Fall is here, and that means Texans all over the state are now following their favorite high school or college football team and hoping for the best. The enthusiasm for football in Texas is well known — but less well known are the many physicians off of the field who keep Texas athletes healthy enough to compete and win on the field. Without general team physicians, orthopedic specialists, and pediatricians, athletes would suffer — and of course, so would the sport.
Dr. Leslie Aiello, a pediatrician with the Pediatric Associates of Austin, is one of these physicians. In the past few years, he has become immersed in treating concussions in high school football athletes, an injury that has been hotly debated in relation to athletes who have suffered long-term damage because of football head injuries. Dr. Aiello is on the forefront of helping to prevent long-term damage.
Treating concussions with cognitive testing
“We’ve had a paradigm shift in this country with our understanding of the injury and the potential long-term consequences, and how we can make the game safer,” he says.
“Twenty percent of football players are going to have a concussion injury every year,” says Dr. Aiello. “Before we had cognitive testing, we did our evaluation, our follow-up, and return-to-play assessments of athletes based primarily on the history and the physical exam and specifically the neurological exam, and then fudged in a safety margin. With the cognitive test, we have a more sensitive tool to use to determine when it’s safe for athletes to go back to play.”
“When the kids get better and they’re [playing the game] safely, it’s fabulous. It’s the kind of thing where you can really make a difference in protecting kids, and that’s rewarding.”
Dr. Leslie Aiello, Pediatric Associates of Austin
Dr. Aiello uses ImPACT™, (Immediate Post-Concussion Assessment and Cognitive Testing), a cognitive tool developed at the University of Pittsburgh Medical Center. The 20-minute test assesses various aspects of the injured athlete’s cognitive functioning, including attention span, working memory, non-verbal problem solving, and reaction time. Since he started using the test a few years ago, he has become a sought-after specialist for high school football teams to help them assess and treat football players with head injuries.
The dangers of second-impact syndrome
One of the major concerns with concussions, Dr. Aiello says, is second-impact syndrome. With athletes under age 19 who still have developing brains, second-impact syndrome can be devastating. The syndrome occurs when an athlete suffers from a second concussion before he is fully recovered from the first concussion. “When that happens,” says Dr. Aiello, “you can have a cellular, metabolic meltdown in the brain and it can cause bleeding, pressure, and may even result in disability or death.” Cognitive testing — which gives a more accurate reading of the healing process — helps to prevent second-impact syndrome.
Dr. Aiello works with several high schools in the Austin area. “I really like teenagers, and I like athletes,” he says. “When the kids get better and they’re [playing the game] safely, it’s fabulous. It’s the kind of thing where you can really make a difference in protecting kids, and that’s rewarding.”
Dr. Aiello says he believes that even though there are risks, kids should still be allowed to play football because there have been many advances in helping to reduce the risk, including a better understanding of when it’s safe to return to play, better equipment, and a better understanding of when it’s time to retire an injured athlete from a particular sport.
Bigger, stronger, faster athletes
However, he says, there is room for more progress. “We have much more sophisticated helmets than we had 25 years ago. But the technology of protection is not necessarily keeping pace with the size, strength, and mass of the athletes. The athletes are stronger and faster. When you have collisions, you have enormous amounts of energy, which the body is not necessarily designed to withstand.”
Dr. Stephen Brotherton at the Fort Worth Bone and Joint Clinic, and a senior orthopedic consultant and associate team physician for Texas Christian University (TCU), agrees. “One big change in football,” he says, “is the players keep getting bigger and faster. So the types of injuries are evolving. They tend to be slightly increasing to more high-powered injuries as time passes.”
Dr. Brotherton, in addition to his private practice, has been working with the TCU team for 25 years. He shares the responsibility with his partner, Dr. Joseph Milne. “I cover all the home games and the close away games. On the farther trips, we’ll decide early in the summer who is going to what games. I’m right there on the sidelines with the team. It’s a lot of fun.”
“One big change in football is the players keep getting bigger and faster. So the types of injuries are evolving. They tend to be slightly increasing to more high-powered injuries as time passes.”
Dr. Stephen Brotherton, Fort Worth Bone and Joint Clinic
Dr. Brotherton typically treats two or three ankle injuries a week, sprained shoulders, AC joints, and neck sprains. “The injuries that probably draw the most attention are the knee injuries,” he says. “The most common thing that is going to drop a kid out and require surgery and have substantial amount of missed time is an ACL injury.” Those injuries typically take about five to six months before they can allow them to return to play. Dr. Brotherton says athletes heal at the same speed as everyone else. “The advantage is they have a team of athletic trainers they work with daily. So their physical therapy is maxed out. But the biological part of their healing is going to be the same as anyone else.”
Making “return-to-play” decisions
Even though football is a highly popular sport in Texas, Dr. Brotherton doesn’t feel that adds pressure to put players back into the game before they’re ready. “We’re doctors, and there’s high-performance pressure all the time. So that type of pressure is not a big deal. You have to know your craft, and you have to make your decisions on sound principles as much as possible — evidence-based medicine. If an athlete is ready to go, he’s ready to go. But if he’s not ready to go, he’s not ready to go.”
Recently, he said, he had to break the news to a 17-year-old high school senior that he wasn’t ready to get back into the game. “He badly, badly wanted to play,” he says. “I looked at him and said, ‘Well, your original doctor was correct — you can’t play.’ He was mad! He didn’t know if he wanted to shout or cry,” he says. “It’s hard for me. It’s tough to see a 17-year-old kid that upset. But the right decision is always the right decision.”
Reaping the rewards
He says it’s rewarding treating TCU athletes. “You see those guys relatively quickly, compared to other specialties, come back and then perform at a high level. You see a guy you’ve operated on, let’s say, or just treated, and he’s performing at a really high level, sometimes on TV, and on a national stage. It’s nice to see people who you’ve helped reach that point.”
Dr. Brotherton has treated many TCU football players who have gone on to play in the NFL. He’s still wearing his ring from the Horned Frog’s 2010 Rose Bowl win, but is not sure the team will be returning to Pasadena again this year. “We’ve already lost a game,” he says, “so I don’t think it’s looking as good.”