Concussions: a big hit part 1

Concussions: a big hit part 1

Concussions, concussions, concussions. It is the “hot-button” sport topic of the decade. Whether it’s a high-profile lawsuit or parents discussing risk of concussion in sport for their children, there is rarely a conversation in sport that doesn’t involve concussions these days. With a 2015 report suggesting that there are anywhere between 1.6 to 3.8 million sport related concussions in the US every year and roughly 4.5 concussions occurring for every 10000 hours of sport at the college level it’s no wonder the alarm bell is sounding.1 But with all the hype comes a plethora of information that everyone has to somehow wrap their concussion-free head around. Because of the sheer volume of information I have broken the blog into 2 parts. Part 1 will discuss the science and symptoms behind concussions. Part 2 will be more related to recovery as it’s a huge issue these days.

A concussion is a brain injury NOT brain damage caused by an impulse of force applied anywhere on the body that is transmitted to the head.

First and foremost what is a concussion? Most people assume a concussion is some sort of brain damage caused by the brain “bouncing” off the inside of the skull. This is incorrect. A concussion is a brain injury NOT damage caused by an impulse of force applied anywhere on the body that is transmitted to the head.2 A popular theory within the scientific community is that axons within the brain are “stretched” during concussion leading to metabolic crisis.3 Let me take a minute here to combine and decode the last two sentences: Any hit to the body or sudden motion can cause the microscopic nerve fibers within the brain to “stretch” causing a dramatic change to the energy/fuel used by these nerve fibers in the brain. The most current research suggests that these changes are temporary in most cases.2 Perhaps the most important aspect of what causes concussions is that the scientific community has no firm answer to date. Most of the research done in this area is on severe brain injuries in the deceased (which the majority of sport related concussions are not) or animal studies. All we can say for certain is that rapid acceleration or force applied to the head or anywhere on the body can result in concussions signs and symptoms in anyone.

Since we don’t completely understand what actually happens at a basic science level during the sport related concussion, perhaps it is better to focus on the signs and symptoms of what we see when a concussion occurs. Watching what happens during a concussion can be quite scary especially if it involves the onlookers as parents, coaches (a.k.a. extension of parents), and/or teammates. Unconscious athletes laying on the field twitching uncontrollably for few seconds will leave lasting impressions on everyone. Experts suggest that these signs are a definite indication a concussion has occurred and that they are short-lived indicating a temporary disturbance to the brain. Not structural brain damage. This is important.2 This means with no structural changes nothing will show up on MRI or CT imaging. In other words when we can clearly see the signs of a concussion (loss of consciousness, loss of balance, blank stare off into space, and or “noodle legs”) it is much easier to diagnose. When these signs are not present we must rely on the athlete to provide us with honest symptoms. This is and always will be problematic for many reasons. An assessment with a trained professional (any healthcare provided trained in concussions is a good start for evaluation) in order to identify subtle signs and symptoms is highly recommended. Check out completeconcussions.com for a trained professional in our area.

In conclusion to part 1, it is important to realize that concussions are not going away from the public eye and media anytime soon. It is also important to realize that scientific research on concussions has dramatically improved with all the attention, however, it does not have all the answers and probably never will. Another key take away is to understand concussions can be hard to spot and need an honest approach. Seek the opinion of a healthcare professional trained in concussion evaluation and management for help or email me for more information at stevepiper@mysportchiro.com.

References

1. Zuckerman, S. L., Kerr, Z. Y., Yengo-Kahn, A., Wasserman, E., Covassin, T., & Solomon, G. S. (2015). Epidemiology of Sports-Related Concussion in NCAA Athletes From 2009-2010 to 2013-2014 Incidence, Recurrence, and Mechanisms. The American journal of sports medicine, 0363546515599634.

2. McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., … & Turner, M. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British journal of sports medicine, 47(5), 250-258.

3. Spain, A., Daumas, S., Lifshitz, J., Rhodes, J., Andrews, P. J., Horsburgh, K., & Fowler, J. H. (2010). Mild fluid percussion injury in mice produces evolving selective axonal pathology and cognitive deficits relevant to human brain injury. Journal of neurotrauma, 27(8), 1429-1438.