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AMA Update
Diagnosing and treating concussions in contact sports with Brian Sutterer, MD
Feb 14, 2023
Featured topic and speakers
Brian Sutterer, MD, a sports medicine expert at Southeast Health in Missouri, and host of the popular YouTube channel @BrianSuttererMD, talks in-depth about injuries in contact sports. From head trauma like concussions and CTE—to cardiac events like Buffalo Bills Safety Damar Hamlin's collapse. Also covering how parents and physicians can improve athlete safety in every level of sport. American Medical Association CXO Todd Unger hosts.
Speaker
- Brian Sutterer, MD, sports medicine expert, Southeast Health
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about sports injuries and what physicians and patients need to know. I'm joined today by Dr. Brian Sutterer, an expert in sports medicine who's at Southeast Health in Cape Girardeau, Missouri. He's also the host of the popular YouTube channel Brian Sutterer, MD. I hope that's all right that I said it like that. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Sutterer, thanks so much for joining us.
Dr. Sutterer: It's a real pleasure. Thank you very much for having me on to talk about some sports injury topics and hopefully help educate your viewers here.
Unger: Excellent You have quite the following on YouTube, where you review sports injuries soon after they happen, and you break them down for laypeople. It's kind of an interesting thing. What inspired you to get into this, and what kind of gap is this filling out there?
Dr. Sutterer: Well, I love teaching. When I was younger, I was always tutoring high school students, middle school students, and so I've always had a passion to teach and just reach other people and also just kind of a desire to create something in this creative outlet. And so there seemed to be a gap four or five years ago when I started this where you would hear about sports medicine topics on ESPN and it was not really clear. People maybe didn't really understand what was going on.
And so I thought it was a nice opportunity to try and sort of take advantage of what people were interested in with popular sports while also teaching them some very basic anatomy and medical concepts along the way. And to my surprise, initially, people really enjoy learning about things and I'm able to use more relevant interesting examples, like what they see with their favorite athletes, to start that whole conversation and use that as a launching point for the teaching.
Unger: Tell us a little bit about what you've learned by doing these videos and how it's helped your practice.
Dr. Sutterer: I've learned that people just genuinely are curious to know more information about what's going on and particularly with their own diagnoses in their own body whenever I see them in clinic. And I've also learned that you can never make something too simple. I think as health care providers, we have this tendency to talk in medical speak to our colleagues, and we've learned all these really complicated concepts with really big words. But you can never make something too simple for your patients.
And so whenever I'm making my videos, I pretend I'm talking to somebody who is even in middle school, potentially, and trying to keep things as basic and simple as possible. Because I think once patients and athletes understand what their injury is or their diagnosis, they have more buy-in to the treatment plan, and so it's been a lot better for that patient-doctor relationship when I can really make sure they understand what's going on.
Unger: I'm just curious what the hardest part of that is. Obviously, your lessons that you're talking about here apply to a broader set of issues around medicine. When you think about that kind of translator work that you've got to go into, what's been the biggest challenge for you?
Dr. Sutterer: It's honestly harder to then go talk to other physicians because I'm so used to sort of trying to simplify things down that I always have to almost consciously remind myself when I'm talking to a surgeon or a radiologist to sort of switch back into the more technical doctor speaks that they don't think I'm just like some idiot that doesn't really know what I'm talking about.
Unger: Like, and you hurt the thing. I'm just kidding.
Dr. Sutterer: Right, right.
Unger: Exactly.
Dr. Sutterer: The bone, you know?
Unger: Obviously, sports injuries have been a big topic of conversation. Obviously, gap-year filling there. But recently, a lot of attention on Damar Hamlin and that injury. Thankfully, he pulled through, and he's now doing well. I don't know if you saw that when it happened. What did you think?
Dr. Sutterer: I was watching when it happened, and I was honestly really terrified for what the ultimate outcome could be. Whenever we see an athlete collapse, particularly in a contact sport like football, we often see a head injury or we see a neck injury or something that makes us equally concerned, but not as afraid for something like a cardiac arrest. But in his case, we saw there was no clear mechanism that made us think about a concussion or a spine injury. We basically just saw an athlete collapse.
And any time we're dealing with a collapsed athlete, it's one of the most concerning situations we can come across, because we immediately have to go to those life-threatening types of things, like cardiac arrest, which was, unfortunately, what Hamlin suffered and, thankfully, has recovered from. And so I was initially horrified for what was going on, but then seeing the response and just the urgency and how high-quality care the medical team was able to get out there and administer to him made me feel a little bit more reassured, of course, about what ultimately would happen.
Unger: Do you think that this particular incident reveals something about safety protocols that are in place for professional football, or is it kind of a one-off here? Is this a success story or is it really calling attention to a bigger issue?
Dr. Sutterer: I think it's definitely a success story. Everything happened exactly by the book and what you would hope to happen in terms of immediate initiation of CPR, followed by AED defibrillation as quickly as possible, and then transfer to a hospital. And so if you just simply go by the book with the emergency action plans that those teams have in place, this was absolutely a success story and should really highlight the excellent care and work that both of those medical staffs put in week after week to really get these protocols down pat.
What it more so then highlights on the concerning is just the discrepancy that we see between what's available to athletes at the highest level in the professional sports compared to, unfortunately, what we still see with lack of resources and athletic training services in our community high schools around the country, and it's just as important to have that AED, to have that medical team at the local middle school or at the local high school on a Saturday afternoon as it is to have it at the NFL level.
And so it highlights what we can achieve if the proper resources are in place with lifesaving measures, but also reminds us that we still, unfortunately, have a lot of work to do with bringing more access to that health care on the more local community level.
Unger: Well, let's talk a little bit more about it, because on one hand, you have kind of an injury you don't see all the time, and you've got tons of resources and training that had a very positive outcome here. On the other side, you bring up the reality the situation for more normal events, and maybe you're seeing a lot more of it about head injuries, for instance. When you think specifically about that, are you seeing kind of an increase in that, and what is the treatment protocols that you're seeing in place for it now?
Dr. Sutterer: That's a great question. And when we look at the data from the NFL, we're actually seeing a decrease in concussions, and I think a lot of that is attributed to a lot of rule changes that have been put in place over the years to limit the number of times that players get into higher-risk situations such as kickoff returns, where some rules have been changed. There's been some initiative with heads-up tackling programs where players at a younger age are being taught to tackle with more proper form, where they're not lowering their head and potentially having a higher risk of a concussion.
On this more community level, like patients we're seeing every day, I think we are seeing more proper awareness brought to head injuries and concussions. It's no longer the time where we would just say, well, you got your bell rung. Get back out there and go play. I think we really are starting to see more awareness about the severity of head injuries, how they should be treated very appropriately and very seriously. And I think some of that is attributed to what we've seen at the NFL, at the college level, with just more discussion.
There's less fear to talk about concussions as there might have been 10, 15 years ago when the NFL was putting out greatest hits compilations. We're starting to see those changes at the pro level, and fans watch, kids watch. And I think we're finally starting to see at least more awareness on the local community level. I think we still have a ways to go in terms of just optimizing that, making that access to care better for high schools and community areas, but I think we are making some good progress for management and recognition of concussions.
Unger: So I'm wondering if today in football, they still put the little guy, me, and the really big guy head-to-head just for kicks, watch what happens.
Dr. Sutterer: Yeah. Unfortunately, you still see those clips pop up on Twitter where it's a little peewee scrimmage, and they're putting two people together. And it's clearly not safe and clearly dangerous. And that's one of the unfortunate things with all the social media access. We're seeing more examples like that pop up, but then what you see afterwards in the comments are, this is not safe. This is dangerous. What are these coaches doing?
And so, despite some of it's still going on, I think people are more aware and recognizing the risks and that we should be making better changes to make drills safer, to have better awareness about head injuries and concussions.
Unger: And let's talk a little bit more about that, too, because on one hand, you've got the awareness of these issues trickling down as people become more familiar with them, let's say, at the pro-league level. It's pretty important, too, because there are not just the short-term effects of what these are, but there are long-term effects of these injuries as well. Can you explain a little bit about the longer-term implications of, say, something like CTE around head injury.
Dr. Sutterer: One of the best quotes I heard from someone talking about the long-term risks of concussions is that each time we have a head injury, we're taking a deposit out of our account in the bank, and the problem is nobody knows how much money is there in the bank. I wish I could recall who I read that quote from. But I think it describes the challenge with concussions perfectly.
Because how it affects one individual or one athlete is completely different from how it might affect somebody else, and we don't really have a clear sense yet of, for example, how many concussions is the threshold before you're at risk of something, potentially, like CTE. We know that, obviously, more concussions is worse than fewer concussions, but in terms of how it's going to individually affect each athlete, we don't really have a great way to predict that yet. And it's similar with CTE. We've clearly found that there are some associations with repetitive head trauma, but we don't quite know the frequency, the dose, so to speak. And also, having difficulty with actually diagnosing it and somebody who's living is still a major issue.
And so it's encouraging to see that we're continuing to make strides with the research. There's better criteria from a research perspective with how to potentially diagnose something like chronic traumatic encephalopathy, but we still have a long way to go, I think, before we can really tell patients, this is your exact risk. I think, at least, people are, again, aware of CTE.
And so when I have young athletes in my clinic, parents are now asking me, what do we know? What are the risks? And what we're able to know now is that, certainly, the more head injuries that somebody sustains, that seems to be a higher risk and the longer your recovery is from those head injuries seems to potentially play a role. But we absolutely still have a very long way to go before we completely understand how many concussions, how bad a concussion is, who is exactly at risk and who is not at risk.
And so I just try to be sensible with my athletes in terms of, look, if you're clearly having repetitive concussions, we need to have a conversation about long-term safety. And just treating everybody individually I think is the biggest thing rather than lumping everybody into one treatment protocol, one return to play protocol, having that awareness to just know it's a very individualized approach, and everybody is going to respond differently, where one concussion might knock somebody out for the rest of the year, whereas two concussions might not affect somebody else in the same way.
Unger: So given all of those different variables and the individual nature of it, which you're talking about, how do you advise physicians and pediatricians to talk to parents and patients about the dangers of head trauma?
Dr. Sutterer: I think being very realistic upfront about the potential dangers with things like CTE down the road, and I think just having that education and not brushing it off as, well, you've got your bell rung. You'll be fine. Go back in.
I think up front, it's very common for any contact-sport athlete to suffer a concussion at some point in their career. And so I try to not typically scare patients too much when they're early on or maybe have just had their first or second concussion. It's really when we start to see those repetitive concussions that I start to have more of those in-depth conversations. Because we also don't want to put unnecessary fear into everybody that one concussion is going to lead to these bad things down the road.
And so I would encourage pediatricians, people who maybe aren't as sports-trained, to, again, take that individualized approach with patients. Know that just because we see a professional athlete return to their sport in five days after concussion doesn't mean that that's the standard that a high school or a middle school athlete has to live up to. Treat them all individually, progress them at the rate that they can safely progress, and then once we start to see a second concussion, a third concussion, potentially, I think it's important to have some of those conversations about looking at the risk of the sport that you're playing and just be educating parents, educating athletes about what some of those risks down the road might be and then help to make a shared decision about the rest of their sports career.
Unger: Do you run into any common conceptions or sometimes misconceptions about concussions that you hear from people who watch your videos? Or patients?
Dr. Sutterer: Yeah, there's definitely still some misconceptions out there, and I think the biggest one is that when somebody has a concussion, they need to lock themselves in a dark room and not do any activity and exercise for four or five days. And what we're starting to actually learn more is that some gradual exercise is helpful for concussion recovery, and so there's a little bit more of a push after an initial time period of relative rest to actually get athletes moving more and just pay a close attention to their symptoms and watch to see how bad their symptoms might progress.
But we're understanding more and more that the quicker you can sort of get somebody back to school, importantly, the quicker you can start to introduce some gentle activity, that tends to help with recovery of concussions. And so one of the first things on a Friday night, if I'm talking to parents, somebody who had a concussion, is I'll tell them, initially, we're going to do a little bit of rest. We need to let that brain calm down, but then we're actually going to start to reintroduce some activity.
We want to get you back into school as quickly as possible. And so trying to reintroduce them to life in a gradual manner seems to help more than just keeping them locked away in a dark room until they emerge and go back onto the field.
Unger: Is there anything you advise in terms of, let's say, certain kinds of injuries or symptoms? You're like, get to the emergency room right now. That is a very bad sign.
Dr. Sutterer: Yeah, any time somebody has nausea or vomiting after head injury, that's a very concerning sign, and recommendation is to go to the emergency department because that can suggest something more like a bleed inside the brain. Any time somebody's symptoms are just progressively getting worse and worse. So worsening severe concussion. Certainly if we notice signs that might look like a stroke with any sort of facial asymmetry or altered slurred speech or weakness in an arm or a leg. Those are concerning signs where I tell somebody to go to the emergency department.
But otherwise, it's a lot of close, frequent monitoring and kind of comes back to that access to athletic trainers that we talked about earlier, where we really need to have more athletic trainers that can kind of keep a close eye on these athletes during those first couple of days to make sure they're not going downhill and to make sure they're helping to improve and go in the right direction.
Unger: Well, Dr. Sutterer, last question for all those medical students that are out there and watching this and might have an interest into going into sports medicine, what advice do you have for them?
Dr. Sutterer: Realize that it's a team sport. Obviously, we're taking care of team athletes, but the actual field of sports medicine is full of multiple different providers who all play really important role. And so a lot of people think that if you want to be in sports medicine, you have to be a head team physician, but in reality, we have athletic trainers. We have physical therapists, nutritionists, strength and conditioning coaches, nurses. And so, there are a lot of different avenues and pathways that you can go to still be in the sports medicine community that might not require somebody to go on and be a physician if that's not what somebody is passionate about.
So explore some of those different areas within your local high school team, local college team, and see exactly where you fit into that team environment. Because there's a lot of different people that are involved with getting our athletes back out on the field, and none of us are any more important than the others.
Unger: Dr. Sutterer, Thank. You so much for being here today. Really, really interesting discussion, and I'm sure a lot of folks out there will find your advice really valuable, like they do on your YouTube channel. That's it for today's AMA Update. We'll be back soon with another episode. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Dr. Sutterer: Thank you very much.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
