The Peril of Second Impact Syndrome

When should student athletes return to the playing field after a concussion?

It’s a question that has concerned Dr. Mitchell Seemann of Panorama Orthopedics & Spine Center for several years.

Traditionally, Dr. Seemann says, coaches looked at symptoms like headache and disorientation to determine how severe a concussion might be and when a player was capable of returning. In many cases, players have been allowed back onto the field if they seemed relatively normal.

But when they return to sports after a concussion, young athletes are particularly vulnerable to what’s known as Second Impact Syndrome, when an individual has a second injury before the first one has healed. The second injury may seem relatively mild at first, and the athlete might just appear to be dazed. But in fact, the athlete’s brain can quickly swell, and the consequences can range from cognitive impairment to death.

Concussion is a common injury among high-school athletes, says Dr. Seeman, who serves as Medical Director of Jefferson County Athletic Trainers and the Team Physician for Regis University and Columbine High School. As many as one in five high school football players experience concussion.

“The thought is that there is still a chemical imbalance in the brain that might predispose you to recurrent injury,” Dr. Seemann says.

To more accurately evaluate concussions, Dr. Seemann started using the computer-based ImPACT test of neuropsychological function, developed at the University of Pittsburgh. The 20-minute test measures reaction time, attention, memory, pattern recognition, and word discrimination. Students took the test at the beginning of the season. If a student suffered a concussion during the season, he or she would be retested.

“The test is a very subtle way to pick up neuropsychological abnormalities that help us determine whether the kid can come back to playing,” Dr. Seemann says.

ImPACT testing has underscored the importance of tracking recovery after concussion. A couple of years ago, Dr. John Kirk, a neuropsychologist who assists Dr. Seemann in the concussion program, conducted a small study that looked at how long it took for symptoms to go away, compared with when a neuropsychological test returned to baseline.

“Symptoms such as headaches and dizziness got back to normal in 11 days, but the neuropsychological test did not get better until about 19 days,” Dr. Seemann says.
When a high-school athlete was injured in a Friday night football game, “we would determine on the sidelines whether he had a concussion and keep him out of the game.” The athlete would be seen and tested that weekend by trainers. Then he would see either his family physician or a neuropsychologist for retesting at regular intervals until he reached baseline levels.

Three sports medicine-trained family physicians worked with the program to evaluate athletes during recovery. They partnered with the team doctor, neuropsychologist, coaches, trainers, and parents to arrive at a decision on when they were fit to play again.
Dr. Seemann has been pro-active in educating players, parents and coaches about the dangers of concussions and how to manage them.

“Now coaches and parents are much more aware of concussions and listen to us when we say a player cannot go back in,” he says.

”Our status as orthopedic surgeons allows us to do a lot of good in the community,” Dr. Seamann says. “We give back to the community through volunteerism. I think it’s important for all doctors to do that, whether they go overseas or volunteer for Friday night football games.”

Panorama’s Sports Medicine Department is committed to that philosophy. The department’s eight subspecialty-trained orthopedic surgeons provide state-of-the-art clinical and surgical care for athletes of all ages and skill levels, from professional players to “weekend warriors.”

The Panorama Medical Campus in Golden includes Panorama’s orthopedic clinic, the Panorama Research and Education Foundation, and an outpatient surgery/convalescent center, imaging center, and physical therapy rehabilitation center. Panorama also has satellite offices in Thornton and Littleton.