HN: What have we learned about concussions that maybe we didn’t know a decade or two or three ago?
CT: There are about 30 things that we didn’t know just 10 years ago. For example, the adolescent brain seems to be most susceptible to concussion and takes the longest to recover. It’s rather unfortunate because that age is when kids are now big enough and fast enough that they are getting concussions—it’s also the risk-taking age.
Also, women appear to concuss more easily than men; and that holds for sports like hockey and basketball. We’re not really sure why that is but that’s what the data is telling us.
Unfortunately, there are still a lot of unanswered questions about concussions. We still don’t know the exact mechanism—although, rotational acceleration is more important in producing concussions than linear acceleration. And also, we don’t know how to detect a concussion on imaging techniques; for example, there is no telltale sign on a CAT Scan. And the MRI (magnetic resonance imaging) is still not showing us the effects of concussion. We are hopeful that some newer sequences of MRI will be more informative.
A concussion is still a clinical diagnosis, meaning that it depends on a knowledgeable examiner, like a physician, as well as a compliant patient. And not all patients are compliant; there are still people who want to hide the symptoms and signs of a concussion.
HN: How important is recognition of a concussion?
CT: All you have to do is look at Sidney Crosby—the fact that he got his first concussion on a Monday and it wasn’t recognized; and then on the Wednesday, he got his second concussion and it took a year to recover. It’s important to sit out until you’ve fully recovered and follow the six-step process of gradually incorporating more physical activity, so that your brain is ready to take another hit. If you run around the block and get a headache and get dizzy, that means your brain is not ready for the next hit and then you’re subject to the serious consequences of another concussion because your brain has not recovered fully from the first one.
I am a sports nut, that should go without saying, but one of the most exciting sports has begun its campaign. Living in Illinois, I am often reminded of who are the current keepers of Lord Stanley’s Cup but I also have a keen eye on my hometown team, the Colorado Avalanche. With all that being said I do not follow hockey nearly as well as football, or my own high school sports (our soccer team in undefeated). However, this is a sport that is also classified as a collision sport and is predisposed to disproportionate amounts of head trauma.
This season there should be some interesting findings about concussions as a confluence of a few rule changes as well as an Olympic schedule may in fact reduce the incidence of concussion, here is why;
Longer season (not strike shortened) so the players don’t feel the pressure to play so damned hard so quickly
Olympic schedule will have players worried about country over NHL when the winter gets in full swing
Fighters must keep helmets on for fights (I guess visored players cannot fight) for protection when falling to the ice
Rule 48 is in its third year, referees, players and the league have a better grasp on the outlawed hits
A group reached out to us recently to present something they are doing to help with the awareness issue. This is a common occurrence in the TCB Mailbag, however rarely do you get to see them, call it screening, as I do not want to promote just to promote, I believe that if you have a good product, plan, or story you can get on the blog.
When Chartis, an insurance company approached us they had a unique way to get their message across, a first person account from a former professional athlete. Keeping with the hockey theme I present you Nathan LaFayette and his story about concussions, as part of a promotion for aHead of the Game®. An initiative to reduce the risks of concussions and other head injuries in youth sports. Through greater awareness and education, we want to help coaches, parents and young athletes learn signs and symptoms of concussions, seek proper treatment and follow appropriate return to play protocols to avoid the significant dangers of multiple concussions.
Dr. Echlin spoke yesterday, as we blogged about, and the information he gave was startling for those that love hockey. He stated that concussions occurring in hockey may be seven times higher than in current literature.
Seventeen players had a total of 21 concussions during 52 physician-observed games, with almost one-quarter of those occurring among players involved in on-ice fights, say the researchers, whose study is published in the November issue of the journal Neurological Focus.
Dr. Echlin went on to say that 69% of the hits that caused concussions were blows to the head and 29% of the players sustained a second concussion.
Paul Melia, CEO of the Canadian Centre for Ethics in Sports in Ottawa, described the incidence of concussions in the study “alarming and disturbing” and deemed it “a siren call to action for parents, for coaches, for hockey association executives at all levels in the system.”
It is work by Dr. Echlin and others in this field that is promising for the protection of athletes. And with coverage from news outlets, the word is spreading and awareness is raising.
In no fashion should the sports we love and crave be dismantled, but the concern for concussions need to be addressed for no other purpose than the youth. The rise in concussions is something that many are trying to figure out, but awareness and education is the common theme, as well as keeping the young safe. Remember that you only have one brain.
The National Pastime in Canada has not been without its share of traumatic head injuries. For years the “tough-guy” mentality of the sport did not allow for players to concede what was happening to them. As is common with most collision sports, the fact that your head hurts after a game or a specific incident does not warrant attention from medical personnel. That stigma in hockey is beginning to change thanks to the help from Dr. Paul Echlin in Canada.
Echlin, a sports medicine specialist who has been associated with junior hockey for nine years, ascends the pulpit again in Toronto on Monday, with more accumulated evidence to make parents, coaches and hockey players pay close heed. A brain injury stays with you and can even be permanent, they will hear, as Echlin unveils the results of the independent Hockey Education Concussion Project.
In this presentation there will be loads of information about how concussions and head injuries were viewed by the athletes themselves and other support people. To be honest, it’s kind of scary, but it is not unlike what we have seen in other sports, most notably football.
Two out of three players in one minor-hockey study by Toronto neurosurgeon Cusimano didn’t know they could suffer concussion injuries without losing consciousness. At least half the players couldn’t identify a concussion at all.
Education is the key, as we have been trumpeting since day one on this blog.