Photo by Milad Fakurian on Unsplash.

Because I know you have been glued to watching all the matches in the Women’s World Cup soccer tournament, I suspect you have noticed how quickly the whistle blows, and the action is stopped whenever a player sustains some kind of blow to the head.

Over the past few decades, protocols for assessing head injury during sporting events have grown in sophistication as dozens of professional athletes and probably thousands of youth and school sports participants have suffered serious brain damage from concussions perhaps taken too lightly in earlier times. The “shake it off and get back in there” mentality is being replaced with strict mandatory assessments that err on the side of caution as more and more is learned about the long-term effects of concussions.

Concussion research

Those who reported 3 or more concussions had significantly worse cognitive function.

Recent research released in January of this year indicates that 3 or more concussions lead to reduced brain function later in life and that even one traumatic brain injury can yield a long-term deficit in brain function, especially in the areas of attention and completion of complex tasks.

Published in the Journal of Neurotrauma, the UK-based “Protect” study looked at 15,000 participants aged 50-90 who had reported incidents of concussion earlier in their lives. The data collected was from annual computerized tests for brain function that participants completed over the course of up to 25 years. Researchers found that those who reported 3 or more concussions had significantly worse cognitive function.

After the fourth incident, processing speed and working memory especially deteriorated. Each additional concussion, no matter how mild, contributed to worsening cognitive ability. Research showed that for some, even one single concussion could lead to long-term later-in-life problems. The study concluded with a strong caveat that persons having sustained any moderate to severe concussion should be counseled to avoid sports or other activities risky for taking a blow to the head.

As concussion has also been associated with an increased risk of dementia, the new data highlighting the deterioration of brain function after an injury is coming at a crucial time not just for athletes in a world that loves competitive intensity, but for an aging population that grew up in a timeless aware of the dangers of head injury.

Symptoms and unpredictable recovery

Each concussion has its own constellation of symptoms that occur on their own timeline.

The word concussion comes from the Latin concutere, which means to shake violently. The brain swims in a bath of shock-absorbing spinal fluid and is encased in the protective bony skull, a system that works well to protect the gray matter when a mild bump of the head occurs. However, when the impact is great enough, the brain bounces repeatedly off the inner wall of the skull and can be bruised or sustain damage to the nerves and blood vessels vital to proper function.

The event can cause a variety of symptoms, such as brain fog, confusion, slurred speech, nausea and vomiting, blurred vision, hypersensitivity to noise or light, personality changes, fatigue, memory issues, etc.

While most people will make a full recovery from a mild one-time concussion, evidence showing that might not always be the case is growing. Each concussion has its own constellation of symptoms that occur on their own timeline.

Underestimating the impact

Despite an upgrade in the rigor of on-the-spot testing in sporting events and in workplaces and recreation venues, dangerous incidents continue to slip through the cracks. In the case of an NFL occurrence, language was changed to add the term ataxia (impaired balance or coordination that can be caused by concussion) to the list of symptoms requiring removal from play.

Earlier this season a Miami Dolphins quarterback wobbled upon arising from hitting the back of his head hard on the ground after taking a late hit. It was a symptom that could have suggested concussion except when the player told the Docs it was an aggravated back injury they took his word for it and let him resume playing. Four days later he ended up on the concussion injured list after banging his head again and will miss playing until he passes all the screenings to determine he is healthy again.

Formerly, any such impairment of balance as the Miami player showed could be written off as an orthopedic issue and the player would return to action, as happened with the self-reported back-injury recurrence. Now that the word “ataxia” has been added to the list of symptoms that exclude a player from returning to the field, the player would automatically be removed.

players who’ve sustained a blow to the noggin should be tracked for several weeks.

In the case of Anthony Rizzo, New York Yankees first baseman, manager Aaron Boone says Rizzo passed all the tests given at the time of a violent collision with San Diego Padre Fernando Tatis, Jr. last May 28. However, Rizzo has felt tired and sluggish off and on for two months as his offensive statistics have plummeted. When he finally admitted to his manager that he felt unwell, a series of tests revealed significantly impaired reaction time, not good news for someone who makes his living hitting 100 mph fastballs. Rizzo is now on the bench being treated with supplements by a Doc confident of recovery.

Perhaps in addition to on-the-spot checks during games, and stricter language filtering out more risky symptoms, players who’ve sustained a blow to the noggin should be tracked for several weeks to make sure Rizzo’s post-concussion syndrome does not become a more common outcome of head injuries evaluated too quickly on the sidelines.

And what can we say about a culture in which players are so willing to sacrifice their health to get back in the game, even though we have learned so much about the dangers of concussion?

As knowledge grows on the topic of concussions it makes much more sense to go out of your way to protect yourself, especially if you’ve already had one or more concussions. If you are experiencing cognitive symptoms you can’t quite figure out, see your provider to discover whether some testing might be appropriate. Meanwhile, wear your helmet!

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.