When it Comes to Concussions, Use Your Head
I’m sure most of us have heard in the news about the NFL and the seriousness of concussions and possible subsequent long-term effects. A highly-publicized study from the Journal of the American Medical Association found evidence of chronic traumatic encephalopathy (CTE) in 110 out of 111 studied brains of former NFL players. CTE can sometimes happen after repeated head trauma leads to the buildup of “tau” protein (which affects blood flow and ultimately destroys nerve cells). Often the symptoms can be delayed or hard to assess. Typical symptoms of head injury include (but are not limited to) headache, dizziness, vision difficulties, nausea, fogginess, feeling slowed down, change in temperament, poor concentration or memory and fatigue.
What is a Concussion?
A concussion is an injury to the brain where an acceleration or deceleration (not just head-to-head contact) can shear and damage neurons inside the brain that leads to a cascade of cellular events resulting in structural damage or metabolic disturbances (to both upper and lower motor neurons). It results in headaches, dizziness and cognitive difficulties. The CDC reveals that up to 3.8 million concussions occur each year; 5-10% of athletes will experience a concussion in any given sport season. Fewer than 10% of sports involve a loss of consciousness. Some studies suggest that females are twice as likely to sustain a concussion as males. Even a recent study surveying 300 players, 100 coaches, 100 parents, and 100 Certified Athletic Trainers shows that only 5% believe that there can be long-term effects.
How Serious are Concussions?
Concussions are called minor traumatic brain injuries (mTBI) but are hardly “minor” injuries. In the literature, they seem to predispose the patient to further concussions (almost seemingly priming the brain for further injury due to the metabolic damage) and seem to come in clusters if not treated properly. This can lead to devastating consequences such as depression, permanent memory loss and even dementia in higher rates than in the general population. As seen recently with Tom Brady, athletes are occasionally tempted to hide their symptoms while loved ones notice a difference in their presentation. Reasons for not reporting injury differ from athlete to athlete. Maybe they want to stay on the field or are just confused and can’t communicate. Maybe they want to be seen as the “tough guy.” Whatever the reason, it’s important that we identify possible injury and err on the side of caution.
By now, I hope everyone has heard how devastating the effects of a concussion can be if left untreated. Second impact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to SIS.
The American Academy of Neurology released a position statement that doctors (as well as other healthcare professionals) have an ethical obligation to educate and protect athletes from a concussion. In a meta-analysis of evidence – a literature review demonstrated some interesting trends: concussions were in greater proportion for females participating in soccer or basketball, and the highest incidence of concussions was in American football and Australian style rugby.
How to Mitigate the Risk of Concussions?
Going to a certified IMPACT health professional is important to get baseline testing before your season begins. And it is especially vital after sustaining a concussion to seek treatment from a physical therapist that is not only IMPACT certified but well versed in vestibular, vision, and manual therapy.
A physical therapist can add an invaluable component to the treatment of concussions because of the systems that are affected in a concussion: equilibrium, the vestibular system, the central nervous system, and the visual system.
Regardless of whether you visit a physical therapist or another healthcare professional after sustaining a concussion, always be sure to use your head and do not return to play before you’re ready!
Eric Deakins, PT, DPT, ITPT, c-VRT
Check out this video to see some of the devastating effects of oncussions.
Seven years after Zackery Lystedt suffered multiple concussions that resulted in severe brain trauma, the teenager recounts his goals, successes, and dream of going to Vegas: