnosis, treatment and recovery of concussions. Though there is still much research to be done on the topic, Primus said, it is important to share the information available.
I sat down with Primus earlier this week to chat about some of those findings.
Q: What exactly is a concussion?
A: Part of the controversy that surrounds concussions and concussion management is that there’s no clearly accepted definition, or textbook definition, of concussion. Some scientists tie it into mild traumatic brain injury. Some differentiate the two and make a concussion a subset of a mild traumatic brain injury. So what most accept is a consensus statement, created by a broad group of specialists who have come together to define what they believe is a concussion. From that consensus statement we get that a concussion is a nonstructural injury to the brain. There are a host of variables about how severe an injury can be and about how long it takes for such an injury to repair itself. The research is also indicating that repeated head injuries can lead to dementia and other serious lifelong issues.
Q: Are children more vulnerable than adults?
A: Yes, what we do know for sure is that the younger a child, the more vulnerable the brain can be. So the younger the player, the more conservative the treatment. There are neurochemical changes that take place in the brain during a concussion that may not revert back to 100 percent normal, just like with any injury. If you have a tendon tear and you go back out, you risk tearing it even more. A head injury makes the brain vulnerable, which is why today, if there is any suspicion of head injury, the player is removed from the game and must have one week of being symptom-free before he can return to play.
We know that once you’ve had head trauma, you are at an increased risk for it, just like with any other part of the body. The most difficult thing for me is to tell a kid who’s had two (significant) concussions or three (mild) concussions that the medical recommendation is to not play that sport again.
We don’t have the answer in terms of time frames or how to measure those increased risks. Those are the questions that are still out. So we want to err on the side of conservatism by saying, “Look, you are at increased risk. We don’t know how much increased risk, but you are at increased risk.”
Q: How did the medical and sports community look at concussions during your playing days?
A: The problem in my day and even earlier was that concussion was considered a “hurt,” not an injury. In sports there’s an adage you can play with a hurt but not with an injury. That presented a doctor’s dilemma: Is concussion a hurt or is it an injury? Adding to that was, in the old days, when someone got a hurt, it was a badge of toughness to push through it, to come back fast. Nobody was recognizing that not only was concussion an injury, it was probably the most severe kind of injury. That philosophy has changed dramatically over the past 10 years, a shift that was brought on by the suicides and testimony of former NFL players.
Q: How has the thinking changed?
A: The new thinking is now helping to make the game of football safer. Not only is there less head contact during play and practice, there are definitive rules about not leading with your head and about pulling a kid out of a game if he sustains a concussion. There have been improvements to head equipment, although a lot of schools may not have the resources to buy that. There is legislation in many states, including Illinois, requiring that concussion materials be provided to those involved in football. What lags behind, though, are other sports, particularly soccer and hockey. There has been a huge rise in concussions among men and women in hockey, and among women in soccer. Women are more at risk because their cervical muscles are not as developed.
Q: So, is it safe for kids to play football?
A: I believe football is safer now because of awareness. We’re seeing a slight increase in the number of concussions being diagnosed but I think that’s because there is a heightened awareness and there has been an increase in sports participation. I do believe that as we become safer and more educated about concussions we will see the incidents of concussion declining.
Q: Has there been resistance among parents, kids and coaches to the new rules?
A: At first there was a lot of parental and coach resistance to this new approach to treating concussion. I remember vividly one argument I had with a parent. I was a team doctor for a high school in Southern California. A player got a concussion and I kept him out of the game. The father came down from the stands and got in my face, screaming and yelling that his kid needed to be back in the game. I knew two things: that this guy was one of those parents who lives vicariously through his kid’s sport but also that he was ignorant of the damage a concussion could do. At that time, most coaches did not understand how serious a concussion could be.
Q: Would you let your son (age 5) play football?
A: People often ask me if we’d ever completely eliminate a game like football or other collision or contact sports with this heightened awareness of concussions. I bring up the point that 20 percent of concussions are caused by sport-related activity. That means 80 percent of concussions that are particular in young people are occurring outside of sport. So in order for me to be a strong advocate for eliminating any type of collision or contact sport we’d have to clearly address these other issues that lead to most of the concussions we see coming into our emergency rooms and hospitals. Some of those issues are car accidents, increased risk behaviors, substance abuse, all of these other factors in our society drive more head trauma in our society than sports ever will.
And, yes, if my son decides he wants to play football one day, I will let him. I may buy him a thousand-dollar helmet, but I will let him play.
For information on “Head in the Right Direction: Concussion Awareness,” contact Cindy Copenhaver at (708) 331-2940 or email email@example.com or visit southholland.org.