By Thomas Barnet, Rehab Tech at Waccamaw Community Hospital
What is a concussion?
A concussion is a type of traumatic brain injury (TBI) that is usually caused by a sudden and/or forceful blow to the head or surrounding area. Concussions range in severity and are often described by their most blatant acute (short-term) symptom, unconsciousness. While athletes may be more prone to concussions, specifically those in contact sports, anybody can get one, including in “non-contact sports” such as baseball and soccer. Concussions are also often seen in vehicular accidents, explosions in combat (military), or simple falls.
Symptoms generally associated with concussions include:
- Loss of consciousness
- Lack of balance
- Blurred vision
- Delayed reaction time
- “Ringing” in the ears
- Confusion/Loss of memory surrounding impact
Athletes, coaches, and even doctors have long neglected further research into the chronic, long-term effects of concussions. As a result, many players have tragically collapsed and died in front of crowds or during practice because they were negligently cleared to play too soon.
This phenomenon is known as Second Impact Syndrome. Any person that suffers a concussion could potentially be at an increased risk of further complications for up to a month (estimated). Second Impact Syndrome results from a second blow to the head before enough time has passed for the brain to heal from the previous injury. A second blow to the head can cause massive brain swelling, accompanied by death. Just at it’s critical to assure that athletes can return to play after a concussion, the elderly suffering one concussion is at risk of a second because of a common lack of balance, blurred vision, or disorientation.
Sustaining a Concussion
If you believe a concussion may have occurred, a trip to the doctor or hospital is imperative, because medical professionals can assess the severity of injury and explain treatment options. General treatment options include rest and avoidance of many activities that could add stress to the brain. Work, school, exercise, and even watching TV or looking at a computer may cause excessive stress on the brain and should usually be avoided. Your doctor will also be able to clarify the proper use of medications and treatment after the injury.
Seems pretty simple, right? Even if athletes are persistent and eager to win, is winning worth a life? If sustaining a concussion from sports – do not return to play – not even practice. As a long time athlete, I have often battled with striking a balance my competitive nature and need to support my well-being. It’s also important to refrain from use of over-the-counter medications, drugs or alcohol immediately after the event.
[EDITOR: Dr. Russ Ritter at the University of Texas Health Science Center in San Antonio is known as the world’s expert in melatonin, a molecule produced by the pineal gland and often associated with helping to regulate the circadian rhythm (biological clock). He touts the powerful antioxidant properties of melatonin and strongly recommends it for any brain injury and especially before receiving oxygen.]
What have we learned about concussions?
In 2002, former Pittsburgh Steeler “Iron Mike” Webster died at age 50 after nearly twenty years in the National Football League. Ten years later in 2012, NFL legend Junior Seau uncharacteristically took his own life after a 20-year professional football career.
Okay, okay, so some may rationalize that these guys were an exception because of their intense and lengthy careers. However, there are many examples where this is not the case. We also know that Owen Thomas of the University of Pennsylvania took his own life at the young age of 21 after only a couple of years of experience in collegiate football. Even more frightening is the loss of Nathan Stiles, a 17-year-old football player at a Kansas high school who collapsed on the sideline and died hours later in the hospital. Here I show some statistically too-common occurrences that could have been prevented with simple education and awareness.
So, what do we know? What did these athletes have in common? Three letters: C T E – Chronic Traumatic Encephalopathy. CTE is a chronic progressive degenerative disease in the brain and spinal cord most often found in athletes or those susceptible to repetitive cranial impact. In Layman’s terms, CTE is a disease caused by multiple blows to the head; it gets worse over time and continuously decreases function of the brain. The repetitive brain impacts cause eventual abnormal deposits of tau protein found in the brain during immunostaining. CTE is believed to be present even in those who don’t get concussions but take excessive hits to the head, such as boxers. The most frustrating aspects of CTE are that A) It can only be tested for post-mortem (after death) and B) There is no cure.
Common symptoms of CTE are:
- Memory Loss
- Impaired judgment/impulse control
- Emotional instability (Depression/anger/etc.)
- Dementia (Mental decline)
Recent studies have also suggested a correlation between concussions and Parkinson’s disease though it hasn’t been officially proven. These particular studies yield results stating that post-concussive subjects happened to have similar symptoms to early Parkinson’s patients. Perhaps this is to blame for the mental decline (Parkinson’s) of boxing legend Muhammad Ali. Or, maybe these similarities are the reason CTE is no longer called dementia pugilistica (roughly translated into Boxer’s dementia).
Just take a second to really think about the symptoms correlated with CTE. ‘Sound familiar? It’s believed that CTE was commonly mistaken for Alzheimer’s disease and even ALS (Lou Gehrig’s disease), including Lou Gehrig’s diagnosis himself. Since CTE can only be diagnosed post-mortem it can commonly be misdiagnosed as these other common dementia-related diseases. The same diseases that can effect the brain’s motor function and behavior so much that even walking becomes a challenge. Nonetheless, it is a debilitating disease that needs to be researched and discussed so that others may be spared from its devastating effects.
By contributing towards prevention of CTE you may contribute to just that. Mind you that when a person experiences severe symptoms of CTE, they may no longer be cognitively (mentally) stable. This includes vast behavioral changes that can effect relationships and general perceptions for the patient. Ultimately, as the patient progresses through the stages of CTE, depression and confusion could potentially lead to an eventual suicide as seen in earlier cases such as Junior Seau and even Terry Long – who reportedly committed suicide through consumption of antifreeze.
The research is certainly still evolving on these life-changing topics. What we understand at this point is basically that, yes, repetitive concussions may eventually lead to CTE. Over time, research and development have exposed some witnesses who, more or less, explain that CTE is traumatic to both the subject and their family. CTE often changes a person’s mentality so drastically that it leads to family hardships such as divorce or abandonment. On the brighter side we now have the knowledge to make a difference.
Who and Why?
My main goal of asking Modern Health Talk to publish this article is simply to build awareness about the severity of concussions. This article is certainly not intended to alter sports or to cause fear about playing contact sports; nor do I believe that this topic is necessarily more important than other awareness subjects such as Alzheimer’s or breast cancer. However, it is made available to present simple preventive measures to avoid serious injury or degenerative illness for all, not just athletes. My goal is to help influence scientists, players, coaches, teammates, friends, and family to collectively understand the severity of concussions to help avoid any unnecessary serious or fatal injuries. Coming from the back-end of the “bell ringing” era, I understand the excitement and favoritism towards tenacious and aggressive play in contact sports. Proper coaching and technique can continue to enable that crowd-pleasing tenacity with a substantially lower chance of experiencing a concussion or any other potential injuries.
If concussions weren’t serious, then the National Football League, and other sporting leagues/unions, wouldn’t make amendments to game-play rules. For instance, in 2011 the NFL altered their rules to assure that no defenseless players (receivers particularly) could be contacted. Similarly, in rugby the tackler is not allowed to grab above the shoulders or make tackles without attempting to wrap up the ball-carrier. These simple rules have been created over a time to prevent serious injuries often affecting the head, neck, and spinal cord. Building awareness is a way to create collaboration for progressive thought and feedback to continue to safely enjoy our favorite sports.
How can you help?
Of course there are the basic everyday decisions, which should be implemented and unconsciously pounded into our heads (no pun intended). These include wearing a seat belt in vehicles, helmets on cycles, and using proper equipment during sporting events. For older adults, having access to hand rails and grab-bars is an easy and effective way to give extra stability to avoid dangerous falls when using stairs. Parents should, as expected, baby proof their living area to avoid any falls that could lead to head trauma. And family caregivers for their elderly parents should so similar.
As for preventing concussions in contact sports – it all starts with coaching. Coaching the fundamentals is an incredibly important asset to player safety. Coaching players how to appropriately engage in contact can protect them from injury both offensive and defensive. Just one or two practices can help players understand safe and effective contact methods while realistically building their confidence (knowing they are safe). Some basic rules to apply when planning to enhance head and brain safety are to:
- Keep your head upright so that you’re looking at your target and not the ground.
- Cheek to cheek – When making contact as a defender, you want the cheek of your face to hit the cheek of their hip. Note: Do not cross their body with your head as it increases potential for neck injuries.
- Do NOT lead with your head or make first contact with your head.
- Use hard points (i.e. Knees, hips, shoulders, and elbows)
There are certainly many other effective notes to take about safe contact but these are a few to help with concussion prevention. Recent studies about youth football players encouraged them to do neck-strengthening exercises as another way to help avoid these injuries. This simple task is supposed to help limit “transitional” forces from contact. The extra strength should help absorb the force from contact and prevent some of the sudden impact that could potentially lead to a concussion. As stated before, these exercises may help players feel more confident and comfortable with participating in contact sports. Another suggestion, for players who have recently experienced a concussion and are weary of continuance to play, is to “red shirt” them so that they are able to take part in practice but are highlighted as a no-contact participant. The most successful way to prevent concussions is to spread the word about them. Assure that players and any supervisors or spectators understand the severity. Relay this information and ensure all that missing one game might allow them to play many more in the future. Most of all – accidents happen! Even with caution concussions will continue to occur. Proper care following a concussion is imperative to prevent injury and to see another day.
Meet the Author
Now, who’s the person delivering this information? Sorry, I’m not a doctor. I’m a passionate health enthusiast with specific interest in the mental-health-spectrum. After a seven-year youth (under 18) football career, I embraced collegiate rugby. Between these two sports and some everyday hazards, I’ve suffered roughly thirteen concussions.
Two years ago I lost peripheral vision in my left eye after a routine blow to the head. After two ophthalmologists with zero answers, I was diagnosed with traumatic brain injury – not related to the anatomy of my eye. It was during this time that my curiosity piqued about the issue of concussions when my long-time idol, Junior Seau tragically took his own life.
In Fall 2013, at age twenty-two, I began to experience severe anxiety, confusion, and an inability to stay focused or fully coherent. The world that surrounded me would seemingly stop and blur. My face would go blank and the lights would go dim. These symptoms came in random bouts and certainly caused an unwanted stress and inconvenience on my days. Despite that I was the Captain and President of our Division II Collegiate Club, I decided to take leave from playing Rugby for several months. My bouts started to occur less often and I eventually managed a brief return before retiring and finished the Spring’s season during my last semester. I graduated with a B.S. degree in Exercise and Sport Science.
Since retiring from competitive sports I have become the Head Coach of my alma mater where I have experienced concussions from yet another point of view, as opposed to being the recipient or teammate. I have become deeply interested in this topic and would embrace the opportunity to study and be part of the research to find the answers that might bring about a greater awareness of this devastating illness. For now, I am employed as a Rehab Technician at a local hospital, which allows me to work with many patients, including those with TBIs. I often have rehab sessions with patients (formerly athletes) who’ve been diagnosed with dementia-related diseases and I can’t help but wonder.