Counsel patients, parents on concussion risks in football

iStock-471035985.jpgDrs. Anthony Romeo and Gregory Cvetanovich co-authored this articlein Orthopedics Today about the rising awareness and reported incidences of concussion and how parents, athletes and coaches should be more careful about making informed decisions about play and return to play. They added that orthopedic physicians have a responsibility to share information regarding the risks of contact sports.


There has been increased awareness of sports-related concussions and risks associated with head trauma. The reported rates of concussions have doubled during the past decade, especially among youth and high school athletes. Much of the increase is attributable to greater recognition and diagnosis, as well as more media attention.

Among youth and high school athletes, American football has the highest risk of concussions, accounting for almost half of sport-related concussions in United States and the highest rate of concussions per player. Male athletes have more concussions overall due to greater participation in contact sports, however, female athletes are diagnosed with almost twice the rate of concussions compared with males in comparable sports, such as soccer. Younger athletes may have greater susceptibility to concussions, risk of recurrence, chance of second impact syndrome, as well as prolonged symptoms and recovery.

Risks of concussions

Treatment of concussions in young athletes consists of cognitive and physical rest along with symptom management. Short-term concussion risks include prolonged symptoms consistent with post-concussive syndrome and rare, but potentially fatal, second impact syndrome if the athlete sustains a second head injury too soon after the first. Patients with prior concussions are also at two- to five-times greater risk of sustaining another concussion. Long-term concerns include reported increased rates of dementia and depression potentially related to chronic traumatic encephalopathy (CTE).

In a published study, researchers analyzed the brains of 202 deceased football players. They found an overall 87% rate of CTE on neuropathology. Former high school players had a 21% rate of mild CTE, and the rates of CTE increased based on highest level of play to 99% of former National Football League (NFL) players who had predominantly severe CTE on pathology.

The study had limitations, but it was proposed that CTE may be related to repeated blows to the head in football and the severity may increase as athletes reach high levels of play. Many questions remain about the impact of early exposure to head impacts from youth football and of hits sufficient to result in clinical diagnosis of concussion vs. clinically silent subconcussive hits.

Due to these concerns, football leagues of all levels, as well as those of other sports, have made rule changes designed to reduce head injuries. Many of the interventions have had success in reducing the rate of concussions, although the effect on potential long-term cognitive effects of repeated head trauma and rates of CTE remain unknown. Some rule changes have been shown to have paradoxical increases in rates of concussions, which more likely reflect simultaneously increasing awareness of concussions among players, coaches, trainers and team physicians, rather than a causative relationship of the rule changes and increased concussions. Equipment changes, such as improved helmets and increased use of mouth guards have been made, but show mixed data on their impact on concussion rates.

Counseling patients, parents

As orthopedic sports medicine physicians, we should have a low threshold to suspect and diagnose concussions in athletes in conjunction with trainers and other health care providers. Patients should be removed from play to prevent further injury and allowed to undergo appropriate concussion treatment prior to consideration of return to play. A multidisciplinary team approach can be valuable, particularly in patients with prolonged or recurrent concussion symptoms.

Athletes recovering from concussions along with their parents, in the case of youth athletes, should be advised that certain contact sports are associated with elevated risk of concussion. This risk is inherent to contact sports despite attempts to reduce risks with rule changes, equipment modifications and coaching. Once an athlete is symptom-free and completes a concussion protocol, return to play may be considered as a shared decision with patients and parents.

Counseling patients and families on the long-term risks of single or repeated concussions is more challenging, including risks for cognitive, behavioral and mood disorders and neurodegenerative changes of CTE. Patients should be informed that the growing evidence connects CTE and its associated symptoms to football, particularly prolonged and high-level play.

Existing data make it impossible to project these risks for an individual athlete with a concussion or repeated subconcussive hits to the head. Furthermore, it is unclear how early participation in football and concussions sustained in youth and high school football influence long-term cognitive function. However, we owe it to our patients to discuss the potential risks although we cannot provide firm guidelines about number of concussions or head impacts after which they should consider not returning to play.

Despite uncertainty about long-term and patient-specific risks, the decision to participate in contact sports comes down to an informed decision by patients and parents. Orthopedic sports medicine physicians should provide information about the current understanding of the risks, which patients and parents can use to make decisions about what short- and potential long-term risks are acceptable.                       

How You Can Avoid Biking Injuries

Dr. Gregory Nicholson, Midwest Orthopaedics at Rush shoulder surgeon, treats many patients that have sustained bike injuries. He talks with FOX 32 Chicago host Sylvia Perez about how cyclists can prevent these injuries.

As biking becomes more popular, bike injuries are becoming more common. Researchers found that there were 288,501 cases of non-fatal bike accident injuries in the United States in 2013, up from 177,275 in 1997.  Chicago actually has more bicycle commuters per capita than New York or Los Angeles.

Bicycle injuries are on the rise in Illinois and the majority of them occur on the roads.  With the staggering rise of bike injuries being reported, it is important to follow basic safety tips and prevention techniques to stay safe and reduce injury while cycling.

How to Prevent ACL Injuries

Dr. Nikhil Verma is a shoulder, elbow and knee specialist at RUSH Orthopaedics in Chicago, IL. In this interview, Dr. Nikhil Verma explains how to prevent ACL injuries and ACL injury prevention techniques for young athletes. ACL injuries are becoming an epidemic in the United States. Some publications report over 400,000 ACL injuries occur each year and are continuing to increase rapidly in female athletes under 20 years old.

Basic warm-up plyometrics, which is a series of muscle contraction activities, along with strengthening activities and agility activities are a number of ACL injury prevention techniques for athletes. Today, sports medicine physicians are able to identify patients who are high risk for sports injury and those who are at a low risk for an ACL injury. Dr. Verma can take athletes who are in the high injury risk groups and teach them specific exercises to move them into the lower risk group and ultimately decrease the number of ACL injuries that are happening.

The first step in how to prevent ACL injuries involves an injury assessment. We will film the athlete doing the high risk activities in order to slow down the movement to identify high risk and low risk patients. Once those have been identified a series of exercises that involve core and leg strength a used as ACL injury prevention.

To learn more about how to prevent ACL injuries, ACL injury prevention and the Knees for Life campaign, please visit: Anterior Cruciate Ligament Injury (ACL Injury) Overview.

Related: ACL Reconstruction Surgery

Chriss Schaefer, Tennis Pro, Back on the Court

tennis ball

After 54 years on the tennis court, Chriss Schaefer’s knee had finally had enough.  But the 64-year-old Hinsdale resident wasn’t ready to hang up her racquet.

“This is something I’ve done full-time my whole life,” said Schaefer, whose only job as an adult has been as a tennis teacher and coach.  She wasn’t about to let an arthritic knee get between her and the rest of her tennis career.

So, just months after a full knee replacement in June 2016, Schaefer was back on the court doing what she loves most – teaching others the sport she’s played since childhood. Told she would spend several months off the court, Schaefer got to work.  If the physical therapist told her to work 15 minutes a day, she pushed herself to 20 or 30.

“I was diligent,” she said.

She also credits the skills of her surgeon, Dr. Scott Sporer of Midwest Orthopaedics at Rush, and her physical therapists for getting her back on the court so quickly. With her new knee in full working condition, Schaefer is back on the court 22 hours a week, sharing the sport she loves with players at Five Seasons Family Sports Club in Burr Ridge.  After 35 years at the Oak Brook Racquet and Fitness Club, Schaefer joined the staff at Five Seasons two years ago.  She teaches men, women and children of all ages not only to play at the best of their ability, but also to enjoy the sport.

“I try to make it fun,” she said.

Schaefer has shared her mastery of the sport with hundreds, including her own four children, two of whom played at Hinsdale Central High School.  Son Mark Schaefer won the state doubles title with partner Sumant Bhat in 1998. Schaefer first picked up a racquet at age 10.  After making it to the national college championships as a student at the University of Wisconsin, Madison, she continued playing tournaments throughout the country and the world until about 10 years ago. At 49, Schaefer entered the senior circuit, making the U.S. World Cup team three times and traveling to Austria, Turkey and Germany.  Two of her three World Cup appearances resulted in championships for the U.S. team.

Even after more than 50 years, Schaefer still enjoys the sport. “It’s like playing chess. I love the thought process, the strategy,” she said.


Decades after discovering her love for the tennis, Schaefer discovered another passion in paddle tennis. Played outdoors on a smaller, enclosed court, the winter sport can be even tougher on the body than regular tennis, Schaefer said.