Athletic Training Column

‘Brain Games’

By Jenn Mroz | Aug 28, 2013
Photo by: File Jenn Mroz

Concussions are a hot topic in the media these days.  A multitude of research is being conducted on the causes of concussions, the long-term implications, and how to prevent them.  
Times have certainly changed over the past 20 years in terms of what is considered a concussion, and because of that education is so important.  
I hear all the time from former athletes who say “well, when I played, there weren’t as many concussions as there are nowadays.”
Actually, there probably were more than you think, they just weren’t diagnosed or thought of as serious.  
“We are just seeing the tip of the iceberg in terms of evaluating the long-term effects of traumatic brain injuries,” says Dr. Paul Cutting, an orthopedic physician with Western Carolina Orthopedic Specialists.  
In this column, we would like to clear up the myths surrounding concussions.
A concussion is an injury to your brain.  I ask my students all the time:  what does your brain control?  
The answer is everything.  When you sprain your ankle, in the end, it really is “just” an ankle.  You may walk with a limp, but you can still function pretty much normally.  
When you injure your brain, the following things can be affected:  your concentration ability, memory, balance, sleep processes, breathing, speech, mood, personality … your quality of life, your future.
OK, let’s test your knowledge of concussions.
TRUE or FALSE No. 1: All concussions result in a loss of consciousness.
FALSE. In fact, about 80 percent of all concussions only have minor signs and symptoms.  The most common symptoms of concussions are headache, blurred vision, loss of balance, confusion, dizziness and sensitivity to light or noise.  Athletes may also experience difficulty concentrating or focusing, taking longer to process questions, nausea/vomiting, trouble sleeping, memory deficits, pupil changes or slower brain function.  
Changes in mood or personality can occur as well.  Usually when there is a loss of consciousness, the symptoms are more severe.  We still need to treat every concussion as if it were serious, though.
TRUE or FALSE No. 2: Concussion symptoms appear immediately after the injury.
FALSE.  A lot of times, symptoms take awhile to show up.  Here’s a classic example I’ve experienced on the field:  a JV football player came off the field during a game, complaining of his head feeling “weird.”
I asked him the standard questions, like What day is it?, Where are you?, When’s your birthday?, and so forth.  He was very coherent and answered everything perfectly.  
Ten minutes later, he could not answer the same questions.  He was visibly confused and wobbly, with a dazed expression.
When I told him I was going to get his Dad, he asked, “Who?”  The athlete couldn’t even process the concept of who his Dad was.  Because of this delayed onset of symptoms, it’s extremely important to monitor the athlete closely.
TRUE or FALSE No. 3:  Getting your “bell rung” is a concussion.
TRUE.  That was the favorite saying of coaches when an athlete would come out a game a little off balance, a little dazed, complaining of a headache.  We now know through research that even those seemingly minor “dings” can result in serious injury, especially if the athlete gets a second hit to the head.  This brings up my next point…
TRUE or FALSE No. 4:  The initial concussion is the only danger.
FALSE.  While the initial concussion is serious and should be treated as such, there is a more dangerous situation, called Second Impact Syndrome, which can occur if an athlete returns to activity too soon.  
The effects of a second concussion can be devastating, leading to permanent disability or even death.  I know it’s hard to understand why an athlete who appears to be symptom-free and feels fine still needs to rest.  
But, by giving the brain extra time to heal, we’re reducing the risks of a second concussion.  This is even more important to consider in younger athletes whose brains are still developing.  
“There are anatomic and metabolic reasons to explain why the young athlete’s brain is more susceptible to concussion than the adult brain.  
The cumulative effects of recurrent minor concussions and the vulnerability to injury during recovery phase are being recognized in ongoing research studies,” explains Dr. Cutting.
TRUE or FALSE No. 5:  Concussions only occur to football players.
FALSE.  It’s a common misconception that concussions only occur in football, but there are other sports that are at a high risk as well.  Soccer, wrestling, and basketball are all at high risk for concussions.  
Some of the worst concussions I’ve seen have been to soccer players, most with a loss of consciousness and more severe symptoms than in football.  Any time there is a chance of contact between an athlete and an opposing player, a piece of equipment or the floor/ground, there is a chance of sustaining a concussion.
TRUE or FALSE No. 6:  Concussions can be prevented.
This is TRUE and FALSE.  Certainly there are measures athletes can take to minimize concussions, but unfortunately, we can’t prevent every concussion.  
Wearing molded mouth guards can help reduce the risk by providing shock absorption; just make sure the mouth guard covers the back teeth, not just the front ones.  Also, if an athlete tends to chew on the mouth guard, it should be replaced often.  There’s a myth that certain football helmets can prevent concussions.  When the Revolution helmets first came out, that claim was made.  Honestly, I saw more football concussions with those Revolution helmets than any other type of helmet.  
Make sure whatever helmet the athlete wears that it fits correctly and that they are using the proper technique (keep head up and don’t hit with the head!).  
Dr. Cutting agrees, saying, “I don’t think we will ever eliminate concussions in collision sports, regardless of the sophistication of the equipment.  We can improve the management of these injuries and the first step of that is on-field recognition by athletes, teammates, coaches and parents.”
In 2011, the Gfeller-Waller Concussion Awareness Act was passed by the State of North Carolina.  
The main focus of this law was concussion education, emergency plan/post-concussion protocol, and clearance/return to play guidelines.  It was designed to not only protect the athletes after a concussion, but also to protect the coaches and volunteers from liability.  
It takes the guesswork out of whether or not an athlete needs to be evaluated.  Essentially, when in doubt, remove them from play and refer to a medical professional.  Follow the return to play guidelines given by the athletic trainer or physician.  
Additional information regarding this law can be found at www.gfellerwallerlaw.unc.edu.
In my next column I’ll discuss shin splints, a common injury seen toward the end of a long preseason.  
Until then, play safe.




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