Two for Tuesday: “Two-a-days” and Secondary Prevention/”Second Impact Syndrome”

Photo courtesy of Jay Davis and
Wikimedia Commons

August.  How did that happen?

It’s Tuesday, and it’s still July; but August 1 is a mere two days from now,  and in the United States that means football season is cranking up (the NFL opened their training camps last week, with injuries already mounting).  August has represented historically the time of year when football teams run their notorious “Two-a-days”:  workouts morning and afternoon, intended to prepare the youngsters for the battles of the season (and weed out the poorly conditioned or poorly motivated.)

Two-a-days and August have typically represented a pair that leads to increases in Exertional Heat Illness (EHI), which is definitely something I plan to talk about later in the month.  The epidemiology of EHI in High School athletes is something that has been explored recently by Dawn Comstock  and her group, a team of researchers I have profiled before in these blog pages. 

Today, however,  I wanted to focus on another injury whose incidence is expected to rise this month:  concussions.

This is a topic I plan to return to several times during the month of August, with blog posts planned to look at the 2012 Zurich Consensus Statement on Concussion in Sport as well as the CJSM’s planned collection of free concussion research (up and running soon) and interesting perspectives on concussion from University of North Carolina researcher Jason Mihalik.

But just now, I feel like being somewhat provocative, and I most definitely want to hear from the readership on their views of a controversial subject:  Second-Impact Syndrome.

One of the new wrinkles in concussion management we will face in Ohio this football season is a “Zachary Lystedt” type law which will affect how we return youth athletes to sport after they have suffered a concussion or any head injury suspected of being a concussion.  These laws are predicated on the idea of secondary prevention:  that holding a youth player out from sport until a concussion has resolved will lower the incidence of the complication of ‘secondary impact syndrome.’

The subject of ‘secondary impact syndrome’ is controversial, with some authors arguing against its existence.  There is consensus on one extremely rare catastrophic complication of single brain impacts:  namely diffuse cerebral swelling.   This occurs more frequently in children and adolescents, and is a dreaded (albeit rare) complication of youth collision sports. However, there is more debate over whether having a prodrome of a previous, unresolved concussion raises the risk of having this post-traumatic cerebral swelling.  Paul McCrory, in a CJSM article from 2001 that has been widely cited, argues strongly against the existence of a separate entity known as ‘secondary impact syndrome.’  He updated this position in 2012 with a more recent review of the literature, and came to this same conclusion.

So, I’ll put it to the readership in the form of a poll (in the spirit of this blog, it will come as two polls:  here on the blog, and the same one on the main CJSM web site).   Let us know what you think, and we’ll let you know what the results are…..and what we think about this, and more of the associated issues around the big medical concern of concussions.