Concussions have received much attention lately, and for good reason. Whether you examine professional, collegiate, high school, or youth sports, the serious nature of concussions and their impact on athletes is equally important.
The information available about concussions is frequently confusing and at times just plain wrong. To make sense of this important and complex issue, we are going to explore concussions over a three part series. This week we look at some basic myths versus facts; in the second installment we will explore how concussions are assessed and their unique anatomy; and finally we will look at treatment and prevention options.
Myth 1: A primary symptom for the diagnosis of concussion is a loss of consciousness.
Fact: Loss of consciousness may be a part of the diagnosis, but it is not an essential aspect of the injury. Actually, a concussion presents as changes in the person’s or athlete’s normal brain function. These changes are often seen in the areas of memory, physical attributes (i.e. balance, headaches), mood, sleep, and personality. Observable differences in these areas indicate a change to the central nervous system (the brain and spinal cord communication and function).
Myth 2: A normal MRI or CT scan means that a person or player can be cleared to resume normal activities and training.
Fact: Concussions are injuries of a metabolic nature, meaning these injuries relate to the brain and spinal cord function rather than their structure. MRI and CT scans are excellent ways to look at the structure of the body, but they provide little insight into how the central nervous system is working in real time. How the body coordinates decision making, motor coordination, and normal metabolic functioning/pathways is a very precise process that must be examined through multiple methods. These test methods can include neuro-cognitive testing, an examination of balance, computerized brain function tests, and clinical examination.
Myth 3: Most, if not all, who suffer a concussion will recover within a week and athletes will return to play even faster due to their conditioning.
Fact: There is no exact timetable for how long to keep a player out and when to have them return-to-play. Each person/athlete should be evaluated on an individual basis and the information gathered should guide the recovery process and the decision to return-to-play. Ongoing research is providing more and more information about changes in the brain and treatment response, enabling timelines to become clearer; however, treatment should always be focused on the individual. Being an athlete does provide some greater resiliency throughout the body’s systems, but the idea that athletes are invulnerable is not accurate.
Myth 4: Once a headache is gone, you are OK and can return to play.
Fact: False. Since a concussion relates to the functioning of the brain, all the negative symptoms must be gone and all functioning must return to normal. To be “cleared” is not an eye-ball test. Not only must the player be symptom-free, they must also demonstrate their return to baseline performance by cognitive testing (testing memory, reactions, and decision making), balance testing, and computerized brain function tests.
Myth 5: A concussion is caused by a direct blow to the head.
Fact: False. A concussion is caused by a direct blow, but it can be anywhere on the body because some of the force is transmitted to the head. In the case of military personnel in battle, concussions can be transmitted through shock waves from explosions wherein no physical contact is even made. The key factor is force transmitted to the head, which can come in many ways and from many angles.
On a final note, concussions in sports are not new; we just have not been listening and watching closely enough. These issues were raised almost a hundred years ago. I won’t be the spoiler, but you can read a great piece by Malcolm Gladwell at:
Now that we have explored some common myths and facts, in the next installment of this three part series we will examine the anatomy of a concussion and the assessment process.
Here are some further resources regarding concussions:
CTE Found in Dead College Football Player
NFL Concussions – Dr. Ann McKee on C-SPAN Oct 2009
Outside the Lines: Traumatic Brain Injury
Outside the Lines: Second Impact Syndrome