STOP The Madness

8 Oct

That was the subject line in an email I received this morning, from a mom, and she is right.  It must be stopped and if anyone continues to do it they should be called out by the press or others.  We are speaking of the headlines around Robert Griffin, III and his traumatic brain injury yesterday.  They all seem to say the same thing.

RGIII has mild concussion

If not in the headline it is in the body and particularly by head coach Mike Shanahan when discussing the issues surrounding the injury;

“He wasn’t sure what quarter it was in the third quarter. So at that time, when he wasn’t really sure what the score was, what the quarter was, we knew he had a mild concussion — at least according to the doctors,” Redskins coach Mike Shanahan said after his team fell to 2-3. “It feels good right now; a lot better right now. But that was … why he didn’t go back into the game.”

There is nothing that grates on me more than that term being used.  I used to get angry and yell at the TV and send emails but that does not work. At least one writer understands this (and perhaps has read my previous posts on it);

Concussions aren’t chicken wing flavors. Calling something a “mild concussion” is like telling someone that your wife is “kind of pregnant.” A concussion is, medically speaking, known as TBI. That stands for Traumatic Brain Injury. Not mild brain injury, spicy brain injury or Caribbean jerk brain injury. Traumatic brain injury.

The term “mild,” within the context of concussions isn’t even mean to say that a concussion is less damaging. In fact, the only reason that the term mild is thrown around by doctors and health care professionals is because it’s not life-threatening.

I guess I will just repost the blog about “mild” concussions and hope that it doesn’t fall on deaf ears/eyes.

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, my son/daughter doesn’t have a headache only has a 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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6 Responses to “STOP The Madness”

  1. lifeafterthegame October 8, 2012 at 09:45 #

    And on my blog, I will be dissecting the chaos that took place in KC yesterday.

  2. Pamela L October 8, 2012 at 16:39 #

    I think I love you. I am a high school nurse that follows all of the kids with concussions in our school of 3200 kiddos. I yell at the TV often and sometimes the hubby won’t let me watch…so hard to educate when the “professionals” minimize

  3. Michael Hopper October 8, 2012 at 19:12 #

    I had a kid “get his bell rung” during pre-season. 6 weeks later he finally got to put the pads back on…

  4. DMATC October 10, 2012 at 14:42 #

    By the way, RGIII was cleared to return to practice today. Two days after his injury. It’s a Festivus miracle!!

    Seriously, though….is anyone shocked? I am not.

  5. Tommy Dean (@CSolutionsLLC) October 12, 2012 at 09:48 #

    Dustin,
    I am currently managing two (female) volleyball players on the same team that have sustained concussions. This is on a team, at a school, that I had to convince the athletic director to implement baseline testing because of the potential of brain injury in the sport. He finally (reluctantly) bought in after being skeptical and now I can’t get him to stop talking about how good our program is. Indeed, a very good problem to have. But my original point of replying was to add to the parental conversation piece that becomes exhausting at the least. Parents, in my opinion, make too many comments and decisions based on emotion and not facts. This is the obvious problem that unfortunately has no solution. I think most are fearful of public ridicule. It becomes a status war if you will. This is a wealthy private school by the way. I had one of the conversations you mentioned above just yesterday. The girl took an elbow to the head two weeks ago this Saturday. Long story short she did progress well, and started a gradual return. The very next day she became symptomatic. Mom and Dad stood outside of the gym with me yesterday (the coach was present) and tried to use the physicians note that they had received two weeks ago that said “no play for two weeks” in their argument. They didn’t care that the daughter was symptomatic again, only that they were trying to get her ready for a game on Saturday because that’s what the note said. In the end, the coach had my back and understood the game plan and I emerged victorious in the conversation. Because it’s the right thing and emotion cannot be the driving force in these cases.

    Tommy

    • Dustin Fink October 14, 2012 at 21:29 #

      Tommy,

      Great that you are getting the backing you need… If you could just get everyone on the same page! You know where to find me!

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