Some of the most important posts will be re-published from time to time. This one was published January 2 and May 12.
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.
Seems like nothing changes if nothing changes applies here…to mild concussions
Excerpts from A Preliminary Investigation of Active and Retired NFL Players’ Knowledge of Concussions (Brady, 2004):
Physical limitations, cognitive dysfunction, personality changes, and atypical social emotional symptoms are major indicators of a concussion (Damasio, 1994; Evans 1994; Evans 1996; Prigatano, 1992). These presenting temporary and sometimes permanent symptoms exact a social cost that adversely impacts on a person’s ability to perform and successfully complete adaptive daily living tasks such as employment, school, and interpersonal/socialization skills. In addition, death may result from an athlete sustaining a concussion or multiple concussions (Cantu and Voy, 1995; Kelly, 1995; Saunders and Harbaugh, 1984).
Given the possibility of death or significant brain damage resulting from an athlete sustaining another brain injury while still demonstrating symptomatology of a previous concussion, a mild concussion does not exist (Sturmi, Smith, & Lombardo, 1998). Furthermore, the use of the term mild brain injury is a misnomer, as no brain injury should be considered minor (Kelly, 1999; Poirier & Wadsworth, 2000). Unfortunately, many individuals continue to believe concussions are minor injuries that easily heal. Common football slang such as “ding” and “had his bell rung” reflect perceptions that reinforce the notion that concussions are not serious. Vestag and Goldsmith (2002) reported neurologist, James Kelly, M.D., as saying, “language [‘dinged,’ ‘having rung your bell’] trivializes concussions to the point where people say, well, that’s not a real concussion, you do not have a concussion without unconsciousness” (p.437).
Kelly (1999) earlier pointed out that concussions, like the concussion sustained by National Hockey League player Pat LaFontaine, not only destroy athletes’ dreams and aspirations, but could also result in death. Richter’s numerous accomplishments included being named a three-time NHL All Star, and in 1997 he was one of 12 players named to the all-time USA Hockey Team.
“The silent epidemic” is a phrase that has more recently been assigned to concussions since the injury is not often directly visible (Goldstein, 1990). As the effects to the brain are subtle and difficult for the casual observer to recognize, subtle brain injury is another term utilized to describe concussions (Johnson, 2001).
Totally agreed. By the way, Didier Drogba of Chelsea (English Premiere League) suffered a “mild” concussion last month during a match. He was unconscious for 30 minutes. Still not back playing.
You are most correct sir, their is no “Mild” concussion and as an avocate for concussion awareness I am knowledgeable about the subject. However, I must admit, I did use the word in an article I wrote. Thank you for reminding me, I apoligise for my error and will correct it. thanks again for your posting.
Even the ‘jabs’in boxing add up,, likewise being hit by hard helmets repeatedly means damage to brain tissues. ,! Damage that often accumulates into life changng issues.
A corrective design concept for less damaging helmets can be viewed at Herculeshelmet.com.