No Such Thing As A “Mild” Concussion

12 May

Hogwash!  There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors need to reassess how we describe this particular injury.

During my public speaking I often relate being “mildly” concussed to being “mildly” pregnant…  You are either concussed or not, just like you are pregnant or not.

Some may say that “the symptoms are mild”, or that the “prognosis of the injury is mild”, in terms of being sidelined.  The first may be correct the second is a slap in the face of those that study and deal with concussions on a daily basis.  So the symptoms are mild; no headache, slight vision issues, just “foggy”…  SO WHAT!!!  The insult to the brain that occurred has created a problem, a problem that we currently in the medical field cannot “fix”, not with tape, pharmaceuticals, or surgery.  And anyone that has ever dealt with a concussion or handles them in a management role (this guy) knows that traumatic brain injuries do not recover at a pre-set rate.  It is not a broken bone that will heal in 4-6 weeks, we are talking about the brain.  A frontier that both research and education have not even scratched the surface on.  For everything we know about the human brain there are about 1,000 things we have no clue of, making this injury much more than “mild” in any form.  Counterproductive.

Others say may say “everyone understands mild is about the symptoms”, um WRONG.  Being in a high school setting we deal with parents all the time and when a player is concussed there are a lot of instances where the parent will say “It’s just a mild concussion, right?”  ARGHHHH.  Then I have to spend the next 10 minutes telling the parent why, even though his/her kid feels “OK”, that this is a problem that we must stay on top of.  My other favorite is “Well ‘insert NFL’er here’ had a concussion and was out only 3 days, his was mild, may son/daughter doesn’t have a headache only has problem with loud noises/bright lights.”  ARGHHHH again!  Using terms that diminish what is actually happening with the injury makes the job a lot harder.  Constantly dealing with the stigma of “bell rung” is one thing but dealing with expectations due to a simple term of “mild” is outright maddening.  If we all remember Sidney Crosby was listed as a mild concussion as well; he missed five months.

Finally the term “mild” also has connotations of ease, when it comes to recovery.  As mentioned above concussion recovery is very dynamic, and as I have posted before, instead of a liner recovery it is more like a sinus wave.  Those dealing with concussions will have good days and bad days then great days and feel recovered only to be back to about “square 3″ after a stressful day at school/work.  The 3rd International Conference on Concussions in Sport dismissed and took out the terms “simple” and “complex” when describing this injury, just for that reason alone.

For the sake of confusion and simplicity why don’t we all just use the term “concussion” for now.  I do believe that Traumatic Brain Injury is more descriptive, and a post for another day.  If you know of someone who is concussed and were told it was “mild” let them know that is not the case for most.  Then find the MD/DO, health care provider that told them that and forward this post to them.  It is one word, carries along with it a certain level of seriousness and along with current educational efforts means more now than every before.  Putting the tag of “mild” on it only makes all efforts in vain.

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11 Responses to “No Such Thing As A “Mild” Concussion”

  1. John Gonoude May 12, 2011 at 11:14 #

    great post, Dustin… i agree with you in every aspect of this read, and stand strong to the same belief that you hold. my first diagnosed concussion was consider to be “mild,” and less than a week later i took another hit during football practice that essentially delivered me to a hospital bed… the word itself complicates all efforts calling attention to this injury, and paves avenues that allow for self-diagnosis, rejection of advice, and the feelings of “i can play with this.” redundancy matters here: a concussion is a brain injury… how mild could that be?

    • Craig French May 12, 2011 at 15:35 #

      Dustin,

      I agree with your sentiments viz. people misunderstanding if the word “mild” is used. But just to play devil’s advocate here, how would you propose distinguishing between the two following TBI scenarios:

      A) Joe, a professional hockey player, takes a legal hit to the body yet sees stars, stumbles to the ice momentarily, and is taken off the ice to be evaluated in the training room. Joe remains conscious, answers all of the Maddocks questions correctly, has no coma symptoms, passes the BESS tests flawlessly and breezes through the coordination, orientation, memory and concentration tests, ending with a SAC score of 29 (out of 30) and a SCAT2 score of 94 (out of 100). The next day Joe feels fine but because he wasn’t 100% on SCAT2 the team physician runs him through ImPACT where he scores the same score as his pre-season baseline ImPACT score. Joe takes a week of complete rest with no activity and then gradually works his way back into light then heavy training over the next 3 weeks and comes back to play a month later, with no further issues;

      B) Timmy, a 12-year old first-year peewee hockey player, gets cross-checked and goes headfirst into the boards, and gets taken off the ice unconscious; at the hospital the ER doc evaluates Timmy using the Glasgow coma scale and he scores 7 (out of 15) with deficits in all 3 areas; skull x-ray indicates no fracture but MRI reveals internal bleeding which subsides without surgery over the next week; leaving the hospital after 2 weeks, Timmy is referred back to the neoropsychologist who provided the team ImPACT tests in the pre-season and scores at 50% of his baseline; Timmy misses the rest of the hockey season and the rest of his schoolyear is also missed as he recovers with further bedrest at home. Timmy continues to suffer terrible headaches as well as memory and vision problems which slowly subside over the following year.

      Is it unreasonable to say that Timmy suffered a “severe” concussion and Joe suffered a “mild” concussion? If so, how would you suggest we distinguish between two such vastly different injuries in a reasonably informative manner?

      It is a great blog you have, thanks for all your efforts.

      Best,

      Craig

      • Dustin Fink May 12, 2011 at 15:52 #

        Timmy had a brain bleed, possibly a subdural hematoma, more consistent with a TBI (rather than a mTBI/concussion) a VERY DIFFERENT injury. That not withstanding; both players suffered a concussion, period.

        Joe recovered quickly due to the “mild symptoms of the concussion”, while Timmy was dealing with “more complex and severe symptoms” of a concussion.

        Either way both players sustained a concussion. Inserting the symptoms would be the best way. However the issue is that if we tag something “mild” the expectation will be recovery in a week, while a severe may be career ending… I have personally seen both ends of the spectrum you elude to and both recovered in the exact opposite fashion of expectations (the “mild” one continues to be out 22 months later, while the severe one was released by a neurosurgeon 3 weeks post injury).

        When someone breaks a bone, do we say Joe and Timmy broke their collar bone, or do we say Joe is recovering from a non-displaced fracture of the clavicle where Timmy had a spiral fracture requiring a non-surgical approach… Joe is out 4 weeks, while Timmy is out 8 weeks…

        Just saying…

        Thanks for the question, and thanks for reading, these questions you propose is one of the reasons I do this…

  2. Craig French May 17, 2011 at 11:11 #

    Maybe another, even larger, problem with the medical nomenclature is that concussions of any sort are often defined as “mild TBI”. As in “If it’s mild, what’s the big deal? he got his bell rung, get back out there!”

  3. Michael Hopper May 17, 2011 at 13:15 #

    Craig, I would agree with you. I will never refer to a concussion as a “mild” injury. I had that argument with a gentleman the other day. He brought up a very similar scenario to what is posted above and did not want to understand what I kept telling him.

    A concussion is a brain injury and a brain injury is a BIG DEAL!

  4. Charles Hamilton September 9, 2012 at 18:24 #

    I am aware that when a person gets a concussion, the brain tissue gets slightly bruised. Also if they never allow the tissue to heal properly, the constant bruising that piles on will cause irreparable damage due to the tissue constantly recieving bruising without ever heaingl properly. Mild second impact syndrome is largley to blame for the additional bruising. Mild concussion is regards with the severity of the symptoms. Symptoms from a mild concussion will subside quicker, even post concussion syndrom. Brain tissue will heal if given the proper time and care. When a player returns to action too soon, he usually will bruise tissue that is already bruised. If this happens on multiple occasions, the constant bruising will weaken the tissue, and the constant beating with no healing will cause serious damage to neurological pathways, and the swelling of the tissue will damage the cells inside the tissue which will cause the tissue to diteriarate at 10 times the rate of normal tissue.

    • elder September 11, 2012 at 20:03 #

      CH, thanks for that info. Everything I keep reading is saying what
      you have stated and far more. Irreversible damage even with one
      concussion.

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