AAFP, NFL Foundation Partnership Tackles Concussions Head-on

Initiative Aims to Reach Family Physicians, Patients

August 19, 2015 01:44 pm Chris Crawford

When a student athlete is concussed in a game, it's often a family physician who provides his or her initial care. Given that fact, family physicians need to be able to identify concussion symptoms and best treat these patients to get them healthy again and back in the game.

[Football players in action on field]

That's why the AAFP has entered into a partnership with the National Football League (NFL) Foundation to pair the evidence-based medical knowledge of the Academy with the league's influence and longstanding mission to improve sports safety. The ultimate goal: Raise awareness of the serious nature of concussions, their potential long-term effects and the fact that they often can be successfully managed.

When it concludes, the initiative will have produced three free webinars for family physicians, as well as patient education materials. The AAFP has full control of the educational materials and retains final editorial authority over the materials.

The Academy will use the NFL's brand and logo on the patient education materials, which should help capture the attention of student athletes and their parents. After all, NFL games reached more than 200 million unique viewers last season alone.

"Concussions are serious injuries. As physicians improve their ability to recognize and treat concussions, patients and public health will be better served," said Jeff Miller, NFL senior vice president of health and safety policy, in a joint news release. "That is why the NFL is committed to both patient and physician education and is proud to partner with the AAFP to help bring this important information to its members across the country."

Story highlights
  • The AAFP has partnered with the National Football League Foundation to produce three free webinars on concussion management for family physicians, as well as patient education materials.
  • Two of the webinars have already taken place; the third is scheduled for Aug. 20 at 8 p.m. CDT and will cover long-term brain health in athletes, practice and play modifications, talking with parents about their youngsters' sport participation, and other topics.
  • Patient education materials based on these webinars will be mailed to all active AAFP members after the webinar series concludes and also will be posted on FamilyDoctor.org.

"These are important public health concerns," agreed AAFP President Robert Wergin, M.D., of Milford, Neb. "That's why this educational initiative is the right thing to do. It's the right thing for physicians and it's certainly the right thing for our patients."

Origins of the Partnership

In 2006, Zackery Lystedt, a 13-year-old football player for Tahoma Junior High School in Ravensdale, Wash., was concussed during a game but returned to play and finished out the event. As a result, he suffered a severe, life-threatening brain injury.

Stanley Herring, M.D., medical director of Sports, Spine and Orthopedic Health at the University of Washington School of Medicine in Seattle, told AAFP News this outcome could have been prevented if Lystedt had simply been taken out of the game when he first was injured.

The incident led a group in Washington that included Herring to advocate for enactment of a youth concussion law in the state that would require medical clearance for youth athletes suspected of having sustained a concussion before they could return to competition, practice or training. The bill was written, easily passed the state legislature and was signed into law in 2009.

The NFL, the American College of Sports Medicine and others -- including AAFP members -- then began campaigning across the country for other states to replicate the law, Herring said.

"Within four years, we were able to get concussion laws in all 50 states and the District of Columbia," he said. "Now, 22 states have already modified their laws to provide even greater protection for student athletes."

In addition to his medical school duties, Herring is a team physician for the NFL's Seattle Seahawks and serves on the league's Head, Neck and Spine Committee, chairing its education and advocacy subcommittee.

The partnership between the Academy and the NFL Foundation actually grew out of a committee discussion, he said. With concussion laws on the books and education for young athletes ramping up, what would be the next logical step?

The answer: Provide up-to-date concussion resources for the health care professionals who treat these injuries.

"The AAFP's members are most likely to see the great majority of concussions," Herring explained. "Family physicians have good training in a variety of injuries and illnesses. So we wanted to produce a series of webinars, giving AAFP members a current resource for concussion diagnosis and management in young athletes so they can provide the best care to these patients."

The partnership is just one piece of the NFL Foundation's ongoing larger effort to promote safety through education and research.

Rundown on the Webinars

The first of the three webinars produced, "Sports Concussions 101: The Current State of the Game," defines concussion and identifies the signs and symptoms physicians would expect to see during an initial evaluation. Herring presented the webinar on July 23, along with Matthew Silvis, M.D., associate professor in the departments of Family and Community Medicine and Orthopedics and Rehabilitation and medical director of primary care sports medicine at Penn States' Hershey Medical Center.

A key piece of information to remember, said Herring, is that professional athletes routinely take five to seven days to recover from a concussion; in a younger person, recovery often takes 10 to 14 days.

"You'd think that kids get better faster from every injury," he said. "But that is not the case with concussions. We are not exactly sure why, and different theories have been offered. Perhaps young people have not developed alternate cortical pathways for problem-solving and other cerebral activities that adults have available and that may come into play when one part of the brain is affected by a concussion."

Herring said it also is important to remember that young athletes are not just athletes -- they are student athletes. "In these patients, part of concussion management -- long before return to practice or play -- is the return to learn," he said. "They need to be doing schoolwork and homework and social activities at their baseline levels before considering reintroducing sports."

The second webinar, "Sports Concussions 102: If You've Seen One Concussion, You've Seen One Concussion," instructs viewers in how to best analyze the variability of the clinical presentation of a concussion, construct an individualized, evidence-based treatment plan and recognize when to seek consultation or referral for a concussed athlete.

The webinar was first presented on Aug. 6 by Jason Matuszak, M.D., director of the Sports Concussion Center in Buffalo, N.Y., and Yvette Rooks, M.D., assistant professor of family and community medicine at the University of Maryland School of Medicine and a team physician for the University of Maryland Terrapins.

Matuszak told AAFP News the webinar emphasizes the fact that no two concussions or concussed athletes are the same.

"We focused on certain signs and symptoms that can predict a longer recovery, such as number/severity of symptoms, certain symptoms like dizziness or concurrent injuries, especially cervical, vestibular or ocular," he said.

Because there is no singular presentation for concussions, Matuszak said, the definition has changed considerably over time.

"For example, we used to think there had to be a loss of consciousness for a concussion to occur," he said. "We now know that's not the case."

Rather, physicians should look for patterns that include the mechanism of injury, the symptoms manifested and some type of brain dysfunction (e.g., problems with cognition, balance, coordination, etc.).

"It's also interesting to note that while most people would say the hallmark symptom of concussion is a headache, nearly one in six people with a concussion never have a headache, and nearly 50 percent of all football players have a headache after any given practice," Matuszak said.

The third webinar, "Sports Concussions 103: Debates and Controversies,"(attendee.gotowebinar.com) is scheduled for Aug. 20 at 8 p.m. CDT and will cover long-term brain health in athletes; rule changes, practice and play modifications, and legislative efforts regarding sports concussions; limitations of protective equipment; and counseling parents about their youngsters' sports participation. It will be presented by Herring, Matuszak, Rooks and Silvis.

Patient Education

Patient education materials based on these webinars will be mailed to all active AAFP members after the webinar series concludes and also will be posted on FamilyDoctor.org.(familydoctor.org)

The materials are intended to help patients understand the definition of concussion and its signs and symptoms, know when to seek medical evaluation, understand concerns about long-term brain health in athletes and understand the limitations of protective equipment.

With national interest in the concussion issue currently elevated, said Herring, this is a great time for family physicians to update their knowledge on the topic through the AAFP's new resources.

"The best thing we can do is offer the right resources and tools (to family physicians) so they can make informed decisions with their patients about concussion management," he said. "I'm excited about this partnership."

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