As he sat among celebrities watching the premiere of the movie Concussion in Los Angeles, David Baron, DO, reflected on the advancements made in both his own and others’ concussion research—a point he wished the movie addressed.
“The movie missed an opportunity to get people talking about concussions in a thoughtful way by overlooking how this research changed the rules in contact sports,” says Dr. Baron, a psychiatry professor at Keck School of Medicine of the University of Southern California in Los Angeles who presented on concussion and sports at OMED 2015. “For instance, the big hits on the field that used to be met with applause would now get players pulled from the game.”
Starring Will Smith, Concussion, which opens Dec. 25, is a fact-based accounting of research conducted by forensic pathologist Bennet Omalu, MD. Dr. Omalu identified chronic traumatic encephalopathy (CTE) in deceased pro football players and faced strong resistance from the NFL when he sought to raise awareness of the disease.
Although commonly associated with football players, the degenerative brain disease can occur in other sports, such as boxing and soccer. Currently CTE can only be diagnosed in an autopsy, but scientists are developing CTE imaging methods that can identify the disease in living patients.
“We’re still at the infancy stage of understanding CTE. We don’t know how many concussions it takes to develop CTE or if people with a family history of dementia are more prone to it,” says Jeffrey Bytomski, DO, head medical team physician at Duke University in Durham, North Carolina. “We don’t know which are the important risk factors for long-term problems with concussions.”
Advancements in treatment
The culture of evaluating and managing concussions has evolved in the decade since the events of Concussion took place.
“Physicians now perform more objective testing, focusing on visual function and balance, to better evaluate youth athletes,” says Dr. Bytomski.
The old “rest is best” philosophy toward athletes with visual or balance issues has been replaced by treatment with a neuro-optometrist or vestibular therapist.
“The players are much more excited because they can be actively engaged in their own treatment, and they’re already used to doing rehabilitation for injuries,” says R. Robert Franks, DO, the co-medical director of the Jefferson Comprehensive Concussion Center in Philadelphia.
Dr. Franks, who attended a pre-screening of Concussion in Philadelphia, says the movie is “a good compressive history of cases we’ve seen both scientifically and in media coverage.”
Concussion playbook for DOs
As millions of moviegoers flock to theaters in coming weeks, physicians may see an increase in questions about the safety of contact sports for young athletes.
“Be aware of the most recent clinical research for concussion, so you can make good suggestions to your patients,” Dr. Baron says.
All 50 states now have Return to Play laws to address concussion management in youth athletes. The laws address issues such as when to remove a youth athlete from play and guidelines for collecting concussion histories.
Many people do not know the symptoms of concussion, Dr. Baron says. Instead of asking patients if they have ever had a concussion, ask instead if they have ever had a headache that would not go away, he suggests.