The Truth about Concussions

Dec 12 / Build Muscle

America has always loved its sport heroes—the guys who can take a hard hit to the head, then get right back in the game again. We admire the players who can chalk it up to just a “bump” or a “ding.” The problem with this attitude is that researchers are discovering those seemingly innocent hits carry major consequences. Men’s Health talked to Linda Carroll and David Rosner, authors of musclemorphosis.com, available September 15, 2011, to find out what you should know about concussions—and the future of sports.

Men's Health: Why don’t you think people take concussions more seriously?

The problem is that concussions are what we call an “invisible” injury. By that, we mean that it has no outward signs and it can’t be seen on conventional brain scans. So, doctors—and patients themselves—need to go on symptoms, which can be subtle. If you’re a coach, for example, it’s hard to get as concerned about an injury you can’t see as one you can see, like a broken ankle.

MH: What exactly happens when you sustain a concussion?

Experts now say that a concussion is any jolt to the brain (and that doesn’t necessarily mean a hit to the head itself) that causes a change in mental status. The change can be subtle: a brief sensation of dizziness, confusion, or fogginess, for example. Those kinds of symptoms occur when the brain is jolted and the nerve cells are stretched and wrenched in response to a sudden acceleration or deceleration—like when you slam to a stop after colliding with another player. In response to that trauma, two things happen to the nerve cells. If the jolt is strong enough, the internal structures of the cells can be damaged and the cells can even die. But even lesser jolts can lead cells to dump all their chemical messengers in a kind of mini seizure. If the brain isn’t allowed to recover from these effects there can be a host of consequences—and even death if the athlete is young—if there is another jolt to the head.

MH: Why don’t some people recognize that they’ve suffered a concussion?

They don’t know all the concussion symptoms, many of which can be subtle. That’s why the most fundamental weapons to fight this silent epidemic of concussions are education and public awareness. All of us—from athletes and parents to coaches and healthcare practitioners—needs to learn about the dangers associated with head injuries and the importance of recognizing and managing any and all concussions.

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MH: Is it possible to suffer a concussion and not know it?

Yes. You might not realize that a headache or a brief spell of dizziness or fogginess or confusion could be a sign that you had a concussion. What really confuses the issue for many young—and sometimes older—athletes is the host of names people have given to hits to the head: dingers, bellringers, among others. That allows people to dismiss their symptoms as something other than a concussion. They’ll say, “Oh, I didn’t have a concussion—it was just a dinger.” Making matters even more complicated is the fact that many people still think you need to have a loss of consciousness to have a concussion. But we now know that only a small minority of concussions—probably fewer than 10 percent—involve loss of consciousness.

MH: How common are undiagnosed concussions?

That’s something no one really knows. In fact, no one knows how many traumatic brain injuries of any sort there are in the general population. The numbers quoted by the Centers for Disease Control and Prevention (CDC) come from a very old survey study—1990s vintage—of people who show up at hospitals for diagnosis and treatment of a head injury. So, even the official stats vastly underestimate the scope of this silent epidemic.

MH: If you sustain a concussion, is the damage irreversible?

That’s another question that we don’t have a complete answer for yet. There’s a suggestion that there are permanent changes to the brain from studies that show that people become increasingly susceptible to a second concussion after they’ve suffered one. Other studies have found long-term differences between people who’ve been concussed and those who have not. One of the more concerning studies found that while concussed students eventually got back to where they were before they were concussed, their non-concussed peers had passed them by. As one researcher said to us: “If you got back to where you were before the brain injury, you might think that is recovery. It’s not. I don’t know any person who says, ‘I’m going to stay right here, at this level.’ ”

MH: Why don’t athletes—either pro or high school—just take themselves out of the game when they get hit?

Athletes tend to be very competitive and also very loyal to their teammates. They want to win and don’t want to let their teammates down, so they’ll get back out there even if they’re injured. Although that’s true for other types of injuries as well, it’s easier for players to justify ignoring the injury if it’s one they can’t see and they’re not really worried about. Beyond this, many haven’t fully recognized the seriousness of this brain injury and how severely it can impact their lives.

There was also a study that looked at this issue. When asked why they didn’t report concussions to coaches or trainers, high school football players gave researchers enough reasons to fill a playbook: didn’t want to leave the game, didn’t want to let teammates down, didn’t want to appear weak or injury-prone to the coach, didn’t want to risk losing playing time or a starting position, didn’t realize it was a concussion, didn’t think it was serious enough to report. These reasons become exponentially magnified in the pro game, where what’s a stake isn’t just playing time or a starting position but also a job and a paycheck.

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MH: What’s the difference between an “official” concussion and an “unofficial” one?

Historically, some athletes have made this distinction to diminish the importance of so-called “unofficial” concussions. They’ll say that they have an “official” concussion if they’re knocked unconscious and have to be carried off the field. Jolts to the head that have less dramatic symptoms—headaches, fogginess, short-term memory problems, for example—are dismissed as “unofficial” concussions that athletes just play through. So, when you ask athletes how many concussions they’ve had, you’ll often get a far smaller number than what is the true incidence, since all the “dingers” and “bellringers” are being left out.

MH: Why can’t players just wear thicker helmets?

The way to fix the problem is not through better helmets. This isn’t a perfect analogy, but it will give you an idea of why that’s so: Think of the brain as a raw egg. The brain floats around in fluid inside the skull just like the yolk floats around inside its shell. If you hold the egg and shake it hard, you can damage the yolk without ever harming the shell. That’s similar to what happens to the brain when it’s jolted. No matter how well you protect the outside of the head, you’re not going to stop the brain from slamming around inside the skull when there are rapid accelerations and decelerations. The damage is caused by the stretching and wrenching of the nerve cells inside the brain.

MH: What do you think about the future of the NFL?

The NFL has been under pressure for the last couple of years, and it’s finally begun to take steps to deal with its growing concussion crisis by strengthening protocols and amending rules: for example, by sidelining obviously concussed players until they are cleared by independent neurologists, by cracking down on illegal head hits to “defenseless” players, by reducing practice exposure to head contact. We certainly hope the league can continue to find ways to make the game safer through a culture change that would presumably trickle down to all levels of play in all sports.

More from MuscleMorphosis.com: musclemorphosis.com

musclemorphosis.com The Concussion Crisis: Anatomy of a Silent Epidemic.