As the lecture and speaking season is in full swing for professionals I feel it is a good time to dig up a post that unfortunately needs repeating, it is about “Mild Concussions”.
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 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 than 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.
The Concussion Blog 
Thanks for re-posting. Rest is important for recovery from a concussion, and those told they have a “mild” concussion may not get the rest they need (time away from school, electronics, etc.).
Your post reminded me of an article I recenlty read (note the “tip of the iceberg” quote):
http://www.theglobeandmail.com/sports/striving-for-a-breakthrough-in-sports-concussions-research/article4230712/
Charles Tator, CM, MD, PhD, FRCSC FACS, neurosurgeon at Toronto Western Hospital, professor at the University of Toronto, founder of ThinkFirst Canada, will be celebrated and thanked for the decades of work he has done on brain injuries and the mysterious effects of concussion.
There is likely no one who knows more about hockey concussions than Tator, and yet he would be first to admit he knows next to nothing at all.
“We know only the tip of the iceberg,” he says. “There remains a huge amount we do not know.”
The Pop Warner announcement has certainly gotten a lot of attention. I hope the trickle down approach to safety (where steps taken by the NFL slowly trickle down to the lower levels over a period of years), eventually gets flipped, and that there will be more studies and precautions taken at the youth level. It’s somewhat amazing that a helmet impact study was not conducted at the pee wee level until this past fall.
http://www.csmonitor.com/USA/Sports/2012/0614/Why-Bear-Bryant-might-not-have-liked-Pop-Warner-s-new-concussion-rules
“It is an attempt to instill a new normal for coaches at the lowest levels, who “a lot times … coach like they were coached 20 years ago” – denying kids water breaks and running rough drills to teach toughness, says Kevin Wright, coach of the Carmel Greyhounds, last year’s Indiana high school state champions.”
““What you have to do is change the rules, helmets are not going to do it,” says Rosanna Sabini, a doctor of osteopathic medicine at Southside Hospital on Long Island. “Eliminating the drills that lead to injury will limit the number of concussions, and this is certainly a step forward.””
http://www.nytimes.com/2012/06/15/sports/pop-warner-football-rules-limiting-contact-raise-new-questions.html
“Results showed that about 95 percent of the impacts were between 15 and 20 g’s — what Duma likened to an “aggressive pillow fight.” The other 5 percent spiked to 50 to 100 g’s — what Duma characterized as a “car accident.””
““There’s much more that we don’t know, than what we do know,” Guskiewicz said about football’s impact on head injuries. Pop Warner has decided to wait for more definitive proof before issuing even more restrictive rules. Guskiewicz said it could take another four or five years before research determines the short-term effects, and the length of an adult life to determine the resulting cause of depression or dementia.”
Found this story concerning:
http://www.foxnews.com/sports/2012/06/15/nfl-concussion-concerns-prompt-youth-football-changes/
“Brad Wenzel watched in agony as his son took a heavy hit.
“He was rolling out to do a pass, and this monster … came over and leveled him, and his head popped up off the Astroturf twice,” Wenzel said.
“It put a little knock in my head,” his son Preston added. “And it hurt, a lot. But I got up and shook it off.”
But not everyone does shake it off.”
http://www.thepeterboroughexaminer.com/2012/06/14/learning-about-concussions
“Brody McBain suffered his second concussion when he took a late hit in a Peterborough Lakers Midget 1 game May 17.
The 14-year-old St. Peter’s High School student’s first concussion, two years ago, was also lacrosse-related.
“Right now I’m feeling all right, but I still have occasional headaches and it’s hard for me to focus sometimes,” he said Thursday at an open house hosted by the Youth Sports Concussion Program.”
ESPN radio on Pop Warner changes … don’t listen to “meathead guy” … a good thing “trying to save football, not kill it” ….
http://espn.go.com/espn/story/_/id/8046203/pop-warner-toughens-safety-measures-limiting-contact-practice
Dustin … were you looking for some doctors in IL to help with your IHSA project to reduce concussions/subconcussive impacts? Perhaps some of the doctors involved with the “Hidden Injury” series would be supportive of your initiative. (I’ve read a number of the articles in the series, and think it’s been great so far – the paper serves Dixon, Sterling and Rock Falls, Illinois.)
http://www.saukvalley.com/2012/06/08/the-hidden-injury-state-rules-provide-foundation-for-growth-in-athletes-safety/ay059jo/
“The law adopted in Illinois requires each school board to adopt a concussion policy that complies with IHSA guidelines.
The missing element? The criteria by which athletes are cleared to return to action.
Dr. Michael DeFranco, an orthopaedic surgeon and sports medicine specialist at CGH Medical Center, has worked hard with others to establish that criteria.
“Concussions are not an issue we want to be reactive about,” DeFranco said. “It’s something we want to be proactive about. We believe that the medical care begins before any season starts.”
DeFranco has worked the past 7 months to establish the Sports Concussion Program for CGH. It closely follows a template in place for years at Newman Central Catholic High School. Newman teacher and coach Andy Accardi and Dr. Joseph Welty, a family practice physician at KSB Hospital, have shepherded that program.”
Sauk Valley video, interview with Dr. Michael DeFranco, an orthopaedic surgeon at CGH Medical Center in Sterling, Ill., who specializes in sports medicine.
http://www.saukvalley.com/articles/video/2012/06/08/38452628/index.xml
Dave Pear’s blog has a link to a Terry Bradshaw interview … doesn’t suggest football for young boys … but, if he had to do it all over again, he would … knows of 6 concussions he sustained because he was totally knocked out each time … may have sustained additional brain injuries …
http://davepear.com/blog/2012/06/terry-bradshaw-talks-concussions-with-jay-leno/
“Terry Bradshaw opened up on Jay Leno’s Tonight Show once again when asked about his injuries and concussions from his years in football. Best stuff starts around 2:30 in this clip from his appearance on June 13th – “
http://aol.sportingnews.com/nfl/story/2012-06-14/terry-bradshaw-nfl-concussions-pittsburgh-steelers-head-trauma
““If I had a son today … I would not let him play football,” Bradshaw said.
As for those players like him who have already been in the NFL and have paid the price with deteriorating health, Bradshaw believes the league isn’t doing enough to help them.
“I have to be careful here because I work for FOX and NFL Network,” Bradshaw said, “But I don’t think they care. When I got out in 1983, do I think they cared about me? No. And you know what? I don’t expect them to. I don’t need them to worry about me. I take care of myself. But, do they care?
“They’re forced to care right now because, P.R.-wise, it’s not very favorable to them.””
http://www.washingtonpost.com/blogs/early-lead/post/terry-bradshaw-in-the-next-decade-we-will-not-see-football-as-it-is/2012/06/14/gJQAbAPUcV_blog.html
““There will be a time in the next decade where we will not see football as it is, I believe. I know in the state of Texas it’s the king, but I believe soccer is going to elevate itself,” Bradshaw said. “I think basketball and baseball [will as well]. Contact sports are gonna phase away. I would not want my child out there…the fear of them getting these head injuries — and they’re out there — is just too great for me. There’s too much fun to be had in athletics.””
http://www.opposingviews.com/i/sports/nfl/video-steelers-terry-bradshaw-latest-nfl-legend-who-doesn-t-want-his-kids-playing
“Much in the same way that boxing had its day in the sun as America’s most prominent sport before dying out, now it’s football’s time to shine. Sure, nobody cares about the long-term ramifications of all these hits at the moment because of how popular the NFL is, but at some point they will.
The problem here is that there is no fix for what ails football. Roger Goodell is doing his damndest to make the sport safer (despite his players’ ridiculous kicking and screaming reaction), but you can’t make a sport that revolves around tackling safer. It just doesn’t work. The thing that makes football dangerous is too deeply embedded into its DNA, too much of what also makes it great.”
Good to see … suspect the Palm Beach Post reporter asked some good questions … appreciate Dr. Dawn comstock’s comments about the “troubling knowledge gap in youth sports.”
http://blogs.palmbeachpost.com/highschoolbuzz/2012/06/15/area-pop-warner-league-to-require-injury-reports-to-prevent-concussions/
“Concerned about the lack of hard knowledge surrounding concussions in its young athletes, the area’s largest Pop Warner football organization this season will require all teams to provide detailed injury reports.”
“The decision, he said, came after talking with a Palm Beach Post reporter …”
“The news will be applauded by Dr. Dawn Comstock, who leads a concussion research team working with the National Federation of High Schools. In a January interview with The Post, Comstock said while concussion reporting at the high school level has vastly improved, there remains a troubling knowledge gap in youth sports.
“We know quite a bit about professional athletes,” Comstock said. “Quite a bit about collegiate athletes. Quite a bit about high school athletes now. We don’t know anything about youth sports.””
Health professionals to “examine possible link between brain injury and young people in the juvenile justice system.”
http://www.nbc12.com/story/18775176/brain-injury-summit-starts-in-richmond
“Concussions from football account for more than half of concussions among high school sports.
That’s from a study in the American Journal of Sports Medicine.
Those brain injuries are now the focus of a two day summit that starts Wednesday here in Richmond.
Health professionals from across the country will be here to examine the possible link between brain injury and young people in the juvenile justice system.”
http://www.medscape.com/viewarticle/764998
“The American College of Sports Medicine (ACSM) has teamed up with the US Tennis Association (USTA) in a campaign to make children’s sports less dangerous, starting with a junior version of tennis, the 2 organizations announced here at the ACSM 59th Annual Meeting.
Children are hurting themselves by playing sports too competitively at a young age, said Michael Bergeron, PhD, executive director of the new ACSM National Youth Sports Health & Safety Institute.
“We want to change the culture of youth sports,” he said at a press conference. “Injuries caused in a variety of ways are exponentially increasing.””
http://www.vch.ca/about_us/news/what-happens-when-youths-don-t-recover-quickly-from-concussion-
“The study will compare the usual standard of care (mental and physical rest) with a group of participants who are given a specific rehab program, including mild cardiac exertion, sport-specific coordination activities, and positive visualization techniques. Post-concussive symptoms, balance, and quality of life will be compared between the two groups as markers of recovery.
Youth participants age 14 to 18 will be recruited for this study on a voluntary basis through GF Strong Rehab Centre, beginning in September 2012.
Outcomes from the study will help the team develop new clinical treatment protocols, providing health care professionals with clear guidelines to promote healing and safe return to normal activity.”
http://www.medscape.com/viewarticle/764120
“Chronic Daily Headache in U.S. Soldiers After Concussion
Brett J. Theeler, MD; Frederick G. Flynn, DO; Jay C. Erickson, MD, PhD”
“One hundred ninety-six of 978 soldiers (20%) with a history of deployment-related concussion met criteria for CDH and 761 (78%) had episodic headache. Soldiers with CDH had a median of 27 headache days per month, and 46/196 (23%) reported headaches occurring every day. One hundred seven out of 196 (55%) soldiers with CDH had onset of headaches within 1 week of head trauma and thereby met the time criterion for posttraumatic headache (PTHA) compared to 253/761 (33%) soldiers with episodic headache.”
Pleased to see so much attention being paid to youth concussions:
http://www.kctv5.com/story/18803061/national-group-meets-to-address-making-sports-safer-for-young-athletes
“”I think the headline out of this meeting would be that we are still pushing science to come up with an answer in concussions in sports. The biggest wall we face to changing standards to address concussions is that there isn’t scientific agreement on what causes it,” NOCSAE Executive Director Mike Oliver said.
That’s why the National Operating Committee on Standards for Athletic Equipment is spending millions of dollars on research to help find some answers to the complex issue.
Their new research has shown that children and women get more concussions than males playing the same sport, and one of the reasons, they said, is their neck structure is weaker.
“Basically our youth are like bobble head dolls. They have large heads and weak necks and that’s a bad combination as far as brain trauma,” Dr. Robert Cantu, a neurosurgeon on the NOCSAE committee, said. “One of the major plans for the future is for NOCSAE to come out with a youth football helmet standard – a standard tailored to the youth taking into consideration the particular needs of youth. The science isn’t there and it isn’t known how to do this in a scientific way.””
If I read this correctly, McKee is expected to publish another paper:
http://www.kansascity.com/2012/06/15/3660609/concussions-are-a-big-concern.html
McKee, who also recently found a link between concussions and ALS (Lou Gehrig’s Disease), is about to release more information related to concussions and head trauma, Cantu said, as the lead author on a paper entitled Brain. The paper cites 68 cases of CTE and will be the world’s largest study on the subject.
http://blogs.houstonpress.com/hairballs/2012/06/pop_warner_concussions.php
“In essence, Pop Warner has instituted a “hit count,” an idea that has been suggested by Eric Nauman, an associate professor of mechanical engineering at Purdue University.”
Another oldie but goodie, shares a number of stories of youth athletes suffering from multiple concussions:
http://www.houstonpress.com/2011-08-18/news/knocked-out/
“When speaking to her, you wouldn’t know that Natasha, who was forced to give up an athletic scholarship to Texas State University-San Marcos, is a brain-damaged 19-year-old. “But academically,” says her mother, Micky Helmick, “everything is three times harder.””
Good article … positive sign that changes reduced the number of concussions for fall althletes from 50 to 25.
http://www.northjersey.com/englewood/Youth_sports_teams_in_North_Jersey_battle_concussion_risks.html
“Ridgewood High School’s athletic staff postponed the start of hitting in the preseason, improved hydration and heightened concussion awareness among coaches and athletes. They’ve also taken steps to comply with the state’s recently approved rules governing summer practices, which apply only at the high school level.
The changes reduced the number of concussions Ridgewood’s fall athletes suffered in 2011 from the previous year, from 50 to 25, according to school athletic trainer Nick Nicholaides.
“There needs to be a culture change in the way we look at concussions and the way [football] is played if we’re going to make a dent in the concussion issue,” Nicholaides said.”
From article linked above … well worth reading:
“Bottiglieri and Mike Prybicien, the past president of the Athletic Trainers’ Society of New Jersey and the athletic trainer at Passaic High School, advocates for athletic trainers to be on the sideline for all youth sports leagues.
Prybicien estimates 75 to 85 percent of Pop Warner programs do not employ an athletic trainer — especially at practices, where most concussions occur.
That leaves volunteer moms and dad attempting to recognize concussions with nothing more than basic first-aid training.”