Vinita: It is now for Morning Rounds at CBS News contributor Dr. Holly Phillips, and Orthopaedic surgeon, Dr. Neil Roth. Neil is sports medicine specialist and has served on the medical staff for several teams. First up, football and concussions. Concern over head injuries is dominating all levels of the sport and the CDC plans a rigorous evaluation of the risks of tackling in youth football.
One study found that 1 in 30 players ages 5 to 14 will suffer a concussion during any one season. I still think despite all of these talks, some people don’t really know how to evaluate if they’ve had a concussion. What is it?
Doctor Holly: Concussions actually can be confusing, but I’m so glad there’s increased awareness. It’ll help our young people, it’ll help athletes, it’ll clear up a lot of misconceptions. Concussion actually comes from a Latin term that means to shake violently and that’s essentially what it is. Concussions happen after a sudden and violent blow to the head.
Our brain is made of soft tissue. It is cushioned by a strip of spinal fluid inside of the skull. The impact from a sudden blow to the head can jolt the brain or sometimes physically move it within the skull. That results in bruising, damage to blood vessels, damage to nerves. The ultimate effect of that is that the brain doesn’t function normally whether that’s for a period of days, weeks or month. There can be a huge number of symptoms ranging from nausea, or vision disturbances.
We’re understanding more and more that concussions can affect your mood or even your personality. We see depression, we see changes in the way people behave.
Anthony: Neil, I know from having had a concussion that didn’t really show itself the effect for about a week to ten days later that it can be complicated to know whether you had. Have you actually diagnosed a concussion?
Doctor Neil: It’s a great question. Concussions are like snowflakes. They’re different all the time, there’s really no two that are alike. As we will look into the brain which basically controls every function of our body it can manifest itself in a lot of different ways. You can have some dizziness, you can have headaches which are some of more obvious, but you can have more subtle findings with mood changes and things along those lines.
The real way to diagnose it is to, number one, know your kid, know your athlete and if something just does not seem right, then that’s a pretty good indication that something could be wrong and you could have a concussion. Doesn’t mean you necessarily have to, but it certainly would warrant having it worked up and being looked at.
The best way to really diagnose it is we do these preseason evaluations. We do baseline testing, there are a lot of neurocognitive tests, there are balance tests that are done preseason so in the event that an athlete gets a concussion, we can evaluate it to where they were at their baseline and monitor their progress and additionally monitor the severity of the concussion itself.
Vinita: I have to, though as a parent, it makes me nervous that I should notice certain things and that the symptoms could always be different. Is there a way for there to be some definitive diagnostic tools? Is that something in the works?
Doctor Holly: There’s a lot of work going on in that area. Just this past week at the American Academy of Neurology conference, ome researchers presented a small,but very promising study using something called a transcranial doppler. They developed basically a device where you can put it on the head, it does a Doppler ultrasound of the brain which measures blood flow.
What they found was that it was 83% accurate in distinguishing between high school students that had concussions and high school students that had healthy brains. The point of all of this and other research like it is to try to develop some type of device or diagnostic tool that is fast, that’s portable and it’s accurate and it can be used right on the sidelines of the game.
Neil, I know you were a team doctor for the LA Lakers, if you just a quicky device right there on the sidelines, I’m sure that would have been a big help.
Doctor Neil: Of course, in an ideal world if we had these portable devices that were reliable and gave us instant information that would be fantastic. The fact remains that concussions are very subtle, tough sometimes findings. Athletic trainers, parents, and coaches need to know your athlete and be able to see what’s going on.
Obviously, we’ve spoken about how the brain is a metabolic type of organism and if it basically has a concussion, the metabolism is altered and a brain flow study or something in those lines would be the crux of being able to diagnose that.
Anthony: Okay. Next up, a problem that sidelines many elite athletes. Of course, back spasms don’t only affect the pros, millions of Americas suffer from the painful muscle contractions each year. Neil, what actually causes this?
Doctor Neil: Back spasm is an end result of irritating one of the nerves in your lower back. It can happen from our everyday activities, from an impact, from an athletic maneuver, from doing something very strenuous and in turn the nerve will send an impulse to the muscle and the muscle sees this constant on signal and goes into spasm, because it’s basically turning it on, like you are flicking the light switch on and off, it seems as though the light switch is on, that the light is on all the time. The muscles go to spasm and becomes very painful and debilitating.
Vinita: I’m convinced led to my back spasms.
Because I also get a massage when it was really intense, what are the best treatments? What should you be doing?
Doctor Holly: Right, massage is a very good one, my oldest childhood friend called me everyday to switch. She was suffering from terrible back spasms. She said, “What’s the treatment?” There’s really isn’t a quick fix, what I can say is that using heat and cold therapy is important. Medications we use very judiciously just some anti inflammatories, muscle relaxants. We try by all means necessary not to use heavy duty medications like the opioid, pain killers or anything else. Massage, acupuncture, stretching, yoga, all of these things are really keys to getting better. Then, strengthening your core and your lower back muscles is critical so you don’t re-injure yourself.
Vinita: Well spasms are just one symptom from those who suffer from chronic back pain. A study of 342 patients by researchers in Seattle points to a potentially helpful treatment; meditation. It found those who engage in yoga and mindfulness based meditations had a 61% improvement in the activities they could do compared to 44% who stuck to their normal routines. The meditation group also reported 55% improvement in pain compared to just 27% in normal care mind over matter a little bit of that.
Doctor Holly: Very much so.
Doctor Neil: We’re talking about how the brain, how it affects concussions. It would certainly follow that you have a complete connection on the physical nature of back issues that are tied to your brain, that are tied to your mood, your stress levels, there are hormonal changes that occur with stress levels that will affect your entire muscular approach to things. It’s a great connection and one that obviously should be incorporated into any type of therapeutic regiment.
Anthony: Doctor Neil Roth, Doctor Holly Phillips, thank you both very much for being with us.