The who, what and where of concussions.
Concussion is one of the most common injuries in the average population, occurring in both sport and work environments. But how much do you know about them and have you ever had one?
So, what is a concussion?
This is a common question that many of us have, especially those in sport that are now having to question “how to deal with concussion in an athlete”. Over the past decade we are asking this question more frequently with the mainstream media latching onto this enigma that is concussions. The 2015 film Concussion with Will Smith, it highlights the long term effects of concussion and a doctor fights to bring light to these issues. It emphasised the importance of concussion recovery time on the big screen and therefore led to a lot of people becoming more aware of this invisible injury. This followed along after the NFL (National Football League, USA) faced a lawsuit filed against them in 2012 on behalf of more than 4,500 retired players after they claimed they had been lied to over the severity of concussions. Naturally, this got the attention of the public, with how prominent the NFL is in the states and was finally settled in court in 2014 at the extent of upwards of 1 Billion Dollars.
So, whilst the mainstream media only picked up on this in the recent decades, however medical professionals have been aware of concussions for centuries with the first record being mentioned in 950AD. The first official definition took a little while to be agreed upon and did not happen until 2001. Over the years it has changed several times as more research comes to light around brain injuries. The concussion in sport groups currently defines concussions as “is a traumatic brain injury induced by biomechanical forces.” (McCrory, et al., 2017). It is most common in contact sports such as American Football, Rugby, Football and Ice Hockey as well as other sports with high risk of impact such as Horse Racing.
Now we have a definition, what happens to the brain when a concussive event occurs?
Concussion typically occurs, as defined in extensive research, by the person receiving a direct blow to the head, face or neck area. However, they can also occur after a hit to the body with enough force to transmit to the head in a whiplash fashion. When an athlete faces a concussive event, there is many pathophysiological (pathophysiological is the abnormal changes in body function) changes that occur in the brain (Harmon, et al., 2013). The primary issue is the damage to the axons in the brain, axons are the nerve cells in the brain that conduct messages from one cell to another. This damage triggers an inflammatory response from the body, which leads into imbalances in the brain (Harmon, et al., 2013). This damage leads to effects on cognitive function, balance and emotional stability, even though it is classed as on the less serve end of the brain injury spectrum it can have catastrophic effects.
What are the symptoms of concussion?
Concussion symptoms are so varied, and present uniquely in different people at different times due to the inflammation response in the brain. They can present within hours or days after an event occurs and in the initial time has often been described as ‘having your bell rung’. Typically, people who are concussed report symptoms such as:
- Light headiness
- Vertigo (sensation that the environment around you is spinning)
- Loss of balance
- Headache
- Memory dysfunction
- Tinnitus (ringing in the ears)
- Blurred vision
- Fatigue
- Personality changes
- Sleep disturbances
- Nausea/Vomiting
These can occur at any stage of a concussion with many taking place during the first week (Iverson, et al., 2017). Not everyone will present with all or even most of these symptoms and symptoms can resolve themselves within hours or days, sometimes however they can persist and lead to long term consequences.
These symptoms can be devastating to people so, can we prevent them?
Yes and No.
The literature that is available discusses a variety of different modalities to prevent concussions. However, research is consistently ongoing as there is no conclusive method in which we can confidently determine a way to prevent this injury.
Currently there has been ways to minimise the risk of concussion such as rule changes in sport, reducing contact during practice or training, looking at the equipment used and adapting training strategy. All of these have seen massive reduction in concussion occurrence across multiple studies. Currently this leads us to having methods in the sporting realm to reduce the risk of concussion occurring in practice as well as competition.
There is so much we still do not know about concussions and what actually happens when the body goes through a concussive event. Especially in regard to recovering from concussion which will be covered in a later blog post.
If you are concerned about someone having a concussion, find some useful links below:
https://www.headway.org.uk/ for advice and guidance on all head injuries.
https://www.nhs.uk/conditions/concussion/ anyone in the UK for guidance on when to call the emergency services.
https://www.thechildrenstrust.org.uk/brain-injury-information/info-and-advice/what-is-acquired-brain-injury/concussion-in-children-and-young-people additional information specific for concussion in children.
Harmon, K., Drezner, J., Gammons, M., Guskiewicz, K., Halstead, M., Herring, S., . . . Roberts, W. (2013). American Medical Society for Sports Medicine position statement: conussion in sport. British journal of Sports Med, 15-26. doi:10.1136/bjsports-2012-091941
Iverson, G., Gardner, A., Terry, D., Ponsford, J., Sills, A., Broshek, D., & Solomon, G. (2017). Predictor of Clinical Recovery from Concussion: a systematic review. British Journal of Sports Medicine, 941-948.
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., . . . Vos, P. (2017). Consensus Statement on Concussion in Sport - the 5th International Conference on Concussion in Sport held in Berlin, October 2016. British Journal of Sports Medicine, 838-847.
