Dr. Kevin Most: Backpacks and Concussions

Doctor Kevin Most

Doctor Kevin Most

Friend of the show, Dr. Kevin Most, joins the Steve Cochran crew to talk about kids and their backpacks and conclusions.

BACKPACKS

Kids are back in school and parents are happy. Throughout the year we try to touch on health related topics that we think you as a parent need to know. As these are the first few weeks of school lets touch on a few. The first is the backpack. We all have seen the small child walking from school, hunched over with a huge backpack riding on his back. He looks like he is ready to climb Everest when in fact he is just bringing home his books for homework. Have any of you weighed the back pack? We all should, in fact the recommendation is that a backpack should not weigh more than 10% of a child’s total weight.

Ok the average weight of a 10 yr old boy is 68lbs, so that child should not be carrying a back pack over 6.5 pounds. A study done in 2010 showed that the average weight of a 6th graders back pack was close to 18 pounds, three times what they should have been carrying. There have been studies where a back pack equivalent to 40% of a child’s weight has been noted. That would be like a 200 lb individual carrying an 80 lb back pack

Pediatricians see children with neck and back pain often and many can be traced back to the back pack weight. Do we know the long term effect of the backpack? Not yet but studies are being done, the difficult thing is we want to stop the child from carrying this weight not waiting 10 years to see the impact on the child’s back. Many studies have been done that show compression of the back with weight bearing of this magnitude.

The take home message is weigh your child’s back pack, do not let them carry one that weighs more than 10% of their total weight and strive to lower that. Also make sure the child wears the backpack with both straps this assures that the weight is distributed evenly and not causing a strain on one side. The padding for the back pack straps is also important as a wide well padded strap will help disperse the pressure placed on one area. Of the shoulder.

CONCUSSIONS

I am sure we will be discussing concussions a few times this fall football season. Lets take a minute and remind ourselves of what to look for and what to listen for. When a student athlete has a collision we should be looking for signs of concussion. The signs include the individual cannot remember what happened just before and just after the incident, They will appear dazed or stunned, often moving with clumsy motions. They may forget a simple instruction. Some may actually be knocked out, but loss of consciousness is not needed to have a concussion. They may complain of headache, dizziness and confusion. Some individuals will have light or noise sensitivity. The next few days or weeks the individual may have difficulty concentrating, difficulty sleeping and emotional lability.

The most important action we need to take when we even remotely suspect a concussion is remove the individual from the activity immediately, not at the end of the series, not at half time, immediately. Concussions are essentially bruises to the brain and studies have shown that a second concussion soon after the initial can be devastating. All High School coaches and officials have taken classes on how to identify a player with a concussion. They know to remove the player immediately. One difficult thing is that a concussion can occur away from the ball. In Football we all have a tendency to watch the ball but not the whole field, yet many concussions occur away from the ball as 2 players away from the ball collide. Coaches and parents need to be aware of every player on the field. Watching for that player who may look a little unsteady on their feet needs to be removed. Any player who is thought to have symptoms or signs of a concussion should not be placed back on the field. They are removed from play and practice until cleared by a physician. Prior to awareness of concussions, players were often placed back in the game after a short rest.

Each school is now required to have a Concussion Oversight team, the function of this team is develop return to play protocols. This is interesting that the state has not set the standards and asked these teams to enact them. Most of them are very similar. As a parent of a child playing sports you should request a copy of the protocol and review it with your physician. It is important to have these protocols in place, many students , some parents and some coaches want the player back on the field as they try to make playoffs or a student athlete is concerned about a possible scholarship.

Many studies have shown that the correct way to treat concussions is with rest and close follow up with a sports medicine physician, a neurologist in conjunction with the pediatrician or family physician. Hopefully each student athlete had a baseline testing before the season started. There are many baseline testing tools, essentially what they are is a tool that assess your memory, ability to pay attention, how quickly and accurately they can solve problems, measure of reaction times as well as their balance and coordination. The reason for the baseline testing is to use as a comparison on a patient we suspect sustained a concussion. This gives the caregivers some objective data with which to compare. There are many tools out there, some are available commercially others are home grown. The key is that the test is objective and can be used as a comparison tool. Another good thing about baseline testing is it gives the physician an opportunity to educate the athlete about concussions and the need to report all symptoms, it informs them of what to look for, tips for recovery and how to reduce the chance of another concussion.

Athletes that do sustain a concussion need to understand the restrictions that are put in place following the concussion and why. The damage that is sustained from a second concussion is substantial if the recover time has not been long enough. We will restrict physical activity until symptoms resolve. This will include gym class, practice and any organized sports. The athlete should also not drive a car for a minimum of 24 hours and further if any symptoms of dizziness are noted. The return to activity is monitored and outlined by the sports medicine physician as well as the primary care physician. Parents must also sign a consent showing they understand that the child has had a concussion and is returning to play.

Standards are easily set by the state for High School players, however we have to realize that there are many club teams for soccer and baseball. There are many junior teams for football as well. These areas do not have tight regulations surrounding the care of the individual who has a concussion.