WHAT EVERY MOTOCROSS RACER NEEDS TO KNOW: BLOWING THE LID OFF CONCUSSIONS

October 15, 2012
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Concussions are commonplace in motocross ? helmets or not. According to the Center for Disease Control an amazing four million Americans suffer concussions every year (and it is thought that the majority of concussions go unreported). A very small amount of that number come from motocross (high school football players sustain 100,000 diagnosed concussions every year), but with the advent of bigger jumps, tracks that are nothing but jumps and the desire to emulate the heroes of Supercross, motocross’ numbers have grown. In fact, the Journal of Pediatrics says that the number of children who are concussed has doubled in the last 15 years (and those are only the reported events)

Assuming that concussion are a statistical fact of life, and most people are unlikely to modify their behavior before it’s too late, it is important to understand what happens when the brain is knocked around?and what can be done about it, before and after the fact. While most athletes look at a concussion in the same way as any other sports-related injury?it is not the same. Sprained ankles and broken bones will heal, but brain injuries are cumulative. A broken arm may be ready to go in six weeks, but a brain may be damaged for a lifetime.

MAKING THE SUBJECT HARDER TO RESOLVE IS THAT “BEING KNOCKED OUT,” “SEEING STARS” OR “HAVING YOUR BELL RUNG” ARE NOT THE ONLY INDICATORS OF A CONCUSSION.

Making the subject harder to resolve is that “being knocked out,” “seeing stars” and “having your bell rung” are not the only indicators of a concussion. Only 10 percent of athletes suffering concussions actually lose consciousness. Most concussions don’t even require that the athlete hit his head. A racer who hits the ground hard or comes up short on a jump can have his head “whiplash” back and forth fast enough to slosh the brain sufficiently to cause a concussion.

So if being knocked out is not the best indicator of a concussion, then what is? There are a host of symptoms to look for, and they include neck pain, headache, vomiting, sensitivity to light, dizziness, confusion, memory loss, repetitive questioning, irritability and not knowing what happened.

We could make the case that any person who has suffered a brain injury needs a long period of recuperation before returning to vigorous physical activity. Sadly, the majority of athletes and racers who experience a concussion return to their sport almost immediately. One need look no further than Travis Pastrana who, by his own account, suffered nine concussions in one racing season yet kept racing. It could be speculated that Pastrana’s first concussion led to his second and so on down the line. Plus, several mild injuries can do more damage than one severe one.

There have been several well-known sports cases where second-impact syndrome, in which an athlete suffers a second blow to a previously concussed head, has resulted in death from bleeding in the brain. According to medical sources, second-impact syndrome causes six fatalities a year.

MOTOCROSSERS, FOOTBALL PLAYERS AND EVEN GIRLS’ SOCCER PLAYERS CAN ALSO BECOME PUNCH-DRUNK.
 

Have you ever heard the phrase “punch-drunk”? It refers to a perpetual state of confusion, slowed mental acuity, blurred speech and lack of concentration. Boxers become punch-drunk because of multiple concussions (boxing is all about concussions). Motocrossers, football players and even girls’ soccer players can also become punch-drunk. Each time you get a concussion, it is easier to get another concussion in the future. Repeated concussions can lead to long-term memory loss, psychiatric disorders, brain damage and other neurological problems. In severe cases, a rider may have to retire from racing if he suffers from the cumulative effects.

Second-impact concussions?those that occur before the brain recovers from the first, second or third concussion?can slow recovery, increase the likelihood of long-term problems, and result in permanent brain damage and even death.

Additionally, special care must be taken with female athletes?especially in the high-risk world of professional racing. Are we being chauvinistic in trying to protect the fairer sex? No. It is a medical fact that females are more susceptible to concussions than males. Worse yet, they suffer much more severe symptoms. The reasons are unclear, but cases have been made by medical professionals that a female’s weaker neck muscles, estrogen levels and reduced muscle mass are contributing factors.

What can be done about concussions? First, if you suffer a concussion, don’t race until your brain is recovered and healthy. Second, wear the best and most protective equipment you can afford. Third, replace your helmet every five years or after any big crash where it hits the ground. Fourth, no upcoming race is worth being punch-drunk for the rest of your life. There are always more races. Fifth, seek medical assistance if symptoms arise, persist or get worse.

TO COMPETE IN THE 2012 AMA NATIONALS, A LICENSE HOLDER IS REQUIRED TO TAKE A BASELINE TEST AT THE BEGINNING OF THE SERIES AND BE RETESTED POST-CONCUSSION.

As for the sanctioning bodies of professional racing, it is as simple as mandating that every AMA professional motocross racer take the imPACT or SCAT2 test and not be allowed to return to racing until he can prove that his cognitive ability has returned to where it was before the injury.

To the credit of the typically do-nothing AMA management team (motocross and Supercross), they have joined most major professional sports, as well as large universities and 4000 high schools, in implementing a computer testing program known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The imPACT test measures basic memory, word recognition and pattern recognition skills. To compete in the 2012 AMA Nationals, a license holder is required to take a baseline test at the beginning of the series and be retested post-concussion to determine if there’s been any erosion of skills. The imPACT test doesn’t just ask the racer to remember words, but, instead, produces scores for five different areas?motor processing speed, reaction time, visual memory, impulse control and verbal memory. The idea is that each professional racer would take the test once before the season starts and then again after a head injury. If he scored substantially lower on the second try, he’d be kept off the track until he could match his baseline score or otherwise get full clearance from a doctor.

There’s nothing particularly novel about the ImPACT test. Even its proponents admit that it’s essentially a fancier version of existing protocols, like the Sport Concussion Assessment Tool (SCAT2) that also measures cognitive abilities. And by no means should the imPACT test be considered the gospel of concussion diagnosis. Its popularity is in large part a response to the we-have-to-do-something crowd, but the imPACT test is better than the previous Wild Wild West of professional motocross, where a rider would be knocked out in his heat race and be back on the starting line for the Last Chance.

THERE HAVE BEEN INFAMOUS CASES WHERE A CONCUSSED RIDER HAD TO ASK HIS MECHANIC WHICH WAY THE TRACK WENT AFTER A CRASH, AND EVERYONE REMEMBERS WHEN THE ASTERISK MEDICAL CREW HELD JAMES STEWART’S BIKE UP FOR HIM AT DAYTONA AND PATTED THE SEAT TO HELP HIM GET BACK IN THE RACE.

There have been infamous cases where a concussed rider had to ask his mechanic which way the track went after a crash, and everyone remembers when the Asterisk medical crew held James Stewart’s bike up for him at Daytona and patted the seat to help him get back in the race as he staggered around. So the impACT test is something, and even a flawed something is better than the organizational blind eye.

The best medical way to evaluate a head injury is with a CT scan. This machine takes cross-sectional X-rays of the head (or other body parts), and a computer reassembles the information into images to let the doctor see details of the inside of the body. When a CT scan is used for a head injury, the doctor is looking for evidence of bleeding under the skull or within the brain tissue itself. With less severe head trauma, a doctor may elect to have the patient observed, either in the hospital or at home, for any symptoms. If none appear in the first 48 hours, the athlete is usually safe.

On a medical side note: The old saw about not letting a person with a suspected concussion fall asleep is not supported by most medical advice. If, however, a person who was initially normal after a head injury cannot be awakened, or is extremely difficult to awaken, then the person may have a more serious head injury and should be immediately evaluated by a doctor.

Youth sports are under scrutiny, and although legislators are most interested in team sports, amateur motocross?especially the big-time NMA and AMA   amateur events?could find themselves bound by government rules in the future. As more attention is brought to the concussion problem (by incidents like the Junior Seau suicide), more legislators will get involved. Right now, 20 states have passed laws that require any high school athlete who is suspected of suffering a concussion in any sport to be pulled from play and not return until a doctor or certified athletic trainer declares him or her fit. Other states are considering similar legislation, and two separate bills were introduced in the House of Representatives trying to make it federal law. The mantra of these bills is, “When in doubt, sit them out.”

If a school, coach, league, organization or sanctioning body fails to follow this protocol, they can be subject to legal action?not just penalties for failing to act, but liability for any brain injury that may accrue after the date of the first suspected injury. That means that if a rider falls at Loretta Lynn’s, Ponca City or the World Mini and suffers a suspected concussion but is allowed to continue racing?and then suffers permanent injury or death?the race organizers could be held liable.

Motocross is a dangerous sport. It will never be sanitized to the level of guaranteed safety. There is always risk. And the assumption of risk is a big part of an individual rolling up to the starting line. A motocross racer accepts that he could hurt his knee, break his arm or get cut by roost. But, he doesn’t always make the connection that a concussion could injure his future.

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