Young athletes need closer watch after concussions

New AMA policy requires written physician approval before a youth suspected of such an injury can return to play or practice.

Posted Dec. 6, 2010.

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On football fields across the country, from the National Football League to high school, renewed scrutiny is being given to the impact that hits have on players -- specifically, the lasting effects of concussions.

Last year, the NFL strengthened its return-to-play rules for players and recently decided to impose fines and suspensions for dangerous hits. The league also is examining ways to improve helmets to provide players with greater safety from head injuries.

Along with the NFL, the National Collegiate Athletic Assn. prevents athletes diagnosed with concussions from returning to a game the same day. Meanwhile, the National Federation of State High School Associations calls for removing a player suspected of having a concussion until cleared by a health professional.

Lawmakers also have tried to lessen the damage from concussions, approving or considering related legislation in at least a dozen states. For example, in 2009, Washington enacted the Zackery Lystedt Law, named for a teen who had a serious head injury while playing football. In part, the law requires parents to sign an informed consent form acknowledging the risk of head injury before their child can participate in sports.

Research shows that these and other steps are needed, not only in football but also in many other sports, including hockey, boxing and baseball. A study in the July 2009 Journal of Neuropathology & Experimental Neurology found progressive, degenerative brain disease in retired football players, wrestlers and boxers who had sustained repeated head trauma such as concussions. The Centers for Disease Control and Prevention estimates that more than 400,000 young athletes get concussions each year. Four in 10 high school athletes with concussions return to play too soon, according to the Center for Injury Research and Policy.

The medical community has taken steps to protect against the health effects of concussions by offering guidance to physicians who deal with concussions, both on the field and in the office. In 2006, the American College of Sports Medicine published guidelines to help physicians diagnose and treat concussions in athletes. In October, the American Academy of Neurology issued a position statement that players who may have a concussion should be kept from returning to action until evaluated by a physician.

The American Medical Association is calling for more protection of young athletes from the impact of concussions. At its Interim Meeting in November, the AMA House of Delegates adopted policy that youths suspected of sustaining a concussion need written approval by a physician before they can return to play or practice.

The AMA will promote adoption of this requirement for school and other organized youth sports. The Association also will encourage educational efforts to improve understanding of concussions among coaches, trainers, athletes and parents.

Delegates also took steps to protect youths from sustaining head injuries while snow skiing or snowboarding. They adopted policy that the AMA support legislation requiring the use of helmets by youths 17 and under during both sports activities. The policy encourages adults to use helmets, too.

Physicians should educate their patients about the importance of using helmets while skiing and snowboarding, the policy says. Rental helmets should be available at commercial skiing and snowboarding areas, it adds.

The AMA has added its voice to the important public health issue of ensuring the safety of pro athletes, school players and weekend warriors from injuries such as concussions.

Physicians play a vital role in limiting the health effects of concussions, and it stands to reason that the doctor has the final word on a player's well-being before any return to play is allowed. With doctors keeping an eye on the action from the sidelines, fields of play across the nation will be safer for everyone.

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