Concussions and You

It seems like a new article comes out every day regarding the effects of concussions on professional athletes. Yesterday was no exception. But how do concussions affect everyday athletes? Do you have to hit your head to sustain a concussion? Doesn’t a helmet protect you from concussions?


What is a concussion and what does it look like?

In the general medical community, a concussion is known as a Mild Traumatic Brain Injury or MTBI. As the name implies, it is damage inflicted on the brain itself, not necessarily the surrounding tissues (skull, skin, etc).  The injury disrupts the cellular processes of the brain for days or weeks.

The most common signs and symptoms of a concussion include headache, nausea, dizziness, and light sensitivity. Another symptom is a cognitive “fog”. The person may be a little confused, disoriented, and/or have difficulty focusing their attention. In general, they may feel “off” or “weird”. Loss of consciousness is not required to sustain a concussion. Getting your “bell rung” is a concussion and should be managed as such.

How do you get a concussion?

As I mentioned before, the damage inflicted is on the brain itself, not necessarily the surrounding tissues. This usually occurs by the brain making impact with the inside of the skull. Typically this happens when the head is moving in one direction and then abruptly stops. The brain essentially keeps moving and “mushes” against the skull. It can also then rebound and mush against the opposite side.

The most common example is two athletes running into each other at high speed banging their heads together. A lesser known example is falling off of something (such as a rock wall while bouldering) and hitting the ground. Remember, you do not need to strike your head to sustain a concussion. You just need to stop abruptly.

What to do once you have a concussion

A concussion is a serious condition that needs to be managed properly. More dramatic concussions that involve loss of consciousness, amnesia, and/or vomiting are easy to identify and therefore usually receive better attention. Notice that I said “dramatic”, not “serious”. Studies have found that even concussions that result in convulsions are ultimately no more serious than those without – they are just scarier to watch. Simply having your “bell rung” has hidden issues that can cause permanent damage, even death, if not treated properly.

This gets into second-impact syndrome (SIS) which is usually fatal. SIS occurs when a person sustains a repeat concussion while they are still having symptoms from a previous, sometimes very minimal, concussion. This second impact need not happen immediately, just sometime while still having symptoms, which can last for weeks. It results in a rapid swelling of the brain and is seen more in athletes under the ago of 18. SIS is not very common, but just the possibility is terrifying. That said, even if the second blow does not result in SIS, it can amplify the effects of the original concussion causing more permanent injury to the healing brain.

As a rule, if you suspect even the slightest concussion, do not continue the activity. The best advice that I can give is to wait until ALL of the symptoms are gone plus an additional 7 days before returning (it has been shown that the brain may still be healing even after symptoms have ceased). Remember those symptoms? May be as simple as a headache or feeling “off”.

A word about helmets

Helmets are a great thing. They do a wonderful job preventing one of the most dangerous kinds of head injury: a skull fracture. This is often fatal, sometimes immediately. Sure, a skull fracture usually involves a concussion as well, but this is like pointing out that detonating an atomic bomb also results in a power outage. Remember how a concussion is caused? The head stopping abruptly. A helmet does very little to affect this. As a matter of fact, helmet use may actually result in more concussions.

This has become an issue in american football. Athletes strap on that helmet and suddenly become fearless. Since the effects of a concussion are slow to develop the symptoms are often disregarded by players. That is until they develop more serious problems later in life.

I cannot imagine anything more likely to cause an abrupt stopping of the head than one helmet slamming into another – the helmet-to-helmet hit. The argument that penalizing that kind of contact “softens” the game is one of the stupidest things that I have ever heard. The helmet is there for reducing the occurrence of skull fractures, not to be used as a weapon. For example, if you took away the helmets, only the dumbest of idiots would slam their head into another player’s head at full speed.

If helmet-to-helmet “softens” the game, then let’s take away that silly facemask rule as well – along with spearing, horse-collar tackles, etc.