Dr. Michael "Micky" Collins says the best advice he can give student athletes is to "get off the playing field immediately" when feeling symptoms of a concussion.
Collins is assistant director of the University of Pittsburgh Medical Center's medicine concussion program, chief clinical officer of ImPACT Applications and one of the developers of ImPACT's baseline testing program.
He talked about concussions in an interview with The Eagle-Tribune.
Q. Are youths more vulnerable to concussions and why?
A. We know that the vulnerability is much higher at the youth sport level. We've published research showing that when you compare the recovery rates of high school kids, for example, versus college athletes, the recovery is severely longer in the high school age population.... We don't know exactly why. There's several hypotheses. One is the neck strength. Clearly the necks aren't as well developed. And neck strength does play a key role in mitigating some of the forces that cause concussion.¬
Q: What about girls?
A: We just published another paper where we did a study looking at recovery from concussion in high school soccer player girls and high school soccer player boys. They have the same protective equipment, which is none for the head in soccer. And they have the same rules and everything. And when you look at a large sample of patients we actually find that girls have worse symptoms early on and have longer recovery rates. ... Maybe neck strength is involved in that. One other thing: We're finding that migraine is a significant predictor of someone who has poor outcome following a concussion. So if you have a history of migraine, it is easier to get a concussion and the outcomes are worse. And the female to male ratio of migraines is 4-to-1 female to male.
Q: How dangerous is it for a youth to play with concussion symptoms?
A: It's extraordinarily dangerous. I mean it's a brain injury. We know for a fact that until recovery is complete, less biomechanical force is going to cause more serious problems, and in rare cases it can be very serious and even potentially catastrophic. Here is a profound statement, but it actually speaks to this injury very well: the mild injuries become severe and the severe injuries become mild. The mild injury becomes severe because the kids who get their bell rung ... who don't tell anyone but continues to play through it and gets hit and exerts ... those are the kids who end up taking months or longer to recover. The kids who lose consciousness for a minute, and everyone takes a knee, and everyone sees it in the stadium and they put him on a spine board and they take him to the emergency room and he rests over the next several days and everyone asks how he's doing, those are the kids who get better the fastest. So the mild ones are the ones we have to be very concerned about.
Q: When is it healthy for a youth athlete to return to play?
A: There's three criteria we use for return to play. The athlete has to be completely, 100 percent symptom-free at rest. And there's 21 symptoms of concussion. It's not just, 'Hey, do you have a headache and how do you feel?' It's going through all 21 symptoms of concussion. ... No. 2 is the athlete has to be completely symptom-free at rest and with physical and cognitive activity. So not only are they symptom-free after doing sprints and weight-lifting, but they are symptom free after a full day of school and studying for that physics test. And then the third criteria is that the athlete has to be normal on formal, computerized neurocognitive testing.
Q: Is there a chance someone could have symptoms and not know it?
A: Absolutely. ...There's an insight issue sometimes with a brain injury and sometimes kids don't have the insight they normally have in self-evaluations.¬ We see it all the time where kids come in and they think they feel OK and then you do the testing and they are having problems.
Q: What's the most important recommendation you can give to athletes?
A: The most important thing is to understand the subtlety of it and to understand that if there are symptoms to get off the playing field immediately and to get to a clinician that understands how to evaluate this stuff and let the clinician help manage that athlete.¬
Q: Other thoughts?
A: I think one of the most critical pieces of this is athletic trainers. I think athletic trainers, by and large, are very well-trained with concussion management. They know the athletes and they can serve as the liaison to getting these kids off the field, a getting them the baseline testing and getting them the clinicians that know how to do this stuff. I would never put my kid into a school that doesn't have an athletic trainer.