Concussions: don’t lose your head

Posted on 29 March 2017

Concussion is a very common, often under-diagnosed and previously misunderstood condition – and sport seems to be an important cause of it.

In 2011, 50-year-old Dave Duerson sent several text messages to his family and wrote a note for the police that said: ‘Please see that my brain is given to the NFL’s Brain Bank’. Then he shot himself in the heart.

Duerson had been a national American football hero who had won two Super Bowls with the Chicago Bears and the New York Giants. His brain was sent to Boston University, where it was discovered that he suffered from chronic traumatic encephalopathy (CTE), a degenerative condition that may be caused by repeated and cumulative blows to the head – in other words: repetitive concussion.

Duerson’s case was far from unique: a string of former NFL players have been posthumously diagnosed with CTE. (In 2014, a study revealed that 101 out of 128 ex-football players tested positive for CTE.) And while the scourge of CTE is obviously higher in a contact sport like American football, the story illustrates that repeated instances of an injury as common and generally unthreatening as concussion can have life-threatening ramifications.

What exactly is concussion?

Concussion is the most common type of brain injury, and occurs when sudden jars to the head cause the brain – which is floating in cerebrospinal fluid – to jolt or make contact with the inner skull. This causes the axons in the impact zone to stretch, and the cells in the affected area undergo several distressful metabolic and chemical changes that disturb signal transmission across brain cells.

The physical damage itself is so subtle that even the most advanced medical imaging techniques have difficulty ‘seeing’ it, and because less than 10% of concussion result in loss of consciousness, experts now agree that the best way to test for concussion is to test brain function after the suspected injury.

What are the symptoms?

The symptoms of concussion fall into the following broad clusters:

• Physical: headache, dizziness, nausea, sensitivity to light and noise
• Cognitive: poor concentration and memory loss
• Emotional: irritability, depression and aggression
• Sleep: disruption in sleep times, difficulty falling asleep
• Balance: Difficulty balancing

The good news is that most symptoms of concussion are temporary, and can be gone from between 24 hours and 10 days. But the biggest danger is that the condition is unrecognised and the brain is not given the time and treatment to recover. In the worst-case scenario, another blow is received before recovery, exponentially worsening the initial injury. This danger is very real – research suggests that people who get one concussion are far more likely to have more.

How can one prevent concussion?

The facts about concussion don’t mean you should forbid your kids to play school sports or hang up the five-a-side soccer boots just yet.

Dr Jon Patricios, a leading expert in the field of concussion, member of the Concussion in Sport Group and director of Sports Concussion South Africa (www.sportsconcussion.co.za), reminds us that only 21% of concussions occur as a result of organised sport.

‘Firstly, all physical activities have a degree of risk associated with them,’ says Dr Patricios. ‘Kids use roller skates, skateboards and bicycles – all of which pose some risk. Secondly, the benefits of physical activity – physical, cognitive and social – far outweigh the risks.’

Dr Patricios points out that making sure that kids are well conditioned, have good technique (especially in contact situations) and play by the rules, go a long way in reducing the risks of concussion. He adds that all schools and clubs should have a concussion protocol and network for the management of head injuries.

How is concussion treated?

Until now, it was thought that the only way to treat concussion was rest. Concussed people were required to curtail physical activity and mental stimulation. But Dr Patricios tells us that a new approach ‘involves active treatment of all the systems potentially involved in concussion, rather than just rest. Active rehabilitation of balance and vestibular systems is encouraged.’

‘We have a concussion mantra: Recognise, Remove & Refer. That summarises the key elements of our approach,’ Dr Patricios explains.

Of course prevention is best, so take care during physical activities and make sure children wear suitable protective gear such as a helmet when cycling or skating, or a scrum cap for rugby.