When I saw the tweet from Greg Rosenthal yesterday “ @greggrosenthal The NFL should fine coaches for the use of the term “mild concussion.” All I could think of was this post.
Originally posted in 2010
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 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.
The Concussion Blog 
Reblogged this on Broken Brain – Brilliant Mind and commented:
What Dustin said…
I have stopped referring my child’s injury as a “concussion” because everyone assumes it is mild and treats him accordingly. I agree that the most appropriate terminology is “Traumatic Brain Injury”. It speaks to the true nature of the injury and causes “bystanders” in the life of the injured athlete to take it a little more seriously. It has been more than a year and a half since I was told in the E.R. that my child suffered a “mild concussion” and let me tell you. There has been nothing “mild” about it. Every TBI should be taken seriously.
Every injury to the brain should be referred to as traumatic brain injury. We should drop both the “mild” and “concussion”, because it’s not taken seriously. It’s difficult enough to educate with “traumatic brain injury” but anything suggestive of “mild” will never be taken seriously by the general public, let alone many professionals. We all need to be on the same page.
CTE Chronic Traumatic Encephalopathy is the proper term for repeated concussions. Would this be helpful or confusing? CTE is not just mild concussions…but can be the end result.
While a don’t disagree with your first statement for laymen, the description is necessary for the professional research community. Penetrating injuries are discrete from non-penetrating injuries; treatments and outcomes need to be classified for clinical reasons.
CTE is not a term for repeated injuries. Chronic Traumatic Encephalopathy is a fairly rare condition first identified in boxers thought to result from repeated head trauma. It is a neuroprogressive disease characterized by the propagation of p-tau (toxic tau protein) in the brain. There are many types of brain injury that can result from repeated head trauma and the promotion of CTE as the sole result of these traumas is irresponsible.
There is a need for mTBI and MTBI and TBI… Those are significant and have a much different connotation… Concussion is in the mTBI category and can also be called a closed head injury (CHI)… The term concussion is really specific to sports…
You can say there is mild traumatic brain injury (mTBI), and regular traumatic brain injury (TBI), both of those are very specific and because the concussion falls in the mTBI category the sequale should be the same…
While there may need to be a differentiation in medical diagnosis of the concussions, mTBI, TBI, etc., I do think we need to think through the words that we use to portray these injuries, especially to the public. The word dictionary definition of “minor” is “lesser in size, extent, or importance; not serious or important”. I don’t think that the athlete, professional or student, that has had to give up their sport would want their injury referred to as “minor”. I know those who struggle everyday with headaches, fatigue, memory lossn and depression would not want their injury referred to as “minor”. Yes, there are varying degrees of TBI but every TBI changes every life it touches in one way or another and we are only now beginning to understand the breadth and depth of these changes. I think we are going to have begin to consider whether there is ever an appropriate time for the word “minor” to be attached to it.
All excerpts from Brady, D., (2004) … A Preliminary Investigation…
A) Origin of the term concussion
The term concussion is derived from the Latin word concutere, which means “to shake violently” (Evans 1994). A brain may sustain a concussion from direct contact with the head or as a result of a whiplash effect and therefore without a direct blow to the head (Evans and Sharp, 1994; Alexander, 1995). Kelly and Rosenberg (1997) emphasized that the “whiplash effect” from collisions or falls creates ample force to the brain for a resultant concussion. The term called whiplash describes typical hyperextension followed by fixation of the neck” (Evans, Evans, & Sharp, 1994, p. 268).
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B) Common synonyms for concussion over the past 100 years:
Common synonyms for concussion include mild traumatic brain injury (mild TBI) and minor closed head injury (minor CHI) (Kelly, 1999). Other terms which have been utilized since last century to describe the concept of a mild brain injury include
spinal concussion, railway spine, railway brain, traumatic neurosis, nervous shock,
traumatic hysteria, traumatic hysteroneurasthenia, spinal anemia, vasomotor symptom
complex, litigation neurosis, compensation neurosis, accident neurosis, Erichsen’s disease, Friedmann’s disease, traumatic neurasthenia, the posttraumatic concussion state, the posttraumatic psychoneurotic state, traumatic encephalopathy, posttraumatic cerebral syndrome, posttraumatic syndrome, post traumatic nervous instability, postconcussion syndrome, postconcussive syndrome, postconcussional syndrome, posttraumatic stress syndrome, and a persistent postconcussive syndrome (p. 32).
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C) Use of terms Brain Injury vs Head Injury
Since the mid-1990s, the use of the term Traumatic Brain Injury (TBI) rather than head injury has been encouraged by a growing number of professionals and the Brain Injury Association of America. In 1996 the construct was also introduced into federal law (Kelly, 1999). The term Traumatic Brain Injury is viewed as a more precise explanation for the effects of a concussion. Furthermore, the term head injury could be misconstrued to mean an injury to areas of the head such as eyes, nose or mouth, and not the brain (Eschemendia & Julian, 2001).