When 'Small' Head Injuries In Young Athletes Are Cause For Big Concern

Ohio State student, football player and wrestler Kosta Karageorge. (Photo by Ohio State University, Jay LaPrete)

Tragically, 22-year-old Ohio State student Kosta Karageorge, a football player and a wrestler at the university, was found in a dumpster near his Columbus apartment Sunday afternoon. He had been missing for five days.

The young athlete appeared to have suffered a self-inflicted gunshot wound, leaving questions of “why” echoing in the wake of his death.

Before Karageorge disappeared, he texted his mother that “concussions had messed his head up” and he was sorry for being “an embarrassment” as a result of his condition. She confirmed that her son had indeed endured multiple concussions, and resulting spells of confusion, over the course of his athletic career.

Although he reportedly followed the advice of medical teams after each incident, the repercussions may have taken a toll anyway.

While details are still emerging about Karageorge, and other compounding factors certainly could have contributed to any conditions he may have had, we’re still left wondering about the imprint head injuries might be leaving on young athletes. We used to see neurological problems after years of bruising professional sports — such as NFL player Junior Seau, who took his own life in 2012 after suffering from a condition called chronic traumatic encephalopathy (CTE), the result of repeated brain damage.

Now the issue of head injuries seems to be skewing younger

Harrison Youmans, MD, a sports medicine specialist from Orlando Health, says that although concussions have obviously happened as long as there have been contact sports, in the past few years there has been a cultural shift. “We used to look at concussions in relation to big hits — the play flashing across ESPN where someone just gets lit up,” he tells Yahoo Health. “Now we’re assessing hits that don’t look as bad, that may cause symptoms later, or ones that don’t get better after several seasons. Now the question becomes, especially for coaches and parents of young athletes, how much risk are we willing to tolerate?”

Concussion and risk have been topics of conversation this year — in college football, especially

Shane Morris is supported by a fellow player after sustaining a concussion on the field. (Photo via Chicago Tribune)

News of Karageorge’s death comes after “concussiongate” in late September, in which University of Michigan head football coach Brady Hoke left an obviously-concussed Shane Morris on the football field after taking a hit. Despite not being able to stand on his own, while being held up by a teammate moments before the snap, the quarterback played another down of football, which may have left him vulnerable to severe head injury.

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Jessica Viana, an athletic trainer at the Concussion Care and Physical Rehabilitation at Overlook Medical Center says playing after the brain has swelled (and before it’s fully recovered) can be costly. “The biggest concern is second-impact syndrome,” she tells Yahoo Health. “Any hit before the concussion has healed can bring this on, and it could be fatal. The other concern of another hit is extending the duration of the injury, which can lead to permanent brain damage.”

Youmans says says players who have sustained a concussion need to be treated with extreme caution just after an incident. “When I see someone, I’ll take a history,” Youmans says. “I want to know what happened, how it happened, and if they have had repeated injuries. Sometimes it’s less about the concussion and more about making sure there’s nothing worse.” For instance, it’s important to look for signs of a brain bleed, which could be particularly deadly.

And damage to the brains of young people may happen without a formal concussion 

In a new study presented on Monday at the Radiological Society of North America, researchers tracked 24 high-school football players between the ages of 16 and 18 with a Head Impact Telemetry System (HITs), which is mounted on the helmet and used to determined the frequency and severity of helmet impacts in practice and games. After just one football season, before-and-after images of the player’s brains showed abnormalities —even in the absence of head injury.

Brain injury is not just a football issue

Other sports in which players sustain repeated hits, like hockey, lacrosse and soccer — the latter of which Viana says she sees more injuries year-round than in any other sport — are also risky. And although the new research on high school athletes is preliminary, there are still concerns about how hard hits can affect young players’ developing brains.

Youmans says the key age for protecting the brain is roughly 9 to 12. “It’s like anything else,” he says. “In a younger brain, the working parts are more basic. You are growing the network of neurons, how they connect and communicate. We’re trying to answer the question now, ‘If you sustain an injury at a younger age, will this cause the brain to not develop properly?’

And while ages 9 to 12 might mark the most vulnerable timeframe, they’re not the only ages for which a concussion might be more problematic, as the brain grows and changes into our 20s. Sustaining a head injury while you’re young might lead to issues down the road. “We need to protect youth more,” Youmans says. We need to make sure we’re not putting them at risk for injuries at that the brain is developing.”

This is a challenge, for both athletes and medical teams. Viana says there are still prevalent misconceptions about the way concussions present. “There’s still this impression of, ‘I just saw stars, and I’m really fine,’” she explains. “But you might not see substantial symptoms for three days after a bad hit.” This is why the initial assessment by a medical professional or other supervisor is so important — and tricky. Athletes could “shake it off” on the field, look fine, and still be at risk.

However, the best tactic is still looking for a clear head after a hit

For athletes to be given the green light to play after a concussion, they must be completely asymptomatic — no matter how long that takes, whether minutes or months. “Cognitively, they need to be normal, they need to be in school, functioning socially, and not on any medication for symptoms,” Viana says. “They also need to have a physical evaluation. We’ll put them on a graduated exercise program to make sure they are still asymptomatic with all head movement. We have to make sure that the brain has totally reset itself.”

If you’re ever unsure about a concussion, even if symptoms seem mild, Viana says it’s better to be safe. “When in doubt, sit them out,” she says. “You can fix fractures, you can repair ACL tears surgically, but the brain is different. I know games are high-pressure, with scholarships and wins on the line, but nothing is worth sustaining neurological damage and the repercussions of head injuries.”

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