Prepare Your Brain, Protect Your Brain

Concussions have recently found traction in the national conversation. These days, the NFL is paying more attention to this injury because of the associated dementia, suicide rate, and chronic pain that some of its former players have suffered due to repeated concussions.

But you don’t have to be a hard-tackling lineman to be at risk.

What is a concussion? A concussion is the mildest form of brain injury. In fact, the more accurate medical term for concussion is “mild traumatic brain injury.”

How do you get a concussion? A concussion can occur in one of two ways:

1. Being hit in the head;
2. Experiencing rapid deceleration, as in a football tackle when two players collide. This does not always involve a specific hit to the head but may result in a concussion. In other words, you don’t have to be hit in the head to get a concussion.

How do you know if you have a concussion? A concussion has common symptoms: headache, nausea, light or sound sensitivity, dizziness, inability to concentrate normally, memory difficulty, inappropriate emotional response to a situation, fatigue, or tiredness. In the days or weeks after a concussion, you can develop post-concussive syndrome. This brings additional symptoms, including difficulty with normal sleep patterns, fatigue and dizziness with minor activity, severe difficulty with memory or concentration, and inability to return to normal school or work productivity.

How do you know how severe a concussion is? Concussions used to be graded as mild or severe according to different factors, such as whether the person was knocked unconscious at the time of the injury or if he or she suffered memory loss from just before the injury or shortly after. Now we know that we can’t grade a concussion until it has resolved. A minor concussion may take only a few days to resolve, whereas a severe one may take several months.

What other types of head injuries are there in sports? Since concussions are the mildest type of traumatic brain injury, there are more severe injuries such as a fractured skull, ruptured blood vessel in the brain, and bleeding in the brain. These more severe injuries may be fatal or life altering.

Do any helmets prevent concussion? Contrary to what some helmet manufacturers suggest, there is no helmet or gadget you can attach to your head that will prevent a concussion. Picture an egg in a glass bottle that has been cocooned in Bubble Wrap—drop the bottle, and the egg still breaks, despite the glass being protected by the covering. Your brain is the egg. The only way to prevent a concussion is to strengthen your neck muscles so that the head doesn’t bounce around in a collision. While this may help, it will not prevent all concussions.

Are some people more prone to concussion? Yes. Women are (in some reports) four times as likely to get a concussion as male athletes in the same sport. Children tend to take longer to recover from a concussion. Also, if you have had a concussion, you are four times as likely to get another than someone who has never had one. Some disorders (such as ADD and depression) can cause a more prolonged recovery from concussion. And, finally, some people actually have a genetic predisposition toward concussion.

When should you go to the hospital? Since concussions are the mildest type of head injury, they are, in general, not an emergency. But it can be confusing to know whether that injury is a concussion or something more severe, such as a fracture or bleeding in the brain. My general rule of thumb regarding concussions is this: If a concussion is treated properly, symptoms improve over time—they do not get worse. More severe head injuries, however, get worse over time. So, if your symptoms are worsening after the injury, go to the ER immediately. Also, if the symptoms are very severe or simply cause concern, an ER trip is warranted. However, if you have mild symptoms and are improving, it is less likely to be a severe injury and a trip to the ER is therefore not likely necessary.

So, what if I have a concussion? While it is true that concussions are the mildest form of brain injury, that doesn’t mean they should be ignored. Concussions can still be deadly and life altering. Some concussions don’t ever heal completely and cause persistent memory and concentration problems.

Also, if you sustain another concussion while still recovering from the first one, there is a compounded effect that can result in death. If not death, the compounded effect may cause a very prolonged recovery or even permanent mental difficulties with concentration and memory.

How do you treat a concussion? It is simple: Give your brain a rest. The more rest the better. In fact, bore yourself silly—sit in your room with the lights off, doing nothing. The less stimulus the brain has to decipher, the faster it will heal. So, no music, TV, movies, video games, or social events. Rest from work or school is sometimes necessary. People with concussions often have disturbed sleep and may need help getting adequate rest. Proper nutrition—a well-rounded diet with a variety of nutrients—is important as well. Exercise should first be avoided because it is a stimulus that the brain has to overcome, but, if the concussion is lasting weeks, light exercise such as stationary bike riding can be helpful for brain recovery. Ask your doctor before trying any treatments other than rest.

What kind of doctor should I see for a concussion? Ideally, you should see a doctor who is familiar with your sport and life (school or work needs) and treats concussions on a regular basis. Sports medicine doctors are usually a good choice. Neurologists are sometimes needed for injuries that require more prolonged recovery.

So, put me back in, coach! When can I play again? The answer to this question seems obvious: Once the concussion has resolved. But when exactly is that? Studies have shown that people frequently feel they are back to normal before they actually are. The general approach a doctor should take when deciding when a concussion has healed involves three components:

• The person should not feel any symptoms that could be related to concussions. So, they should “feel” back to normal.
• An exam performed by the doctor shows that all nerves are working properly.
• The person needs to be thinking normally.

How do you know when you are thinking normally, especially if you have a concussion? The best way to tell if someone is able to think normally is to test reaction time, memory skills, concentration, higher level decision making, and accuracy with a specially designed computer program. Most of these programs compare scores from an injured person to scores from average people of the same age.

However, the best measure is to undergo an individual baseline test at a time when not suffering from the concussion. Baseline tests serve as markers to compare against tests taken after sustaining a concussion.

Can I return to my sports at a normal activity level? It’s best to come back gradually. For instance, on the first day back, try light aerobic activity; on the second day, weight lifting; and add in sport-specific movements on the third day.

If you develop symptoms while exercising, stop and follow up with a doctor. As was mentioned previously, this is why it is ideal to have a baseline concussion test performed at the beginning of the sport season to determine “normal.” That becomes a very useful tool later, especially if you get a concussion.

Where can I get a baseline concussion test? Medicine in Motion offers free baseline concussion tests at the same time you get a school or sports physical. All student athletes in RRISD and AISD must have physicals, which are offered in the spring and summer of the preceeding year.