Mounting evidence suggests that concussions in football are caused by the sudden rotation of the skull. David Camarillo’s lab at Stanford has evidence that suggests current football helmet tests don’t account for these movements.
By Bjorn Carey
When modern football helmets were introduced, they all but eliminated traumatic skull fractures caused by blunt force impacts. Mounting evidence, however, suggests that concussions are caused by a different type of head motion, namely brain and skull rotation.
Now, a group of Stanford engineers has produced a collection of results that suggest that current helmet-testing equipment and techniques are not optimized for evaluating these additional injury-causing elements.
The ideal way to test any protective gear is to gain a sense of what causes the trauma, set up a system that replicates the way the trauma occurs, and then evaluate the gear against the injury-causing criteria. For the past several years, David Camarillo, an assistant professor of bioengineering and, by courtesy, of mechanical engineering at Stanford, and his students have been collecting and analyzing data in hopes of identifying the signature skull motions that cause concussions.
Because the very part of them that is able to determine whether or not they are OK is the part that’s hurt. Impaired. Injured.
Giving in to a student athlete begging to get back on the field, and letting them play the rest of the game, is like letting them get on a school bus driven by someone who reeks of alcohol.
What people don’t understand about the effects of concussion, is that immediately after you get concussed, you can feel infused with this amazing energy and focus. Your brain has gotten injured, and it’s releasing a somewhat toxic combination of chemicals that don’t belong there… plus, it’s getting bathed in glucose. And we all know what happens when our brains get too much glucose — it’s the reason some parents restrict sugar intake with young kids.
When you’re concussed, you’re the last person who believes that there’s anything wrong with you. You feel invincible, like you can take on the world. And if you have attentional difficulties (as so many kids do — especially those with a history of getting clunked in the head), the sudden influx of adrenaline and other biochemicals in your system can make you feel focused like never before. Your brain is literally under attack by its own chemistry, and your body responds with a fight-flight stress response that blocks out all distractions and puts you into high gear.
Back in the day, when people lived under much more hazardous conditions, that fight-flight response after getting clunked in the head could make the difference between getting out of harm’s way before the second impact/slash/explosion could happen… and getting creamed by yet another boulder sliding down the hill towards your hut, or getting chopped in half by that invader, or getting blown to smithereens by another bomb. So, our systems automatically try to save us by kicking into high gear.
But on the playing field, that impulse can be sorely misdirected — and send kids back into the danger zone, only to get hit again.
I know. I was one of those kids, back in high school. I got tackled once in football, and I could barely walk a straight line. But I insisted on going back in. And when I got hit again, it was really game-over for me. I’m lucky I didn’t get hurt worse.
Anyway, this is something to keep in mind, when you see a kid who’s been concussed, who’s campaigning to get back on the field right away. They may sit out for 10-20 minutes, then appear to be okay, but the biochemical havoc is still happening in their brain. It’s going to take a while for the brain to A) clear out the chemicals that shouldn’t be there, and B) rebuild the pathways that got frayed and broken apart in the impact.
That takes a lot of time. And until then, a concussed kid is not the one to believe about whether they are okay to play.
So, the next time you see someone who’s sustained a head impact and doesn’t seem quite right immediately afterwards, pay no attention, when then assure you that they’re okay to play. The equivalent is that drunk school bus driver taking another swig from the bottle in the paper bag, belching, and saying, “Yaaaah, Imokhaaaytodrrrriiiiiive.“
See also – New for 2012: The wars we wage – of sport, concussion, and our warrior style – Part I – Part II
I’ve been thinking a lot about this statement as it’s used in contact/collision sports, especially after reading this post over at The Concussion Blog. Something about hearing high school athletes saying, “Pain is weakness leaving the body” has always gone against my grain, so I’m doing some digging in search of what’s behind that for me. What I’m discovering is a vein of frustration that runs deep.
I seem to remember having heard this statement used in a military context, so I Googled the quote and found this over at Urban Dictionary:
“Pain is weakness leaving the body”
The above is a piece of propaganda used by the US Marine Recruiting office to get more people to join the marines. Its also figuratively true, and very effective in their commercials.
Pain is weakness leaving the body
If you punch a tree over and over again every day for a few years your hand won’t be broken (unless you punched TOO hard). Instead, it will be toughed, and calloused, and you will be able to take far more pain.
When a problem in life is emotionally painful you are emotionally scarred. But if you learn from it, the emotional scars will scab over and you will be a strong, more experienced and mature person because of it. When this occurs, as long as your emotional pain does not destroy you, it will eventually make you strong if you allow it too.
If you run 15 miles daily for a year, your body will be in a lot of pain, especially the first month or two. By the end of the year, your muscles would be so broken down and rebuilt you would be very strong, provided you had enough nutrients, water, and rest during the year. If you tried to do the same with 50 miles a day, you would end up dead.
Pain truly is weakness leaving the body, provided that the pain inflicted is small enough that you can handle it and grow from it, emotionally or physically.
The complete statement and the information behind it is important. For a number of reasons.
First, the statement is classic propaganda — a partial truth used in a way that triggers emotions that motivate you to take action that is not necessarily something you would do if you thought about things logically. It uses emotion and a promise of fulfilling a wish (to become tougher, less susceptible to pain) to induce someone to sign up for duty which may in fact result in their death.
Second, the grandly succinct statement is followed by an explanation that tempers and explains the statement, but which is left out and forgotten in the repetition of the simple statement “Pain is weakness leaving the body.”
your hand won’t be broken (unless you punched TOO hard)
as long as your emotional pain does not destroy you
provided you had enough nutrients, water, and rest during the year.
If you tried to do the same with 50 miles a day, you would end up dead.
provided that the pain inflicted is small enough that you can handle it and grow from it, emotionally or physically
All of these qualifiers are absent — absolutely absent — from the implied bad-ass-ness of the statement
Pain is weakness leaving the body
And that serves only to cloud the issue and completely gloss over the qualifiers which are about as easily remembered as the fine print on a contract you sign for crappy cell phone service, only to discover that you’re locked in for 2 years without any hope of escape, unless you pay boocoo bucks.
Seriously, how many people qualify this pronouncement with the bullet points above? See how this sounds…
“Pain is weakness leaving the body — so long as you just take it in little bits and pieces and eat right and rest up enough to recover from the damage you’ve done to yourself. You really need to heal, you know…”
“Pain is weakness leaving the body — so long as you don’t do such a job on yourself that you’re impaired for life. Just be careful!”
“Pain is weakness leaving the body — so long as it’s meted out and supervised by a trained professional who has a full medical staff to back them up and get you the proper care, if you overdo it.”
You don’t hear anyone saying that, do you? It sounds silly — and a lot less tough than the 6-word announcement that implies that once you have expelled all weakness, you will feel no more pain.
Third, this is a military statement intended for legal adults… who are going off to situations where they are to be trained to kill and to die. This is not a small thing. For someone facing imminent death – as is always the chance, when you go into battle – ignoring pain is not an option, it’s a requirement. It’s life and death, and perhaps the most important quality a soldier can cultivate is the willingness to sacrifice ALL for their cause. There is no tomorrow. There is only today — This moment alone. And whatever sacrifices you make are (ostensibly) for the greater good. If you’re crippled or maimed or brain-injured, it’s for a greater cause — something much larger and far more vast than anything most of us can imagine. Plus, it’s your job. Granted, it doesn’t make survival any easier, especially if you come home to a country that’s ill-prepared (or willing) to help you back into civilian life, but the bottom line is, serving in that capacity is about putting everything on the line, and it could very well mean your destruction.
Is this the kind of mentality and approach we want for high school football games, which are by their very nature transitory introductions into the larger “field of play” of adult life? Is this the ethos we want 16-years-olds to espouse? Lay it all – everything – on the line, with no regard for the rest of their lives past that game, never mind that it can maim them permanently… and for what? And do we want our student athletes to treat others on the field like enemy combatants — like Al-Quaeda or domestic terrorists who deserve to be obliterated? Do we want to blur the lines about who’s the enemy and who is not, on the playing field and off? Do we want to teach our next generation to use their bodies as weapons against perceived threats, with no thought to the consequences? Life-altering concussions and brain injuries in high school sports are the most cruel of injuries — you may end up sacrificing everything for something that ultimately doesn’t really matter (aside from fond memories later on down the line). Or you could end up doing the same to someone else.
And for what?
Let’s put this in perspective, shall we? Serving your country is a high honor that demands more from those who serve than many people would be willing to do for anyone or anything. It is life and death. It is the stuff that turns the world. It is what makes and breaks countless lives and nations and cultures. It happens on a scale that utterly dwarfs a high school football game — a season — the whole Friday night lights culture.
Hearing high school athletes using that kind of language runs so roughly against every fiber of my being — my great-uncle was killed on D-Day on the beaches of Normandy in WWII and was posthumously awarded a Bronze Star for single-handedly holding his machine gun position on the beach and pinning down the German gunners, so that “his section could maneuver into strategic positions”… and we could prevail. Pain was — for him — weakness leaving the body.
How does this compare to a Friday night lights contest? I don’t want to take away from the importance of the game for anyone, but members of my extended family have paid the ultimate price on the field of battle. Even the ones who survived, returned to suffer for decades with the wounds of their war. To them, the honor of that statement belongs.
Fourth — and I think this is perhaps the most important — the belief by high school students that they should shrug off pain and play through it, is utterly erroneous. Because we’re talking about students — young people still growing and maturing, whose bodies and brains have a ways to go till maturity. I’m not taking away from anyone, I’m just trying to put this in perspective. When you are 14, 15, 16, 17 years old, you have years to go before you are fully mature. It’s not a slight, not an insult. It’s the truth. The human brain doesn’t get out of its youthful development phase till you’re 24 years old. I repeat, 24 years old. If you are 14, 15, 16… and you sustain a brain injury (as I did — several times), you have at least 8 years left before your brain can be said to have stopped that early maturation phase. What effect early concussions have on the developing brain, we have yet to find out.
Now, I was in as much of a hurry to grow up when I was in high school as the next person. I was even in a hurry when I was in junior high. But when I was growing up, being an adult — proving you were a real man or a real woman — was not about playing games and battling pain — it was about going out, getting a job, being a responsible individual who could hold their own in adult company, both intellectually and logistically. The most mature peers of mine were the ones who had jobs at night or after school and all weekend, who had real-world responsibilities in the workplace and who cared more about paying their taxes and keeping their cars running, than scoring touchdowns on the field. Football players were popular, sure. But everybody knew, the real men were the guys who were the night supervisors at the local department store or supermarket, who had their own cars and saved their money for a house or education.
Maybe it’s just the time I was raised in, as well as the area where I grew up — which was rural and of old-school hard-working northern European extraction. But it seems to me, as I look around, there is far less emphasis now on students going out and getting jobs and learning to work, than there is on participation in sports. Maybe it’s a class thing. Nouveau riche parents don’t want their kids to have to work. They want to show the world that they’re wealthy enough to educate their kids and give them every advantage. But the area where I grew up was a rural, working class farming environment, and the most valuable inheritance from your parents and community was learning how to be a productive member of society. If you wanted to be a grown-up, you worked, you didn’t just “work out”.
I’m probably being harsh, but this is serious stuff that just drives me NUTS… not least of all because this is the next generation of Americans who are being harmed by this inappropriately applied philosophy. If I rant, it is out of love for my country and concern for perfectly healthy young people with so much potential for making a difference in the world… our true Homeland Security… who are harmed by the foolishness and narrow-mindedness and short-sightedness of adults who themselves may have been brain injured in their own high school careers, and whose judgment may be blurred because of it.
Who’s going to let their kids’ future be impacted by someone whose own capacity for risk assessment is impaired, whose own head injuries were undiagnosed, and who may in fact be suffering from an invisibly spreading assault on the brain that can only be detected by specific chemicals dropped onto thin slices of their frozen brains after they have died?
Seriously folks, let’s get real about the impact that CTE and repeated concussions has had on the whole discussion about football, to begin with. Dave Duerson was in charge of determining if his former teammates were in need of medical assistance, and while he denied many of their claims, he himself was impaired by his own undetected and unacknowledged neurological medical issues. It seems to me that the strongest opponents of amending football’s deliberately harmful violence probably need to undergo neuropsychological testing, themselves, to see if they are even competent to discuss this. It’s not a slight. It’s just objective consideration.
I’m ranting, I know. But seriously, lives are at stake. When I think of all the pain and suffering I’ve been through because of my own multiple sports-related concussions, and I think of all the student athletes out there who may be experiencing the same thing — even worse — because people are too busy denying there’s a problem or downplaying it, all the while telling student athletes that they should ignore (or even welcome) pain, because it’s “weakness leaving the body” — it makes my blood boil. Yes, I have come a long way since my last injury. Yes, I have overcome a great deal, and I’m living proof that concussion and repeated mTBI doesn’t need to destroy your life. But the price I have paid… I wouldn’t wish it on anyone. My brain injuries started before I was old enough to protect myself and make conscious choices, and in years before anyone knew enough to take my injuries seriously. A number of my mTBIs were also accidents. The thought that adults are putting students in harm’s way out of arrogance and ignorance, incurring completely needless and avoidable injuries, and not giving them proper treatment… all the while reinforcing the “don’t be a pussy” mindset by saying “Pain is weakness leaving the body,” and increasing the risks… it’s almost unfathomable. In this day and age? With all that we know? How is this possible? (Unless it’s directly related to prior head injuries among the people who are debating the issues — I’m just sayin’…)
If you take nothing else away from this (given my rant), I hope you at least take this:
Pain for a student athlete is NOT weakness leaving the body.
It is the body telling the mind that it needs to STOP doing what it is doing, because IT IS DOING DAMAGE TO ITSELF. The reason we feel pain in the first place, is because our bodies are detecting a threat that we are either not aware of, or we are ignoring. It’s the body’s way of saying, “Knock it off – you are harming me.” And the more pain there is, the higher the stakes. Pain is not a frivolous distraction, the domain of pussies and pansies. It is a real thing, the one (and sometimes only) way the body has to communicate to us when we are being idiots about protecting our own safety. Pain should be respected and listened to, not dismissed as the price you pay for character development.
If you’re in anything but a life-and-death situation where the risk of losing everything outweighs the damage you’re doing to your body, well, that false-bravado attitude is just plain stupid.
For my great uncle on the beachhead near Colleville-sur-Mer in France on June 6, 1944, it made sense to ignore whatever pain he experienced, because it was for a higher purpose — the protection of his section’s mission, and the overthrow of the Nazi regime. He also was a 24-year-old man who left school when he was younger and his father became ill, and he supported his family with two jobs. On D-Day, that man made the ultimate sacrifice, “realizing that he was facing certain death… ” His was a “heroic, self-imposed mission” and he made a conscious choice in an honest-to-God real life battle that would have lasting consequences. His sacrifice served someone else, not just his own ego.
But the sacrifice of young brains — young lives — for the sake of staying in a school-age game… whom does this serve? The game is passing, but injury and struggle and difficulty are lasting. And who bears the brunt of the pain? The former player, not the coaches and other players who pushed them to stay in.
Concussion and brain injury (even “mild” traumatic brain injury) is no laughing matter, and it’s not something to be shrugged off. It has consequences. It often comes at an extremely steep price.
Pain is not always weakness leaving the body. Sometimes it’s weak-mindedness betraying the body.
One of the nice things about being a blogger is that I can add my information to the general wealth of data about subjects of interest to me – in this case, mild traumatic brain injury. This blog is about more than telling my side of the story — it’s about fleshing out info that other trusted sources provide, in ways that are personal and individual… and hopefully contributing to the general understanding about traumatic brain injury, and sports-related concussion in particular.
The CDC has a wealth of information on concussion in youth sports over at their Heads-Up site.
What’s missing is a bit of in-depth explanation about the different points they make.
Since this month is Brain Injury Awareness Month, I hope to contribute to the awareness piece with further info and examples from my own concussion experiences.
To help recognize a concussion, you should watch for the following two things among your athletes:
A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.
AND
Any change in the athlete’s behavior, thinking, or physical functioning.
Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.
Signs Observed by Coaching Staff
Appears dazed or stunned
Is confused about assignment or position
Forgets an instruction
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior, or personality changes
Can’t recall events prior to hit or fall
Can’t recall events after hit or fall
Symptoms Reported by Athlete
Headache or “pressure” in head
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light
Sensitivity to noise
Feeling sluggish, hazy, foggy, or groggy
Concentration or memory problems
Confusion
Does not “feel right” or is “feeling down”
Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.
Now, for some explanation to fill in the blanks…
To help recognize a concussion, you should watch for the following two things among your athletes:
A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.
The head, atop the neck, holds our precious brain — which has the consistency of pudding, and is surrounded by fluid which protects it from the bony inside of our skulls. Unfortunately, the bony insides of our skulls can have rough/sharp edges which can rake across the surface of the brain and cause damage that way, should the head/bodybe knocked so hard that the brain pushes past the protective fluid and scrapes against the inside of the skull.
When the body or head is hit hard enough, the brain can hit against the front inside part of the skull, be injured there — and then fly back against the rear of the skull (called coup-contracoup — which means head-back0fhead — injury), causing damage to the rear part of the brain as well. Under ideal conditions, the protective fluid provides an ample buffer to shelter the brain, and the inside of the skull is not really sharp and uneven. Unfortunately, there are no guarantees that that’s the case.
Forceful bumps or blows or jolts to the head can be things like:
being hit on the head by a ball, such as in soccer or baseball
colliding with another player and bumping heads
being elbowed or kicked in the head
colliding with the catcher and slamming your head against his/hers when you’re trying to steal homebase
falling and hitting your head on the basketball court floor
Another way the brain can be injured by a hard hit to the body, is a whiplash effect — where the connections that are located at the base of the skull and neck are twisted and torn by the head snapping forward and backwards really hard. You don’t need to be knocked out, and you don’t even need to have your head hit, to sustain a concussion in sports.
Forceful bumps or blows or jolts to the body can be things like:
being tackled hard in football
being fouled hard and knocked to the floor in basketball
falling during a soccer game
colliding with another player when going after the same ball
landing hard after any kind of fall, even if your head doesn’t hit the ground
running into the wall when you’re eplaying squash/raquetball
It’s important to remember that these very common collision/impact occurrences (which are part and parcel of just about any sport) will NOT necessarily lead to concussion. If everyone who was tackled hard, or fell, or was fouled hard and ended up on the floor/ground sustained a concussion, there would be a whole lot of impaired people walking around.
Being hit or tackled or falling during a game or practice is NOT a guarantee of a concussion. This is where the next criteria comes in… the “and” part.
AND
This AND is important. The first set of criteria — the bump, blow, or jolt to the head or body are no guarantee that a brain injury has occurred, but they can serve as a trigger to watch out for the following. The next point is what acts as an alert that a concussive event has occurred.
Any change in the athlete’s behavior, thinking, or physical functioning.
Signs Observed by Coaching Staff
Appears dazed or stunned
Is confused about assignment or position
Forgets an instruction
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior, or personality changes
Can’t recall events prior to hit or fall
Can’t recall events after hit or fall
Symptoms Reported by Athlete
Headache or “pressure” in head
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light
Sensitivity to noise
Feeling sluggish, hazy, foggy, or groggy
Concentration or memory problems
Confusion
Does not “feel right” or is “feeling down”
Here are some examples from my own experience:
When I sustained a concussion from a hard tackle during a football game in high school, there was an immediate change in my thinking and physical functioning.
First of all, I was not thinking as quickly as I was before the hit. Even I could tell I was slower — I wasn’t following the calls by the quarterback very well, and I was clearly a little dimmer than I had been before the hit. I had trouble understanding what was said in the huddles before the following plays, and I had trouble following the instructions I was given. For example (I can’t remember the exact details, but this is how it was), when I was told to go long and then cut left at a certain point, I went long, but I didn’t cut left.
Secondly, I was not as coordinated as I had been before the hit. I ran clumsily — like I was drunk — and I couldn’t catch the ball when it was thrown right to me. I also stumbled a lot, and I fell a few more times. For all I know, I did more damage to myself, but I was so totally focused on continuing the game and not letting my teammates down, I refused to take myself out of the game. They had to stop the whole game, completely, to get me to quit playing. I was that stubborn.
When I sustained another concussion from a fall during a soccer game a year or two later in high school, there was yet another immediate change in my physical functioning and behavior.
First of all, I was a lot less coordinated than I had been before I fell. I couldn’t control the ball as well as I had before, and it felt like I was moving in slow motion. I stumbled and fumbled, and there was obviously something different about how I was playing.
Second, I was not the same player I’d been before my fall. Before, I had been aggressive and confident on the field. Afterwards, I was hesitant, confused, and I hesitated before shooting on the goal (or just plain failed to shoot). I had a number of opportunities to score, but I didn’t, because I was uncertain and confused. I was also less able to be a team player. I didn’t pass the ball to my open teammates as frequently as I should have. I also became more withdrawn and was not communicating with the coaching staff on the sidelines. It was like I was in my own little concussed world, suspended in a foggy soup that slowed down all the input and output.
Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.
Absolutely, positively. This must be done. Unfortunately, I myself never received any medical evaluation or treatment for my injuries. But on the bright side, I was removed from play in both instances. Nobody watched me afterwards to make sure I was symptom-free and it was OK for me to return to play. Then again, by the time I got to those games, I’d had a number of TBIs already, so I already showed symptoms of impairment. Still, the changes I did experience, on those two separate instances, were clear indicators that I’d undergone a concussive event. I only wish someone had known what to look for, and helped me out.
Another important piece of the CDC info is:
Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.
This cannot be overstated. Concussion, hidden as it is inside the skull, can also be hidden by time. It can take hours or days for symptoms to show up, which is why it is so important that not only coaches, but also teachers and parents and teammates are all familiar with the danger signs and informed about how to respond appropriately.
One of the things that can show up later, are behavioral issues. Indeed, behavioral issues are the bugaboo of mild traumatic brain injury, because on the surface everything looks fine, and the brain may have recovered from its initial trauma, but there are microscopic changes under the surface that can have long-lasting effects. If you know someone who plays sports, whose behavior has suddenly started to change for the worst – suddenly they have a lot of anger, rage, irritability, distractability, sensory issues, fatigue, insomnia — it could be they had a concussion during a game or some other event — and nobody realized it, including them.
Concussion doesn’t just affect the student athletes — it affects everyone who interacts with them, everyone who loves and cares about them. It’s in all our best interests to learn about it, learn what to watch for. And to report it to someone who can help.
As the CDC says, most people recover quickly and fully, and it doesn’t need to wreck their lives. But if you don’t pay attention to the first warning signs, it is all too easy to re-injure yourself (having a concussion increases your chances of experiencing another one from 2-6 times). So, paying attention, right from the get-go can help prevent other problems from happening.
In retrospect, I wonder what might have happened, if I’d stuck with track and field and cross country exclusively, and not played any team sports that involved tackling or the danger of falling/collisions. I wonder if I would have been so susceptible to drugs and alcohol, if my behavior would have been so problematic. Thinking back, I had a ton of problems when I was a kid that actually resolved as a result of organized sports. Unfortunately, the thing that helped me most, also introduced more problems to my mix.
Well, I can’t worry about it. What’s done is done, in my case. I’m just happy I’m as functional and well-off as I am, today.
I also hope that coaches and trainers and teachers and teammates are learning enough, today, to help avoid the kinds of situations I got myself into… and help address the after-effects of the kinds of injuries that I — and hundreds of thousands of others young athletes — experienced. The CDC material is really helpful, and they have lots of free information and additional materials available.
I have to say, it’s probably the most exciting news I’ve come across in a while. With all the talk about the NFL’s new post-concussion guidelines (which may or may not make a difference), and the increasing awareness about head injuries, expecially mild traumatic brain injuries (MTBI), it gets a little depressing, thinking about all the people who are getting hit in the head and suffering for years as a result.
A lot of folks are talking about it being an epidemic, that concussions are no joking matter, and lots of people are getting on the helmet bandwagon (especially since Natasha Richardson died from a brain injury while skiing). Prevention is great. But concussion is all but unavoidable in sports — especially student athletics. It happens. All the time. Yet nobody seems to have come up with a reliable way of addressing it when it does happen. Aside from bed rest and taking it easy, suggests for howto deal with concussions/brain injury are few and far between.
We know concussions happen. We know head injuries are common. We know they can have serious long-term consequences. You can try to prevent them, but you can’t be successful 100% of the time. And if you do have a head injury, you have to be sidelined from your life/sport, with no guarantee that the “treatment” will actually work.
I was starting to get seriously depressed.
Then, suddenly, I was looking around the other day and I found that the University at Buffalo has been working with regulated exercise to treat — even heal — the after-effects of concussion. Post-concussive syndrome is, according to the definitions of Willer and Leddy (at UB), “persistent symptoms of concussion past the period when the individual should have recovered (3 weeks)”. According to them, post-concussive syndrome “qualifies as mTBI.”
This is interesting. I have heard a lot of people say that concussion is an mTBI, and the two are interchangeable. I am not a doctor, and I don’t have medical training, so I can’t throw my hat in the ring on that debate. But it is interesting to me, that people distinguish between the two.
At the UB web page on concussion research, there are some interesting papers, and they do talk about the difference between concussion and mild TBI.
A recent review … of concussion and post concussion syndrome provided a model for distinguishing concussion from mild traumatic brain injury (mTBI) and post concussion syndrome (PCS). The model uses the most commonly accepted definition of mTBI and the one proposed by the American Congress of Rehabilitation Medicine and the Centers for Disease Control: loss of consciousness for no more than 30 minutes or amnesia as a result of a mechanical force to the head, and a Glasgow Coma Score (GCS) of 13 to 15 …. The model also uses the most commonly accepted definition of concussion as established by the American Academy of Neurology (AAN): a trauma induced alteration of mental status that may or may not involve loss of consciousness …. Although not explicitly stated in the AAN definition, concussion is generally viewed as a transient state from which the individual will recover fully in a relatively short period of time …. In contrast, mTBI is viewed as a permanent alteration of brain function even though the individual with mTBI may appear asymptomatic. Post concussion syndrome was defined in the Willer and Leddy … model as persistent symptoms of concussion past the period when the individual should have recovered (3 weeks) and therefore qualifies as mTBI. Neuropsychological testing is often used to describe the impairment associated with mTBI and PCS and have done so with relative success ….
So, basically,
mTBI = a loss of consciousness for no more than 30 minutes or amnesia as a result of a mechanical force to the head, and a Glasgow Coma Score (GCS) of 13 to 15
Concussion = a trauma induced alteration of mental status that may or may not involve loss of consciousness; it’s a transient state from which the individual will recover fully in a relatively short period of time
Post concussion syndrome (PCS) = persistent symptoms of concussion past the period when the individual should have recovered (3 weeks)
PCS, due to its enduring nature, qualifies as mTBI
(Note: I think someone needs to fill in the gap about how PCS satisfies the criteria for mTBI, if they require that there be some loss of consciousness or amnesia involved. How lasting effects qualifies based on these criteria puzzles me. But for the purposes of this discussion, I’ll let this slide.)
I find this really compelling information, and it helps me make more sense of the whole “concussion thing”. I know I’ve sustained a bunch of concussions in the course of my life, and I also know that I have been diagnosed with “Late effect of intracranial injury.” But I could never really distinguish between the mTBI vs. concussion. I actually thought — and had been told — that they’re the same thing.
But that never made much sense to me, because when I look around at me, and I read that “An estimated ten percent of all athletes participating in contact sports suffer a concussion each season” And that’s just athletes. Plenty of people fall down, too, or are in car accidents. I’m not entirely sure what to make of it. Apparently, hundreds of thousands of people sustain concussions each year, yet the general population doesn’t appear to be completely crippled by TBI (though some people I know would debate that 😉 ) How is it possible, that so many people are sustaining concussions, especially in their youth and/or in sports, yet we’re not all running around impaired?
Making the distinction between a concussion that is transient, and a concussion that turns into an mTBI makes all the sense in the world to me. It makes it possible distinguish between someone who’s experiencing short-term issues, and someone who needs to deal with a broader-spectrum and deeper set of challenges. And in doing so, it de-stigmatizes concussion (at least in my mind), by steering clear of the “concussion = brain injury = brain damage” concept, which could be quite debilitating to a youth who has hit their head while playing a sport they love.
There are tons of potential ramifications and implications from being able to state that concussion is not necessarily an enduring brain injury. I may write more about this later, but it requires more thought.
The other very hopeful piece of this is that, by saying concussion is not always followed by brain injury, you’re opening a window to addressing concussions promptly so they do not turn into mild traumatic brain injuries. This, to me, is key. It not only makes sense of the two different kinds of injuries, but it also establishes that it may in fact be possible to treat the concussion to prevent it from becoming a more serious, long-term injury — the “gift” that keeps on giving. And by understanding concussion and brain injury this way, you also up the ante and really infuse the topic of prompt treatment with urgency. If acting promptly to address concussion makes it possible to avoid a lasting brain injury, then it’s in everyone’s best interest to become familiar with and properly trained in the recognition and treatment of concussion.
In this case, if mTBI is only present if concussion symptoms persist, and there’s no guarantee that concussion will result in a lasting brain injury, then prompt recognition and action may save the day.
Now, I’m still noodling over the idea that subconcussive impacts can seriously affect the brain over the long term, which Malcom Gladwell talked about in his article “Offensive Play“. But I am still hopeful. Because while subconcussive impacts may affect the brain, it could be that the damage takes place when no action is taken to address the injuries when they happen. Again, I’m not a doctor or a qualified medical professional, but it seems to me that if actively treating concussion helps with the really obvious issues — as the University at Buffalo has shown it does (albeit on a fairly limited scale) — then it might just help repair lesser damage done.
It might. I only wish I had the medical and scientific background and credentials to be able to speak as an expert on this. But apparently expertise is no guarantee of being able to help out, when it comes to TBI. The vast majority of experts haven’t had the wherewithall to state definitively what can actually be done about brain injuries, let alone recommend specific action that works, and there are thousands upon thousands, if not millions, of people suffering, day in and day out (along with their loved ones and co-workers) with the after-effects of concussion and mild traumatic brain injury.
So, somebody’s got to take the lead in finding a solution… Or at the very least think about finding one. The folks in Buffalo are up to wonderful work, and I can only hope that more folks have the gumption to take their lead and do something about this wretched hidden epidemic of ours.
Broken Brain - Brilliant Mind 