This post was written originally in 2011, but has been re-posted numerous times, it will continue to be posted until we all get the message…
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.
When public speaking I often times compare a mild concussion to being mildly pregnant. It is rather simple you are concussed or you are not, just like being pregnant.
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.
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 the 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.
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.
Absolutely agree Dustin, good post. Perhaps “mild” is a fossil in the lexicon from the pre-2008 days when coaches, trainers and doctors used the concussion grading system. On a separate note, it is also perplexing that coaches still have a “was it diagnosed as a concussion by the player’s doctor?” mentality — if the player hit his helmet and that stopped play or the practice, the coach needs to ask the Maddocks questions immediately (takes, say 20 seconds for 5 questions) and the player HAS a concussion if the score is anything but 0; additionally, after the Maddocks questions, with the player off the field or rink, the coach, an assistant coach, trainer or parent needs to ask the 22 symptoms graded 0-6 and the player HAS a concussion if the weighted sum is anything other than 0. They should be taught this in the coaching clinics. It is up to the coaches to be responsible here since they are the first responders; then they can wait for the physician to subsequently provide a “clear to return to play” authorization. For a coach to ask a parent if the player was diagnosed by a doctor with concussion after just witnessing it occur in a game or practice is akin to British Petroleum asking the Coast Guard if one of their drilling rigs is leaking in the Gulf.
Great post Dustin – very important considerations, here.
I think one of the things that causes people to go into “mild” concussion denial mindsets, is that brain injuries are quite scary to people, and we don’t hear as much about true recovery over the long term. When people hang their hats — and their futures — and their whole self-image on being an athlete or the parent of an athlete, when you suggest that that athlete may have had a life-altering injury (which concussion can be), it scares the bejesus out of people, their biochemical stress reactions start pumping, and complex thought and reasoning becomes well nigh impossible.
I personally believe that it’s as important to talk about REAL recovery from concussion/mild traumatic brain injury (in this case “mild” refers to the injury, itself, NOT the long-term effects, which can in some cases be more major than those from a moderate or severe brain injury — go figure). Having the pro’s talk about being out for 3 days, and then going right back in the game… or how they’ve had x-number of concussions in their careers, and it never held them back.
Of course, this is all changing rapidly, as more people become more aware. I think the best we can do is just to keep talking about these issues, and making our mark in the world with the right information and correcting mis-information.
Thank you for your work in this. Your voice is needed now, more than ever.
Reblogged this on Broken Brain – Brilliant Mind and commented:
Dustin Fink’s great blog about calling any concussion “mild” — it’s like being “mildly” pregnant. Great analogy.
another one that i heard in emergency rooms. you’ll be ok it’s only a concussion. seriously.
that was 27 plus years ago. but i remember because i felt so relieved. again maybe in that particular case if i never had many concussions then it would have been and should have been felt as relief. but ‘mild” and “only” are far from saying it’s ok or no future problems.