SPORTS MEDICINE: Soccer goalie’s concussion definitely requires time out


Q. My son, a high-school soccer goalie, recently sustained a concussion. The athletic trainer at the school would not let him return to play for at least a week after the injury even though he seemed fine to me and the coach. Why is a week such a magic number with head injuries, and what problems could he have experienced if he had returned to play earlier?

A. A concussion should never be taken lightly, especially in sports in which there is a great chance of recurrence. These injuries also are called closed-head injuries and mild traumatic brain injuries. A great deal of research has been done on concussions, and the results all point to the same thing: Return to play has to be closely monitored, recurrent concussions are reasons to disqualify an athlete from competition and adhering to strict guidelines after a concussion decreases the chance for severe consequences, such as death or permanent brain injury.

Certified athletic trainers are skilled in assessing these injuries and following up after games. The standards of care include waiting at least a week after all symptoms of the concussion have cleared before allowing the athlete to return to play. This helps prevent “second impact syndrome.” This occurs when brain tissues have not healed properly before another hit to the head (sometimes even less severe than the first). It can cause severe brain swelling and death. The loss of a week of practice and a few games in a season is minor compared with the possible consequences of returning to play too early.

Q. I am a 38-year-old soccer player who is in great shape except for a recent knee injury. I found out recently that I tore my anterior cruciate ligament, or ACL. This happened a few months ago, and now I have minimal swelling and full range of motion. I feel I am ready to play (I play goalie) but want to make sure I am making the right decision. Do you have any recommendations, such as wearing a brace or whether I am returning too soon?

A. Usually, the knee feels quite unstable after tearing the ACL, but you have not mentioned this. Certainly, after time, an ACL-deficient knee will have lost swelling and have full range of motion. Therefore, unless you are unlike other people or you really do not have a torn ACL, you will need to have that knee braced for all activities or have an ACL reconstruction performed on your knee.

At your age, you probably have minimum degenerative changes in your knee, so surgery would be your best choice if you want a more stable knee and want to stay active the rest of your life. This surgery will allow you to play sports again about six months after the surgery and rehab.

Q. I have severe plantar fasciitis (heel pain) and have heard about a new treatment called extracorporeal shock-wave treatment. How effective is this and is it available locally?

A. This type of treatment has been around for a few years in Europe and Japan. Much has been written about its effectiveness, but most studies are somewhat unclear about how much it really helps. These shock waves are thought to increase the threshold of pain in this region and increase local blood supply to promote healing. Currently, I am not convinced about its efficacy. In the Richmond area, some orthopedic groups offer this as a treatment option to surgery.

Dr. Doug Cutter is director of the Sports Medicine Center at CJW Medical Center (Chippenham). Look for his column on the third Wednesday of each month. Contact him at [email protected] or c/o Balance, Richmond Times-Dispatch, P.O. Box 85333, Richmond, VA 23293.

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