Nearly 2 million of them sustain a traumatic brain injury in the course of those activities, resulting in close to 300,000 hospitalizations and $60 billion in costs. But that’s not the entire picture -- it does not count those with moderate or mild traumatic brain injuries who don’t see a doctor.
A concussion is a traumatic brain injury created by force or impact directly to the head, neck, face or elsewhere on the body. An adult brain floats inside the skull, surrounded by cerebrospinal fluid. This three-pound organ uses the fluid as a shock absorber for minor impacts.
In the most common instance of concussion, a major blow to the head or whiplash effect can cause the brain to strike the inner skull, then strike the opposite wall. In another scenario, called a rotational concussion, the head rotates rapidly from one side to the other, causing straining and shearing of brain tissues. In both cases, delicate neural pathways are damaged, causing the symptoms of a concussion.
Make no mistake -- it is a severe injury, resulting in lost consciousness, behavioral changes, cognitive impairment, sleep disturbances, somatic symptoms, cognitive symptoms and emotional changes. These impairments can occur rapidly and resolve quickly, so quickly that neither the athlete, coaches nor trainers observe or recognize the symptoms. In other cases, it can be decades after the trauma before conditions begin to manifest.
The danger is that concussion effects are cumulative, and symptoms can worsen with each concussion, resulting in debilitating conditions for the afflicted later in life. Some former athletes have constant headaches and can’t stand outdoor sunshine or noises. This largely confines them to their homes. Others withdraw as depression strikes or develop neurological conditions like Parkinson’s disease, as with former boxing champion Muhammad Ali. Some athletes are unable to function and develop other conditions related to their concussions that cause deterioration in overall health.
Advances in sports medicine have created a concussion protocol, which seeks to help educate trainers, coaches and sports medicine professionals on the symptoms and evaluation of blows to the head. This has led to better evaluation and management of conditions. But not every team or league uses the protocols, nor is an educated coach or trainer present for every situation.
Devastating Effects for Pro Athletes
The results of long-term neglect can be terrible. Recently, an autopsy on football great Frank Gifford revealed he suffered from chronic traumatic encephalopathy, a progressively degenerative brain disease sustained from his years in professional football. Gifford was one of the lucky ones, maintaining high-level communications skills and able to avoid (at least publicly) some of the pitfalls suffered by other football players, including dementia, memory loss, aggression, confusion and depression, as well as suicidal tendencies.
Ken "The Snake" Stabler donated his brain and spine to the Boston University School of Medicine after he died of cancer in July 2015 to help researchers better understand CTE. Researchers found classic signs of the disease, including atrophy in the temporal lobe and a tear in the curtain that separates the left and right hemispheres of the brain. Stabler reportedly began having problems with impulse control in his 50s, then suffered from headaches and memory problems in his 60s until he died at age 69.
San Diego Chargers great Junior Seau and Bears safety David Duerson are among the high-profile players whose suicides have been linked to chronic traumatic encephalopathy, and they are certainly not alone.
Nor is the problem solely linked to football. In boxing, the disease was formerly called dementia pugilistica, more commonly “punch drunk,” and was linked to the repeated blows to the head sustained in boxing. Other contact sports, including hockey, professional wrestling, basketball and even baseball have concussion cases, and although some are less dangerous than others, any repeated blow to the head can cause problems.
Concussions on the Rise
Concussion rates have been rising over the past two decades, a disturbing growth pattern. Some claim it’s because detection methods have increased, but others claim it is because athletes, like society in general, are bigger, stronger and faster, able to deliver much more lethal contact than previous generations. It’s a particular issue in football, which has caused many parents to worry about allowing their kids to participate in the sport at young ages, worrying about the long-term effects of head trauma sustained at a young age.
The condition is not confined to men. In fact, women tend to report higher concussion rates than men. A government survey determined that high school athletes who sustained concussions derived them by participating in football, followed by girls' soccer, boys' soccer and girls' basketball. Studies have shown cognitive impairment rates in women is more frequent than in men, a situation that may be attributed to biomechanical differences in body mass, head mass and neck strength, as well as the cultural differences, in which men are reluctant to report injuries. Physiological differences, including hormones, also may play a role.
There are differences in managing concussions at different ages. Research has shown high school-aged athletes have a longer recovery time than college or professional athletes, may have greater symptom severity and more neurological disturbances as measured by tests. An estimated 53 percent of high school athletes have already sustained a concussion before participation in high school sports, and 36 percent of college athletes already have sustained multiple concussions. Because the brain’s frontal lobes develop up to age 25, repeated concussions and brain damage at earlier ages can have far greater impact than those sustained later in life.
Improved headgear in football has helped, but there is no foolproof helmet available, and many sports require no head gear at all.
What Can Be Done to Decrease Concussions?
Injuries are going to occur with any physical activity, but there are some steps that can be taken at least to recognize the problem and deal with some of the issues.
First, pre-participation physical examinations should be mandatory before permission is granted to engage in sports activity. The physician can determine if there is a safety issue in the athlete’s potential participation, and concussion education can be discussed.
In training, conditioning exercises for neck muscles can be emphasized to help reduce some of the force on the head.
Officials also play a role in preventing concussions, identifying potentially dangerous situations and halting play if there is a clear and present danger to participating athletes.