I helped to moderate the second STOP Sports Injuries tweetchat April 25, 2012. We discussed concussions in youth sports and welcomed healthcare professionals, parents, and coaches from all over the country. The post below is a summary of that discussion. For those of you unfamiliar with tweetchats, people answer questions posed by the moderator and comment on other tweets using the hashtag specified, in this case #SportsSafety. It often starts slowly, but it can become difficult to follow when many people get involved and respond to many different questions and comments. (That’s part of why I enjoy them, honestly.) I apologize if some of the tweets are out of order, as I tried to insert related tweets that didn’t include the hashtag. If you enjoy fast-paced discussions about important sports medicine topics, join us for future STOP Sports Injuries tweetchats. I’ll be sure to announce them on Twitter as well as here on the blog.
David
STOP Sports Injuries
Welcome to Round 2 of our #SportsSafety Tweet Chats. Today’s Topic: Concussions in Youth Sports. Remember to use the tag #SportsSafety
STOP Sports Injuries
We will be moderating from w/ a series of questions. I encourage intros while we get out some starter info. #SportsSafety
STOP Sports Injuries
Joining us again today, @DrDavidGeier, Director MUSC Sports Medicine to offer some expertise on youth sports concussions. #SportsSafety
Dr. David Geier
Hi everyone! Excited to be here! Important topic today! #SportsSafety
STOP Sports Injuries
We have a set of questions to guide the hour on #concussions – please address answers or follow-ups with A1, A2, etc. #SportsSafety
STOP Sports Injuries
Also please direct your own questions or concerns too! Remember to use the tag #SportsSafety and let us know you’re here!
STOP Sports Injuries
Ready? Let’s get going w/ Q1: Have you been involved with a youth sports concussion (athlete, parent, coach, etc)? What sport? #SportsSafety
Dr. David Geier
A1: I see #concussions mainly in football, soccer, rugby as a team physician #SportsSafety
Dr. David Geier
A1: Our Sports Neuroscience team sees hundreds/year in all sports though, even in sports you wouldn’t expect #SportsSafety
Neurosurgery
HAPPENING NOW: @SportsSafety #concussions Tweet Chat. Use #SportsSafety tag & join conversation! (via @AOSSM_SportsMed) #health #brain
paula
Excited to be here to discuss concussions in youth sports! @DrDavidGeier @SportsSafety @NATA1950 #SportsSafety
Dr. David Geier
@mrswatchdog @SportsSafety @NATA1950 Thanks for joining us? Do you have kids that play sports? #SportsSafety
Safe Kids USA
We’re ready to chat about concussions in youth sports! @DrDavidGeier @SportsSafety @NATA1950 #SportsSafety
Me Myself and I
@SportsSafety How do you think they can be prevented in soccer? #SportsSafety
Aaron Gray, M.D.
@SportsSafety I am a primary care sports physician who sees kids and adults in the sideline & clinic with concussions #SportsSafety
Dr. David Geier
@MizzouSportsDoc @SportsSafety Thanks for joining us! You see them mainly with football? #SportsSafety
Dan Mahoney
A1: as a HS ATC I see #concussions in all sports, but more prevelant in FB, lax, and soccer #SportsSafety
Aaron Gray, M.D.
@DrDavidGeier i see concussions from all sports and everyday accidents
Aaron Gray, M.D.
@DrDavidGeier do you see concussions in clinic as well as a team physician?
Dr. David Geier
@MizzouSportsDoc No. Fortunate to have sports neuroscience team w neurologists and psychiatrists to evaluate and treat them. #SportsSafety
Dr. David Geier
@DMXathletics You see a lot in lacrosse? From sticks to the head? Falls? #SportsSafety
Daniel Trimberger II
Some evidence on neck control but unsure of quality RT How do you think they can be prevented in soccer? #SportsSafety
Schooled in Sports
@SportsSafety Haven’t personally been involved w/1, but data says while many are seen in football, all sports have concussions #SportsSafety
Dr. David Geier
@sports_ladee101 @SportsSafety Teach proper techs for heading ball, landing to decrease head/head or head-to-ground contact #SportsSafety
Dr. David Geier
@sports_ladee101 @SportsSafety Maybe padded goalposts? Two ideas at least. Others have thoughts about prevention in #soccer? #SportsSafety
Dr. David Geier
@SchooledInSport @SportsSafety Agree that we often focus attention just on football but they can affect most athletes #SportsSafety
Dr. David Geier
@PDXSportsMed Heard opinions that poor neck muscular control is one reason head injuries potentially more dangerous in kids #SportsSafety
Sam Brethauer
Too much “sports specific”, too young and not enough foundational ability development #sportssafety #injuryprevention #rawstrength
Dr. David Geier
@MizzouSportsDoc Do you use preseason baseline testing with your teams? #SportsSafety
Safe Kids USA
Half of parents believe some hard hits are okay & can’t cause a potential concussion: http://tinyurl.com/6tqeqyw
paula
@DrDavidGeier #sportssafety Neck–Same for girls and boys?
STOP Sports Injuries
Thanks for everyone’s tweets on that first question! We covered #concussions and prevention in quite a few different sports.
STOP Sports Injuries
Moving to Q2: Is there ever a scenario to allow an athlete to return to play in the same game (post rattle or head injury)? #SportsSafety
Dr. David Geier
@mrswatchdog Probably an even bigger issue for female athletes. Might be one reason #concussion rate high in girls’ soccer #SportsSafety
Muir Orthopaedic
RT @aossm_sportsmed: Tweet Chat from @SportsSafety today at 12 ET/11 CT on youth sports #concussions. Use #SportsSafety to join!
Dr. David Geier
A2: Would love to hear from others. Even mild #concussion – out rest of game, IMO. Obviously it happens all the time, though #SportsSafety
Jenn G
@SportsSafety A1: 1st Concussion was age 12 in Cheerleading, 2nd Age 15 Soccer #sportssafety only told to sit out 1 week, much has changed
American Academy of Orthopaedic Surgeons
The Academy’s educational site, http://orthoinfo.org has some great info on #concussions #SportsSafety
STOP Sports Injuries
@jgdm106 Thanks for joining us, Jenn. Are you still active in sports considering the injuries? #SportsSafety
Dr. David Geier
@jgdm106 @SportsSafety Cheerleading is another sport people often don’t realize has risk of concussions #SportsSafety
Bill Galway
@DrDavidGeier who is to determine if the concussion is mild in recreational settings. Should suspected symptoms be the deciding factor..
Aaron Gray, M.D.
@DrDavidGeier no evidence that NP testing improves outcomes so I dont push strong for it.
Aaron Gray, M.D.
@DrDavidGeier if you have a baseline then NP can be helpful but I agree only part of exam. NP tests are also misused by testing before asx.
Dr. David Geier
@billgalway I’d argue that any symptoms at all (HA, dizziness, nausea, memory, not feeling right…) and athlete out for game #SportsSafety
Advantage Physio
@DrDavidGeier what do you think of the gyroscope that chiropractic neurologist Dr. Carrick recommends for concussions? #SportsSafety
Schooled in Sports
@jgdm106 @SportsSafety @DrDavidGeier Double down now banned in H.S. cheerleading due to #concussion risk: http://blogs.edweek.org/edweek/schooled_in_sports/2012/04/
Bill Galway
@DrDavidGeier see it in HS rugby consistantly. Complaints of nausea and dizziness after a collision. Might dehydration play a role
Dr. David Geier
@billgalway Could be. We see them in rugby as well. #SportsSafety
Amy Bell
@DrDavidGeier what is your opinion on National Hockey League quiet room head injury protocol Is NHL doing enough for players #SportsSafety
Bill Galway
who is to determine if the concussion is mild
STOP Sports Injuries
Thanks everyone for your continued Tweets. Remember to use #SportsSafety as we go!
Sports Medicine MD
@DrDavidGeier Agree. But it should not be just opinion; should be standard of care according to Zurich guidelines. #sportsafety
Dr. David Geier
@SchooledInSport @jgdm106 @SportsSafety Cheerleading organizations have worked hard to decrease injuries, make sport safer #SportsSafety
Dr. David Geier
@the_jockdoc No question. Think we’re headed in that direction. Removal from game will become mandatory. #SportsSafety
Sports Medicine MD
@DrDavidGeier Already mandatory in most states and bills are pending in others. Already lawsuits for failure to comply. #sportssafety
Aaron Gray, M.D.
@SportsSafety A2: If an athlete has a concussion they should not continue playing. Symptoms often gradually get worse over a few hours.
Dr. David Geier
@LilMissHockey19 Don’t know specifics of protocol, but decreasing stimuli helpful w other treatments; many factors in hockey #SportsSafety
Safe Kids USA
@SportsSafety Concussion bill in Kansas being signed on Monday…another victory in protecting our young athletes’ futures.
Sports Medicine MD
@mrswatchdog @DrDavidGeier In sanctioned HS events, officials now have power to remove athlete if signs of concussion. #sportssafety
paula
@the_jockdoc @DrDavidGeier #sportssafety But how does that work on the sideline at some rec game, or even HS game with no trainer present?
Dr. David Geier
@mrswatchdog @the_jockdoc Essential question. Education of coaches about dangers.Coaches have to pull kids out if any question #SportsSafety
Dr. David Geier
@mrswatchdog @the_jockdoc Athletes have to be honest about symptoms, tell their coaches; Often too much pressure to play #SportsSafety
Aaron Gray, M.D.
@DrDavidGeier if you have a baseline then NP can be helpful but I agree only part of exam. NP tests are also misused by testing before asx.
Dr. David Geier
@MizzouSportsDoc Definitely only one of many evaluation components #SportsSafety
Sports Medicine MD
@DrDavidGeier @mrswatchdog Agree! Education is key to everything. Concussions will never be prevented in any sport. #sportssafety
Schooled in Sports
@DrDavidGeier @SportsSafety On the symptoms note…how can we explain James Harden initially passing NBA concussion tests after MWP’s elbow?
Dr. David Geier
@SchooledInSport Don’t know specifics of his exam, but many feel sideline tests not sensitive enough. What do you guys think? #SportsSafety
The Concussion Blog
@SportsSafety a2: nope, and it is and should be that cut and dry # #SportsSafety
STOP Sports Injuries
In keeping with that theme, our Q3: Do you think young athletes will deny concussion symptoms to keep playing? #SportsSafety
Sports Medicine MD
@MizzouSportsDoc @DrDavidGeier But it is useful tool to provide objective data to show athlete, parent, coach. #sportssafety
Aaron Gray, M.D.
@SportsSafety A3: I spend time discussing seriousness of concussions and hope it helps patient honesty. But kids definitely hide symptoms
Dr. David Geier
@sports_ladee101 @SportsSafety @mrswatchdog @the_jockdoc I think many coaches really do care abt health, safety of their kids #SportsSafety
SCOI
Follow @the_jockdoc through a #concussion live TweetChat! Use #SportsSafety to join!
Me Myself and I
@SportsSafety @DrDavidGeier @mrswatchdog @the_jockdoc I don’t think coaches will pull them.
Jenn G
@SportsSafety A3: Yes, Especially if they are under pressure to perform or not disappoint #sportssafety
Me Myself and I
@DrDavidGeier @SportsSafety @mrswatchdog @the_jockdoc But in the moment of coaching they don’t know exactly when to pull them.
Aaron Gray, M.D.
@SportsSafety concussions aren’t graded anymore. We need stop using the term “mild.” It downplays the seriousness of injury. #SportsSafety
Neurosurgery
Make Concussion Awareness a Part of Your Playbook. @AANSNeuro #Concussion Prevention & Awareness Tips http://bit.ly/GSmRVK #SportsSafety
The Concussion Blog
@SportsSafety a3: this gets to the education part, yes they do and will, hence the need for medical oversight, i.e. ATC’s #SportsSafety
Dr. David Geier
@MizzouSportsDoc @SportsSafety Fantastic point Aaron! #SportsSafety
Sports Medicine MD
@SchooledInSport @DrDavidGeier Tests are only tools in evaluating concussion. Signs, symptoms, mechanism all important too. #sportssafety
Sports Medicine MD
@MizzouSportsDoc @DrDavidGeier But it is useful tool to provide objective data to show athlete, parent, coach. #sportssafety
@jgdm106
@SportsSafety A3: Yes, Especially if they are under pressure to perform or not disappoint #sportssafety
Dr. David Geier
A3: I think most parents, coaches assume kids would tell them they’re hurt. Much pressure on kids to play, they deny symptoms #SportsSafety
Sports Medicine MD
@SportsSafety @MizzouSportsDoc Well stated! #sportssafety
Dr. David Geier
@concussionblog @SportsSafety Med oversight from MDs, ATs; also coaches & officials-All need education, must do what’s right #SportsSafety
paula
@DrDavidGeier @the_jockdoc And education of athletes, b/c they are often the ones that notice change in behavior or cognition. #sportssafety
Schooled in Sports
@SportsSafety A @SafeKidsUSA survey found 3 of 10 kids saying that “good players” should play injured: http://goo.gl/rfviL
Sports Medicine MD
@SchooledInSport @SportsSafety @SafeKidsUSA Exactly the reason why education is the most important part. Culture change!!! #sportssafety
Schooled in Sports
I’m wondering if pro sports aren’t partially to blame. Kobe plays with a torn ligament, he gets glorified. #SportsSafety
Ronald Masone Jr.
@DrDavidGeier #sportssafety in my experience most kids don’t think it is a big deal to “get their bell wrung”. Well kids it is a big deal!!
Sports Medicine MD
@SchooledInSport @SportsSafety Yes. That’s why culture change at the pro level is so imortant too. #sportssafety
Keith Abrams
@SportsSafety Yes. Due to peer pressure or excitement of game. Also, they may see it as a sign of weakness, unfortunately. #sportssafety
STOP Sports Injuries
Solid info all around so far, folks. Going to move on to one last question as we close out the hour. #SportsSafety
Dr. David Geier
@RonMasone Agree! Have to do better teaching kids (& parents, coaches) that these aren’t just “dings” Can be life threatening #SportsSafety
Sports Medicine MD
@RonMasone @DrDavidGeier The term “bell rung” needs to go away. It’s a concussion and it’s serious. #sportssafety
Ronald Masone Jr.
@the_jockdoc @drdavidgeier agreed. I think it comes from poor coaching terminology.
STOP Sports Injuries
Heard a lot about neurocognitive (ImPACT) testing during the hour. Q4: Familiar with it? Do you think it’s a good tool? #SportsSafety
STOP Sports Injuries
In regards to Q4, @MizzouSportsDoc has shared a few Tweets about the tests during this chat. #SportsSafety
Safe Kids USA
Youth sports safety clinics can teach coaches & parents about concussion safety #SportsSafety
Sports Medicine MD
@SportsSafety It’s a great tool. But realize it’s only A tool and not gold standard diagnosis 4 anything. Use appropriately. #sportssafety
Dr. David Geier
A4: Baseline testing important for athletes in all contact/collision sports, not just football. Do your teams take them? #SportsSafety
DV Training Room
@SportsSafety all NC testing must b uses with balance test, symptom check and results interpreted by qualified individual #SportsSafety
paula
@SportsSafety Q4 We need to get the kids out of the game…more important even than testing them later. #sportssafety
Sports Medicine MD
@DVTrainingRoom @SportsSafety Agreed. What’s the definition of qualified individual though? #sportssafety
Michelle Anderson
Every baseline needs to be chckd for validity and similarity in percentiles to the student grades.
Aaron Gray, M.D.
@SportsSafety part of problem with neuropsych (impact) testing is that kids intentionally test poorly on initial test. Messes up results.
Aaron Gray, M.D.
@the_jockdoc NP testing can be helpful but no evidence it improves outcomes. In 1 year using it at UCLA during felwshp it never changed RTP
Aaron Gray, M.D.
@SportsSafety we need evidence that neuropsych (impact)testing improves patient outcomes. Currently have no evidence they help patients
Aaron Gray, M.D.
@SportsSafety parents & kids want a “test” like other areas of medicine to diagnose concussion & tell them when its safe to return to sports
DV Training Room
@the_jockdoc @sportssafety good point. MD or ATC must commit to education as well regarding scores #sportssafety
Aaron Gray, M.D.
@DVTrainingRoom agreed. W/o baseline = worthless, if they even help at all
paula
@SportsSafety @DrDavidGeier #sportssafety all our 7th- 2th gr athletes take the Impact test, but my daughter took at 11pm after a long day.
Sports Medicine MD
@SportsSafety @MizzouSportsDoc Remember though, there is no test that diagnoses concussion or determines safe RTP. #sportssafety
Sports Medicine MD
@SchooledInSport @DrDavidGeier Tests are only tools in evaluating concussion. Signs, symptoms, mechanism all important too.#sportssafety
Sports Medicine MD
@DVTrainingRoom @sportssafety Personally believe that all concussions must receive clearance from appropriate doc before RTP. #sportssafety
Sports Medicine MD
@DVTrainingRoom @sportssafety Absolutely. Neurologists, ER docs, ATCs, orthopods, pediatricians, etc.Everyone needs education. #sportssafety
Aaron Gray, M.D.
@SportsSafety Instead of a “test,” what concussed kids need are patient parents & coaches & well trained doctors and ATCs to guide return
Aaron Gray, M.D.
Agree 100% RT @the_jockdoc Personally believe that all concussions must receive clearance from appropriate doc before RTP. #sportssafety
Sports Medicine MD
#sportssafety Follow @ThinkTaylorORG @concussionblog @ConcussionWise @NogginPro @the_jockdoc for good daily sources more #concussion info.
Daniel Trimberger II
Agree on pros not being good examples, must educate kids that brain develops to early 20s so cant comparing self to a 28 yo #SportsSafety
Tad Seifert
@DrDavidGeier @schooledinsport experience/training of examiner allows for much more sensitivity/specificity of sideline concussion evals.
Michelle Anderson
@SportsSafety @DrDavidGeier learning that also important in non-collision sports like h-back riding and sailing, had one in both last month
Tad Seifert
@SchooledInSport @drdavidgeier @sportssafety can be relatively asymptomatic when tested immediately post-injury. Not common, but happens
Dr. David Geier
Thanks for the great #concussion opinions and suggestions, everyone! #SportsSafety
STOP Sports Injuries
Have topic or question ideas for #SportsSafety chats? Please let us know as we develop future discussions.
STOP Sports Injuries
We were happy to kick-off these chats for Youth Sports Safety Month but want to continue! Stay tuned for more info on Round 3. #SportsSafety
Aaron Gray, M.D.
@DrDavidGeier great chat! Thanks for the invite! Anytime you need primary care sports stuff like this let me know!
Sports Medicine MD
#sportssafety Follow @ThinkTaylorORG @concussionblog @ConcussionWise @NogginPro @the_jockdoc for good daily sources more #concussion info.
Aaron Gray, M.D.
@SportsSafety should do heat illness later in summer
Bryan Toporek
Read my #Storify story: “Highlights From the #SportsSafety Concussion Tweet Chat” http://sfy.co/qjk #storify #sportssafety #concussions
ProfSk8rsAssoc
@SportsSafety thanks for all the great info today! #SportsSafety
STOP Sports Injuries
@ProfSk8rsAssoc Sure thing – glad you enjoyed! #SportsSafety
Remember, if you’re interested in these tweetchats, please follow me on Twitter and STOP Sports Injuries as well!
