Concussions in Sports

Contact sports like football and soccer often involve high-speed collisions that can result in player concussions. Concussions happen when the brain gets jostled inside the skull during an impact like a blow to the head. Sudden, hard hits to the body can cause enough rapid movement within the skull to damage the brain.

Most concussions go unreported because the symptoms aren’t understood by parents, coaches, or players. Youth, college, and professional sports organizations now have concussion protocols that are mandated to follow. Even so, sport concussion statistics are both startling and serious.

What are Concussions?

Concussions are traumatic brain injuries, known as TBIs. These TBIs tend to be mild injuries that allow recovery over a period of days or weeks. However, repeated concussions can seriously harm the brain causing long-term aftereffects. Left untreated, concussions can result in brain damage that affects a person’s quality of life, and in rare cases, they can be fatal. ²

Concussions may also affect brain function. Someone suffering from a concussion may not be able to think, concentrate, or react well when faced with situations that involve rapid decision-making, like driving. Both working and long-term memory may be impaired.

Concussions may affect emotions. This could manifest itself in depression and mood swings. Personality changes may also be evident.

Concussions may affect a person physically. They may suffer from headaches, light sensitivity, dizziness or vertigo, sleep issues beyond excess fatigue, or seizures. Most concussions do not cause unconsciousness.

Although common, concussions always require medical attention. However, over half of concussions go undiagnosed, meaning that 50 percent of all concussions aren’t getting the needed medical attention.

The NCSS and Sports-Related Concussions

While true that not every bang on the head or body slam will result in a concussion, athletes will play sports under a national concussion protocol. This protocol was implemented when The Traumatic Brain Injury Program Reauthorization Act of 2018 was signed into law on December 21, 2018.⁵ The National Concussion Surveillance System (NCSS) allowed the Centers for Disease Control (CDC) to determine how many children and adults receive a concussion and how they receive it.⁴

The NCSS provisions include gathering the following sports-related concussion data:

• National estimates regarding concussions among youth inside and outside organized sports and monitor concussion trends.
• Establish whether current sports-related concussion protocols and prevention efforts are working, including identifying return to work or return to sports recovery needs that are not being met.
• Give healthcare providers, and hospitals insights about the patients seeking care for concussions and their recovery needs to minimize barriers to care.

The NCSS also collects data on concussions outside of sports, traumatic brain injury, and resulting disabilities. Current data only covers 1 in 9 concussions throughout the United States in any given year, which is a crucial reason for concussion protocols and data gathering.

Somebody’s getting the message. Even though half of all concussions are still going undetected or unreported, the American Academy of Pediatrics states that there has been a rise in emergency room visits in the past decade:

• The ER rate for youth ages 8 to 13 with concussions doubled.
• Teens 14 to 19 years old have seen a 200 percent rise in diagnosed concussions.
• High school football accounts for nearly half of all high school sports-related concussions. One-third of those concussions happen during practice.

The good news in this is that more concussions are beginning to be diagnosed and that the symptoms of concussions are being more recognized. That fact aside, 1 in 5 athletes playing a contact sport will get a concussion this year. Youth and high school football see around 300,000 concussions each year, while girl’s soccer and girl’s basketball rank second and third in high school contact sport concussions.

The National Collegiate Athletic Association (NCAA) Injury Surveillance Program assesses 25 collegiate sports to gather data on concussions, much like the NCSS does for sports nationwide. For collegiate football, for instance, the NCAA has found that:

• 34 percent of college football players have suffered a concussion
• 30 percent of college football players have suffered more than one concussion
• 12.2 percent have suffered a concussion through a tackle injury

The NCAA has put together an NCAA Concussion Fact Sheet to help athletes understand and recognize the symptoms of a concussion in both themselves and their teammates, as well as concussion protocols and return-to-play requirements.⁹

Concussions have gotten a lot of press in the professional sports world in recent years. Athletes like Denver Broncos offensive guard Ryan Miller was diagnosed with post-concussion syndrome after suffering a career-ending concussion in 2015.⁸ Team USA’s Josephine Pucci ice hockey career was also cut short due to multiple concussions and post-concussion syndrome.

Many professional athletes, especially in football, have been diagnosed with chronic traumatic encephalopathy (CTE).¹⁰ CTE has gotten much attention recently as several high-profile football players have been diagnosed with the neurodegenerative disease. Those players suffered from repeated concussions during their careers. They develop CTE later in life, exacerbating mental health disorders and the onset of diseases like ALS (Lou Gehrig’s disease) and Alzheimer’s.

Professional football players who died from CTE in recent years include well-known running back and sports commentator Frank Gifford.⁶ CTE is just one reason the medical and sports communities have come together to educate health professionals, athletes, and their families about early concussions and the cumulative effects of multiple concussions.

How are Sports Concussions Diagnosed?

Contrary to popular belief, concussions aren’t brain bruises. Bruising means bleeding somewhere inside the brain, causing the bruise. Concussions do not cause the brain to bleed.

Concussions change how brain cells function on a microscopic level. While imaging is helpful to ascertain whether surgery after a concussion is needed, for instance, it won’t show microcellular brain damage. Neurological and cognitive testing will be more helpful in diagnosing both mild and severe concussions.

Neurological evaluations check for vision disturbances, hearing, body sensation, balance and coordination, and reflexes. Concussions may involve the cranial nerves, which emanate from the brain stem. Concussions affect the nervous system, which is why neurological testing helps diagnose concussions.

Cognitive evaluations involve working memory, information recall, and concentration. When brain cells are injured, neural pathways can be interrupted, causing a loss of cognitive function. This is usually temporary but can be long-term.

Computed Tomography (CT) scans assess complications of concussions right after the occurrence. Magnetic resonance imaging (MRIs) identifies macro-changes in the brain and diagnoses other conditions related to the concussion. However, CTs, MRIs, or X-rays will only show things like skull fractures or physical brain anomalies.

Electroencephalograms, better known as EEGs, monitor brain waves after a concussion. Using electrodes hooked up to the head, an EEG records the electrical impulses in the brain in real-time. EEGs can record interruptions such as seizures after a concussion but will likely appear normal for the concussion alone.

Physicians use an Acute Concussion Evaluation (ACE) form to conduct their initial evaluations of children and adults with suspected concussions.⁷ This provides documentation that aids in clinical protocols and adds to concussion data gathered by the medical community.

Evaluations will include:

Injury characteristics: description of the injury and how it occurred, loss of memory (amnesia), loss of consciousness, seizures, early signs of concussion observed by others

Symptom checklist: the four symptom categories are physical, cognitive, emotional, and sleep. Part of the symptom checklist is if symptoms worsen upon physical or cognitive activity or if the injured individual is acting differently than usual. The symptom scores are rated as a “0” for symptoms, not present and a “1” for symptom present. The symptom checklist score ranges from 0 to 22.

Risk factors for recovery include a history of concussions, headaches, developmental disability, and psychiatric history, including medications and other co-existing disorders. This category serves to identify risk factors that would negatively affect recovery.

Red flags of neurological deterioration include SUDDEN ONSET of symptoms that merit acute emergency attention, such as slurred speech, repeated vomiting, seizures, worsening headaches, and loss of consciousness.

Diagnosis with insurance coding, also known as ICD diagnostic codes:

• Concussion with no loss of consciousness
• Concussion with less than one-hour loss of consciousness
• Concussion that is unspecified or unclear
• Other diagnoses that emanate from a traumatic brain injury

Follow-up action plan, which may include patient monitoring or specialist referral.

The ACE concussion form plays a vital role in holistically evaluating mild traumatic brain injury or concussion, as symptoms are notoriously difficult to recognize and assess.

Recognizing the Symptoms of Sports-Related Concussions

It can be challenging to recognize the symptoms of a sports-related concussion because, often, the symptoms don’t appear immediately following contact, although some signs do. Confusion is one of those symptoms that may happen immediately after hard contact.

The player may appear stunned or dazed, not seeming to know where they are, who they are playing, remembering plays, or the score. They may need help to think clearly and answer questions slowly. They may also need help knowing what day it is or knowing their name.

Other symptoms include:

• Short-term memory loss
• Vision disturbances and light sensitivity
• Balance issues, dizziness, or clumsiness
• Headache or ringing in the ears
• Nausea and vomiting
• Sensory issues like loss of smell or taste

Each of these symptoms, whether singly or together, merit sitting out and getting checked out by a physician or trainer. These symptoms tend to go away quickly or in a few hours. However, some may last a few days or weeks after contact, whether or not a concussion has been diagnosed.

Post-concussion symptoms can elicit sleep difficulties, abnormal fatigue, headaches, and cognitive issues. Personality issues like mood swings and irritability may elude parents and coaches of teenagers as they may be easily mistaken for a normal adolescence.

Sports Concussion Treatment

It’s imperative to get medical care following any kind of head injury. First and foremost, the athlete should be immediately removed from current play. Concussion protocol prohibits returning to play until cleared by a physician or neurologist.³

Concussion treatment includes rest and the monitoring of symptoms.¹ Ask your doctor about pain relievers for headaches, as over-the-counter medications like ibuprofen or aspirin can increase the risk of a brain bleed.

If the concussion is severe or an athlete exhibits symptoms of post-concussion syndrome, further treatment may be necessary. This may include both physical and occupational therapy. Mental health professionals may be needed for psychological or psychiatric support.

The brain is the nerve center for all bodily functions. It contains over 90 billion neurons producing enough electricity to light up light bulbs. Each nerve cell or neuron is covered by a myelin sheath that insulates it. When neurotransmitters are stimulated by electrical impulses, that insulation creates increased communication between brain cells, alleviating various post-concussion symptoms.

So, in addition to traditional concussion and post-concussion treatments, advances in neurobiology can use that increased communication between neurons to treat post-concussion symptoms in innovative, non-invasive, drug-free ways using TMS.

Sports Concussion Treatment With Brain Therapy TMS

Most patients experiencing a concussion will feel better or asymptomatic within three months. Up to a quarter, however, may experience post-concussion symptoms beyond that three-month threshold, many being symptomatic for years.

Headache is the most common symptom that hangs on beyond the initial concussion. There’s no cure for post-concussion symptoms, but there may be help available with brain therapy, most notably transcranial magnetic stimulation (TMS), also referred to as repetitive transcranial magnetic stimulation (rTMS).

TMS changes neural activity to treat mental health disorders like depression and neurological conditions like migraines and sleep disorders. TMS, a non-invasive procedure, is also being investigated in its use to treat concussions. It works on neural pathways by delivering magnetic pulses to the brain.

TMS works by stimulating the brain’s prefrontal cortex. The prefrontal cortex is responsible for cognitive function and control, responsible for things like executive function, working memory, and emotion.

By placing a magnetic coil over the scalp, repetitive magnetic pulses flow through the coil and enter the brain, targeting the prefrontal cortex. This is called neuromodulation therapy, a drug-free therapy. The brain’s neurons are activated in ways that either increase or decrease electrical activity that may alleviate post-concussion syndrome symptoms over time.

One current clinical trial explores whether rTMS significantly improves post-concussion symptoms.¹¹ Still in the recruitment phase, the study will work to determine the relationship between brain function and certain rTMS treatment markers that predict treatment responses for such post-concussion symptoms like depression.

The U.S. Food and Drug Administration (FDA) approved TMS treatment for depression in 2008. Since then, patients have found relief for symptoms of treatment-resistant depression through TMS treatment. Advances in TMS therapy for post-concussion signs continue to be researched.

No longer are post-concussion symptoms being just managed or suppressed by medication. Post-concussion symptoms are now being targeted at their core. TMS is relatively painless with little or no side effects. It is also readily available and covered by most insurances – and it is an effective post-concussion treatment for athletes and anyone who suffers from the aftermath of a concussion.

Brain Therapy TMS Can Help

Concussions can affect an athlete’s quality of life for years. TMS doesn’t treat the concussion itself, but the symptoms of concussion can significantly affect an athlete’s activities of daily living. By rendering electrical impulses to the brain’s core that harbors the signs, Brain Therapy TMS offers post-concussion patients targeted relief that, for many, is a game-changer.

Brain Therapy TMS is a recognized leader in TMS therapy in Southern California. We treat depression, dementia, chronic pain, and other mental health disorders. If you’ve suffered the often debilitating aftereffects of a concussion, contact us to schedule a free consultation.