Concussions: It’s Only Your Brain

When thinking about the delicate and vital organ that the brain is, it is important to be protected, for which the skull, thick bone structure surrounding the brain, protects the brain from most harmful situations; however, despite the purpose of the skull, it can actually end up being injurious to the brain. Most would find it impossible for the skull to damage the brain because of the cerebrospinal fluid filling the cranial cavity, with the purpose of the fluid to absorb the normal amounts of shock the brain sustains from activities like turning the head and walking. Yet, when a person is moving at higher speeds, say running or driving in a car, and is suddenly stopped or falls, the brain can potentially hit into the skull because of the brain continued to move at speed until impact; this collision between the brain and the skull essentially bruises the brain, hindering its function. This impact and subsequent impairment is a mild traumatic brain injury (MTBI), or colloquially known as a concussion.
The Centers for Disease Control and Prevention (CDCP) defines a concussion or MTBI as:

“…a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head…caused by a blow or jolt to the head [disrupting] the function of the brain…[resulting] in a constellation of physical, cognitive, emotional and/or sleep-related symptoms and may or may not involve a loss of consciousness” [1].

Looking at the definition, the symptoms are very common in everyday life, and many patients do not present all of the symptoms; for this reason, many concussions go undetected and unreported. Concussions are most commonly seen in the context of an athletic injury, where no less than 300,000 concussions were reported to the CDCP in 1997; because of the pressures from coaches and the sheer ignorance of the potential harm the injury can cause, many concussions go unreported as a result of athletic injuries [2].

If an athlete does not report the injury, they risk additional injury because most of the effects frequently go unnoticed unless specifically tested for. Many doctors are beginning to use software to compare post-injury results to a baseline test taken prior to the injury; software measures reaction time, memory, and attention span, all of which are effected and could be more injurious to athletes if these areas are not at normal standards and the athlete reenters competition [3]. The software however does not account for the loss of memory usually surrounding the event, symptoms, and effect on the intellect; an athlete can have a loss of intellectual function, putting them sometimes grades behind, as was the case for Christin Anson, a high school soccer player interviewed by Time, who read at a third grade level as a freshman in high school after sustaining a head injury and continuing to play [4].

If an athlete were to reenter competition without full recovery and they do sustain another head injury, the risks are immense and far out-weigh the consequences of not playing; if an athlete were to get hit again, there is a potential to remain with the current symptoms (sensitivity to sound/light, ability to concentrate, and headaches) and at the standing levels of reaction time, memory, and intelligence, all while risking death [2]. As was the case for Will Benson, who sustained a concussion while playing football, began seizing after returning to play before he had recovered because of pressure to play, and entered a coma and died due to his brain bleeding [5].

It is because of cases like Christin and Will, that knowledge about concussions and risks of the injury has become to be more common to the general public. Education is important about this subject is important to parents, coaches and players to ensure that the fewer tragedies occur like Will’s to allow for players to treat this injury just as though it were a broken limb: rest is key [2]. This is not only rest from athletics, but also usually requires the athlete to lighten up on the current academic load; many are open to the academic rest, but are opposed to the athletic rest. The problem lies in that symptoms are easy to hide because it requires athletes to report them, which leads to many dishonest athletes, who feel that they are letting their team down by not participating; many high schools also lack the funding to get software for the computer tests, which puts more reliance on the self-report done by the athletes.

The athletic culture essentially teaches athletes to ignore the signals their body is sending them, such as pain and discomfort, to train and put them at the best chance for success; this trained thought process proves to be effective in most senses of training, but poses problems with injuries and especially ones with the permanency of concussions and. It is hard to explain the enduring effects of concussions to a group of people, who are very concerned about achieving their goals and are not necessarily conscious of life after athletics. For many of the athletes, especially those in high school, they are focused solely on getting scholarships to college, which depends a lot upon the performance in games or matches; for these athletes, this is their future, and they will do anything to reach that goal.

It seems improbable to be able to break the athletic philosophy of “mind over body”. No amount of awareness about any injury will break that, because in essence that is the sport: pushing oneself farther in pursuit of a goal. However, with the media beginning to highlight on the severity of concussions, as seen in articles published by Time and The New York Times within the past year, research and information is beginning to disseminate, doctors and researchers can hope that awareness and understanding the severity of the injury become more common knowledge and can help to break down the notion to sacrifice oneself for sport. While stories like Christin’s and Will’s are sadly not enough to change this culture, there are beginning to be ripples of change to ensure that concussions and injury treatment become more understood by coaches; Will’s Bill requires all high school coaches and official in Texas “involved in every sport to be trained in basic safety and emergency procedures” [5].

Legislation like Will’s Bill is not anything revolutionary, nor will it change the athletic culture, but it poses the potential to allow for coaches to see the bigger picture and allow for players like Christin and Will to take the time necessary to heal properly and recover. While giving the athlete the time necessary is not necessarily ideal for the success of the team, but it is only the athlete’s brain that is injured, and should warrant the same treatment as a leg: allow the swelling to go down and go through stages of rehabilitation because the consequences are detrimental.

[1] Centers for Disease Control and Prevention. Heads Up: Facts for Physicians About Mild Traumatic Brain Injury (MTBI). Atlanta, GA: U.S. Department of Health and Human Services, 2007. Publication Number CS109152. (PDF Downloaded April 6, 2008).

[2] Rosemarie Scolaro Moser, Grant L. Iverson, Ruben J. Echemendia, Mark R. Lovell, Philip Schatz, Frank M. Webbe, Ronald M. Ruff, and Jeffrey T. Barth. “ Neuropsychological evaluation in the diagnosis and management of sports-related concussion.” Clinical Neuropsychology. 22, (Fall 2007): 909-916.

[3] Impact Test. 2006. "Impact Background." http://www.impacttest.com/impactbackground.php (accessed Apr. 6, 2008), paragraph 11.

[4] Sean Gregory. “Head Games.” Time. 170, November 29, http://www.time.com/time/magazine/article/0,9171,1689210,00.html (April 6, 2008).

[5] Alan Schwarz. “Silence on Concussions Raises Risks of Injury.”, updated 15 September 2007, http://www.nytimes.com/2007/09/15/sports/football/15concussions.html?scp=2&sq=concussion&st=nyt (cited Apr. 6, 2008)