Nearly two months ago, I was on a return visit to the emergency room, to deal with a concussion I had sustained during a bike accident. A doctor studied my MRI results for a while and then he talked to me, as another doctor and a nurse had already done, about Sidney Crosby.
Everyone in Concussion Land talks about Sidney Crosby. I heard one brain-injury patient who had been in a car accident several years earlier say, “Thank God for Sidney Crosby. Before Sidney, people just stared at me blankly when I told them about my injury. Sidney put this thing on the map.”
Several people in the waiting room at the clinic nodded. One woman added quietly, “Do you find you’re more emotional now than before your concussion – that you cr …” And before she could finish saying “cry,” all four patients in the room burst into tears. Which I found hilarious, but I was crying too.
During my morning exercise bike ride, I checked out The Concussion Blog on my PDA (thankfully, there’s a mobile version of the blog, so I don’t have to scroll through all kinds of formatting stuff), and I came across a few interesting threads that might have some bearing on each other.
where the brain hits off the side of the inner skull like a piece of jello, here the medial temporal lobe is traumatized when the end of the jawbone pierces the temporal bone. The end of the jawbone rests on the skull base, cushioned by a dime sized piece of cartilage, once this cushioning element is displaced, it becomes dangerous. Its been documented in boxers with a “glass jaw”, when this cartilage disk slips out of place, it creates a bone on bone condition allowing hard bone to hammer the area of the medial temporal lobe where CTE manifest. This is diagnosable and documented in research with boxers and now NFL and NHL players.
Hmm. I had heard some discussion about how mouthguards supposedly guard against concussion. I’ve heard a number of people dismiss mouthguards, saying that they can’t protect against the brain banging againt the inside of the skull, and I myself have been skeptical. But seeing it explained — and taking a look at the location of the jaw in relation to the medial temporal lobe — I’m more convinced. Especially after reading that CTE manifests in that exact area.
This is getting my attention.
What’s also getting my attention is another post over at The Concussion Blog where fighting in the NFL is discussed. And after watching some hockey over the past week and seeing all the fights that are not stopped by the refs (and are egged on and celebrated by cheering fans), I wonder how much these fights — with more than a few hits to the jaw — contribute to the cumulative risk of concussion.
Let’s be clear about something — concussions/head injuries/TBIs all add up. Their effect is cumulative. And I can’t see how encouraging and allowing all the fistfights to escalate and play themselves out until someone goes down on the ice can help matters. Concussion awareness, I think, needs to reach beyond the “head hitting against the bony insides of the skull” and expand into the effects of the jaw hitting against the medial temporal lobe. And I’d also like to see/hear more consideration of not only the dangers of sports, when it comes to concussion, but the dangers of fights and getting clocked in the jaw, time after time.
I watched the March 5th ‘The Hotstove’ where Mike Milbury suggests hockey take a look at the level of violence, and how opposed the rest of the panelists were against it. Fighting seems to be endemic to hockey, but I heard once that hockey didn’t become a violent sport until it migrated south to areas where people couldn’t understand the game, and the league turned to fistfights to attract crowds. Apparently, the strategy worked. Now, can the NFL survive its own success? I wonder.
I think it would be quite interesting to do some data analysis on logged concussions and the frequency and types of fights that hockey players get into. I’d also like to see data on the coincidence of recorded fights and concussion in contact/collision sports athletes. It might shed some light on this, and also help us see other contributing factors, such as behavior choices in everyday life, which can jeopardize the safety and future of student athletes — not because of what injuries they cause, but because of the injuries that they may contribute to.
Courtesy of The University at Buffalo Concussion Clinic, this shows a novel approach to dealing with post-concussive symptoms. I wonder if, given how close Buffalo is to Canada, NHL players who have been sidelined by concussion might be able to make the trip to the clinic pretty easily. Just a thought.
Concussion – especially sports concussion, which is is focus – seems to be getting a lot of air time, lately. The NFL and NHL both have been the focus of some pretty public scrutiny, which is good. Also, soccer is getting attention, though not nearly as dramatic as football and hockey. I suspect part of it is the nature of the games. Plus, it’s been football and hockey season with some very high profile cases of concussion taking out excellent players. I think it’s seasonal as well.
What I wonder about especially, these days, is the impact that all this attention is having on student athletes and other athletes who sustain concussions. We see the truly sobering stories of CTE and dementia and behavior problems… broken marriages, criminality, homelessness, drug abuse, suicide… in football as well as professional wrestling. And we see the scientific evidence that although a brain may look normal on the outside, the inside can be riddled with proteins and damage that only show up through specialized testing.
And it makes me wonder what we’re going to do with this information. Are we going to all get spooked and flee the playing field, as though it were a dead-end trap? Are we going to forbid kids from playing the types of games they’ve played for generations? Are kids going to become so spooked themselves, that when they do hit their heads, they descend a dark spiral down into depression and thinking “Well, it’s all over now. I’m brain damaged and I’m going to end up like Mike Webster.”
It’s bad enough being denied your chance to play because of an injury you can’t see. But having the future be so uncertain, not knowing if you’re going to have post-concussive symptoms like so many athletes who never fully return to the game… that can make you crazy.
I often wonder if the intense focus on the dangers of concussion is 100% helpful. For me, the whole point of focusing on a problem, is to come up with a solution. But no solutions other than changes in rules, stronger enforcement, and benching injured players till they’re asymptomatic, have seemed to surface. Nobody — except the University At Buffalo’s Concussion Clinic — has apparently come up with an actual response to post-concussive symptoms. Yet despite their groundbreaking findings and ongoing work in this area, they’re getting hardly any press.
Everyone seems more focused on the problem, than coming up with a solution.
Why? I think perhaps it has to do with our innate desire to protect our kids, to prevent injury, and to avoid the kinds of dangers that are inherent in contact/collision sports. We want to shield the next generation from unnecessary hazards, and we want to make sure kids are kept safe. There’s no fault in that, certainly. But are we focusing on prevention at the expense of remediation and recovery? Are we so intent on keeping the inevitable at bay, that we are missing our opportunity to craft an intelligent and thoughtful response to the casualties which do occur?
I think perhaps we are. Of course, athletic trainers and coaches are going to focus on health care and prevention. Of course parents are going to look out for their kids’ best interests. In addition to these important activities, I really want to stress the importance of offering concussed athletes (indeed, anyone who’s experienced a traumatic brain injury) some hope and a view of a future that doesn’t center on impending dementia and self-destruction.
When you’re a kid, everything looks big, everything looks final. And it’s awfully easy to lack perspective that can only come from experience. I believe it is up to us, the adults in the room, to provide that perspective, and to stand up and say, “Look, you got hurt. Other people get hurt, too. It happens. And it doesn’t need to be the end of it all. Just because you have to sit out a month … or two … or three… does NOT mean it’s the end of your life or the end of your sporting career. You may need to find other activities to pursue and you may need to take up another sport that doesn’t involve smashing your head against hard surfaces many times each game, but so what? There’s more to life than piling on each other and bringing the hurt.”
I say this not just as an adult who has experienced a number of concussions throughout my life (nine that I can count — probably more). I say this also as a former student athlete who would have given anything to get back out on the field, had my coaches allowed me. I was fortunate to be kept on the sidelines when my performance was so obviously impacted that only an idiot would have let me continue to play. But if it had been left up to me, you know I’d have been out there in the thick of things, no contest.
I’m not sure how I would have taken it, had I been diagnosed with a concussion and told that my cognitive future was uncertain.
This uncertainty, I believe, really needs to be addressed. For everyone’s sake.
It’s a great retelling of a story about how he sustained multiple concussions and could never get answers from anyone… until he was so impacted, it was obvious to everyone that something wasn’t right. It’s also a very telling look into an often hidden world of athletes who know something is wrong, but are told time and time again by doctors and trainers and other expert folks, that they just have a psychological issue and if they just suck it up, they can get back in there and get back to regular play.
Around 19:10 in the video, LaFontaine talks about how he had to keep calling his doctor (the new one who actually had a clue what was going on) to reassure him that the source of his emotions and depression and headaches and not feeling right was physiological. He thought that the doctor was just being nice, because he felt like he was losing his mind.
How true it is.
When you’re going through the disruption of a TBI, you can genuinely feel like you’re going crazy. Things are strange, you don’t feel like yourself, your emotions may be off the charts or completely changed, and nothing seems to be clicking. And trying to get help can be next to impossible, if the doctors you see are not familiar with brain injury/concussion.
This is so important — I wish more doctors and trainers and coaches of student athletes would pay attention to this and keep up to date with the most current research and best practices, so they can not only help people understand what’s happened to them, but they can also take steps to prevent repeat injuries before healing is complete. Concussions among student athletes is much higher than most guess (and former studies showed), and second subsequent injuries before the brain has healed can be devastating. Second impact can complicate concussion symptoms, and if doctors and coaches and trainers are all pressuring the players to get back in the game and/or telling them that they’re really fine, they can get hurt again — and have even worse problems to deal with after the fact.
I was one of those student athletes who went back in the game after the concussions I sustained, but I’m different from many, in that my coaches and trainers had an eye out for me and kept me out of play (against my will). I was very luck. Lots of student athletes don’t have that same level of vigilance and care.
The one problem was that I’m also one of those folks who never got proper medical care until about three years ago. This was long after the period in which I could file for any sort of assistance or get accurate medical records documenting my injuries — so the chance of me getting any help from any organized sources is slim to none.
I’m on my own. And even though I have doctors who know about my TBI history, I’m still on my own when it comes to advocating for my own care and well-being. They mean well, I’m sure, but when they tell me that I don’t need to worry about how much sleep I’m getting, because I may not need at least 8 hours a night, it’s not particularly helpful. And when they look you over, plying you with questions about your mood in search of clues about psychologically based depression, completely ignoring the physiological aspects of mood and emotion, well, that’s even more depressing.
I can tell you from personal experience that dealing with post-concussion syndrome is a real bitch, when you have no idea what it is, you think you’re losing your mind, everyone around you is telling you to just “shake it off” — or they have no idea you have anything to shake off, and all they can do is give you a hard time about struggling the way you do. And then you go to the doctor, and they tell you to take a meditation class or relax more or go on vacation to get your mood back in order… this is not helpful, in the case of TBI.
According to the medical/mental health system, without proper medical documentation of my injuries, in the eyes of others, I’m probably mentally ill. All that emotional volatility, the perseveration, the rumination, the difficulties getting started and stopping what I’m doing, the extreme swings in energy levels… Even some of my friends who are psychotherapists have written me off as mentally ill and refusing treatment. These are the same people who have flatly discounted the effect of TBI in my life and claim that all I need is to deal with my difficult childhood to get on with my life.
They’re wrong on so many different levels. Especially about me refusing treatment — I’m not. I’m actually getting treatment at the level I need — on the neurological level, not on their preferred level. I know that I’m not mentally ill, and so does my neuropsych. And so does every other person who is intimately familiar with TBI and understands the nature of the issues I face on a daily basis. To say it’s maddening to watch the mental health field have a heyday with folks who have been neurologically impacted, would be an understatement. And hearing stories of doctors playing psychotherapist is equally irritating. But at the same time, I can’t let the shortcomings of our “modern” mental health industry impact my own peace of mind and my own mental health.
There’s no sense in that.
So, I seek out answers for myself. And I share what I find, in hopes that others like me may realize that someone out there actually gets it. They’re are not alone, and there is hope.
Where there is good information and good communication, there is a chance for change.
I’ve been giving a bit of thought to all the reports of concussions in the news, lately. Football players, ice hockey players, soccer players… not to mention all the reports of kids heading to the ER. Conflicting as those reports may be — some say more pre-teens are being treated, some say more high-school age teens are being treated — the picture is still pretty significant. And the concern is increasingly palpable.
The message, like in a recent blog post of the Chicago Times Union, frames the issue from a concerned parent’s point of view. This isn’t an isolated case, either. Soccer/hockey moms/dads are becoming increasingly vocal about concussion risks in youth sports, and plenty of times there’s an accompanying dismay at the apparent cluelessness of the coaches regarding the risks of unsafe return to play.
Here’s the thing, from where I’m sitting — as a multiple concussion survivor and a former student athlete myself: If we funnel all our energy into fear and avoidance and attempted prevention of injuries like concussions, aren’t we possibly missing a big lesson that sports can teach us, in the first place — namely, that it’s part of human experience to get hurt… and it’s vital that we learn to pick ourselves up, dust ourselves off, and head back into the fray, facing our fears and dealing with what is.
Getting bent out of shape over concussions is understandable, but does it need to derail the very important process of learning from screwing up that often comes from childhood and youth? Since when did we start believing that all the lessons we can learn should be framed in positive terms, with no harm or danger involved? I would argue that by avoiding and trying to prevent risks, we are depriving the next generation of really critical lessons they need to learn, in order to deal effectively in the world.
If they don’t learn how to handle injury and adversity now, when they are relatively safe within the fold of their parents’ house, how will they handle it when the shit really hits the fan?
It inevitably does, you know. No parent can prevent that, hard as they may try.
Now, I’m sure that there are plenty of parents who will take issue with this attitude. And coming from a multiple mild traumatic brain injury survivor, I realize that credibility is an issue. How can someone who’s gotten clunked on the head as often as I have be a trusted source for judgment about how to deal with sports concussions? I’ve talked about my judgment around risk being a bit impaired in the past, so why listen to me now?
Here’s the thing — it’s not that I’m advocating that we put our kids in harm’s way and not give a damn about their safety. Far from it. But at some point, the helicoptering starts to genuinely prevent the most valuable part about childhood and youth — the learning gained from trying and failing and trying again. That includes the learning gained from falling down, getting hurt, getting up and assessing the severity of your injury, letting yourself heal, and then getting back into the game when it is genuinely safe to do so.
Granted, with concussion, the threshold of safe return to play is often elusive and unpredictable. But the opportunity — indeed, the teachable moments — that healing from an injury provides, can be invaluable in later life.
Concussions happen. They happen a lot. And I suspect they’ve been happening since the beginning of time — we just haven’t always had emergency departments at the ready to accept the steady stream of kids whose parents have good enough insurance and the level of understanding and concern to get them there. I’m not sure there are more concussions happening today than before — we’re just more keenly aware of them. And this increased awareness means we’ve got a shining opportunity to learn all about the injury — as well as how to heal.
And learn we must. It’s not enough to wring our hands over all those mild traumatic brain injuries. It’s not enough to rush the kids to the ER and lecture the coach about their insensitivity and putting our kids in danger. It’s not enough to turn our heads away from danger and injury and/or do everything in our power to prevent it. We must learn to deal directly with this in a way that actually works, so that it doesn’t get the best of us. We need to learn to face up to the danger, the risk, the harm, the inevitable hurt, and master our skills in overcoming it.
After all, if concussions are endemic to the human experience and people have been experiencing them since the beginning of time (which I believe is accurate), and we’re all still here (more or less) and we haven’t all died off due to chronic traumatic encephalopathy and our societies haven’t completely disintegrated into a dust cloud of demented violence (or maybe we have?), isn’t that at least some evidence that concussions can and do heal — and that we can probably find a better, more effective way to heal than we’ve seen in the past 50 years or so?
Rest alone won’t always do it. Concussion and TBI experts tend to agree that resting (and doing nothing else) doesn’t always fix the problems that come from post-concussive syndrome. Exercise, on the other hand, has been shown to clear issues with people with remarkable success — as SUNY’s University at Buffalo Concussion Clinic has found. Even professional ice hockey players are turning to them for help, and it appears to be helping. After decades of partial solutions, we’re getting to a point where we’re learning new ways of dealing with the somewhat staggering numbers of head injuries, and we should use them.
Let’s use them. Let’s deal with the issues around concussion — both the prevention of needless injury, and the healing from the hurt. Short-term recovery should be actively evolved and pursued and talked about in every public forum, from youth/amateur sports to professional circles. And long-term recovery should be addressed as well. Nobody who’s sustained a concussion (or more) should have to live under the dark cloud of the depression, the mood disorders, the behavioral issues, and the cognitive problems… not to mention the public stigma that comes from being considered “brain damaged”.
Concussions happen. But they shouldn’t have the last word.
This past Sunday, the Boston Bruins’ Marc Savard was blindsided by Matt Cooke. Watch it here:
All the YouTube comments about “If you can’t take a hit, you’re a pussy” and “Canucks are friggin’ animals” notwithstanding, getting hit like this in hockey, as well as other sports, is often part and parcel of the game.
Consider also Mike Richards’ hit on David Booth:
I watched both of these videos last night (which is one of the reasons I didn’t get to sleep at the time I was planning), and I had to wonder — if Cooke and Booth actually knew what they were doing when they drove their shoulders into the unprotected heads of their opponents, would they have done it?
If they’d known that repeat concussions can lead to dementia and Alzheimers… memory loss… broken marriages… domestic violence… lasting loss of balance… and more — sometimes ending in unemployment, homelessness, and suicide… would they have done it? If they’d known that “destroying” someone like that isn’t like breaking their finger — it’s more like cutting it off and mangling the other fingers around it — would they have thought twice? And if their coaches and managers and team owners had the right information and any sense, would they have let them get away with it? Furthermore, would the refs have overlooked it?
I’m not sure people’s brains are working well enough to let them make smart choices, here. I’m not sure, given the culture of hockey, and the tough-guy mystique, there’s any chance for anything other than dumb choices, when it comes to these kinds of sports.
I’m not being down on contact/collision sports players. I was one, myself, once. And I loved it. If I could still do it, I probably would. But there’s a logistical issue here, that has to do with how we’re physically constructed, not how mentally and physically tough we are.
One of the problems I see with contact/collision sports is that traumatic brain injury (which is what a concussion is) can lead to reduced appreciation of risk, poor judgment, lousy planning, increased aggression, and a whole host of other cognitive/behavioral issues which can impair anyone. It’s not only pedestrians walking around in the everyday world after car accidents, assaults, falls, and brain viruses, who suffer the ill-effects. Professional athletes do, too.
And when you play a rough-and-tumble sport that involves repeated impacts, including grade 2 concussions, as just part of the game, the cumulative effects can be dramatic and quite serious.
Imagine the long-term effects on kids who are taught/allowed to brawl on the ice or on the field, season after season, year after year, from the time they’re old enough to handle a stick or a ball. We don’t know nearly enough about what concussion does to young brains, but it strikes me (so to speak) that engaging in repeated intense shaking of the brain, which severs fragile axons which are essential for clear thinking and responsible functioning, would ultimately produce the kinds of aggressive and downright stupid behaviors we see in the Cookes and Richardses of the sporting world. It’s not their character I’m questioning (though some might). It’s their neurology.
Add to that the fact that players are getting bigger and faster each decade, and the pressures of money and success, that we’re living in a culture of shoot-first-ask-questions-later and bigger-and-badder-is-better, and you’ve got a recipe for a whole lot more Booths and Savards being laid out on the ice — or on the grassy field/floorboards.
Ultimately, what these kinds of incidents tell me, is that the NHL is not doing its job in enforcing rules that keep play from degenerating to a series of full-on assaults over possession of a little round black puck. It’s also doing a piss-poor job of educating its players about the long-term effects of the concussions they dole out to each other. Either that, or it’s breeding numb (if not hateful and bloodthirsty) assailants who don’t give a crap about the long-term consequences of their chosen actions.
According to some definitions, that would qualify as sociopathic behavior.
One of the reasons I’m so pissed off about this is that Richards and Cooke are professionals. They should know better. They can do better. But they didn’t. And somehow, that’s okay. It’s just part of the game. Never mind skills. Never mind sportsmanship. That’s for pussies. It’s much quicker and easier to knock your opponent out with a blindside hit than have to actually play against them. Screw the game. All that matters is the win.
I have to wonder if folks who resort to violence instead of athletic skill are too impaired from their own repeat head traumas to fully grasp the seriousness of what they’re doing.
If that’s the case, then the NHL is really the ultimate culprit in producing what amounts to little more than (briefly) premeditated assault in the name of a “game”.
And the league can thank themselves — in refusing to penalize these kinds of hits — for promoting this kind of behavior in young players, who are too young to know better — and aren’t being taught any different.
Best wishes to Marc Savard and David Booth for full recoveries. Good luck, guys.