When does a hit become one hit too many? New concussion research shows that head injuries sustained by young athletes have more serious long-term consequences than once thought.
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Until recently, coaches, trainers, parents, and even some medical professionals tended to dismiss most concussions as minor bumps to the head. If a kid received a brain-rattling hit while playing, he or she was simply told to “walk it off” and get back in the game.
Such advice is dangerous—and not only because failure to get quick treatment, even for a concussion that seems relatively minor, can be life threatening. Returning kids to play too soon also leaves them more vulnerable to more extensive injuries.
“It’s easier to get serious brain damage or death with a second impact, even if it is lighter than the first one,” says David King, president of the Brain Injury Association of Minnesota. Kids are particularly susceptible to second-impact damage, he adds, and their brains take longer to heal.
And girls are just as susceptible as boys. Laura Nickel suffered back-to-back concussions in 2009 while playing high-school soccer in Byron. “I had a lot of dizziness, vertigo, and trouble concentrating,” she says. “I also had a little bit of a stutter.” Now a student at Bethel University, Nickel still takes medicine for headaches and finds she can’t sit in front of the computer for very long. “Whenever anybody says they hit their head, I tell them to take it seriously,” she says. “I shouldn’t have kept playing.”
That message—that all bangs to the head are potentially serious medical events—is finally getting through the rest of our thick skulls. One major reason: within the past decade neuroscientists have nailed down a clearer picture of what goes on in the brain during a concussion. And it isn’t pretty. The brain, which floats in a pool of cerebral spinal fluid, first slams into the interior of the skull at the point of impact and then ricochets into the opposite side of the skull.
But that’s not all. The force of all that movement shears nerve cells, triggering a harmful cascade of brain chemicals that leads to even more damage. Those secondary injuries, which may not develop for several hours or even days, are what cause long-term effects, such as cognitive decline and emotional changes.
Brain-imaging technologies offer minimal help with diagnosing a concussion. They can show damage to the skull or bleeding on the brain, but not subtle nerve damage. That’s why so many young athletes, like Matt Hovila, have been sent back onto the playing field: Their brain scans looked “clean.”
Neuroscientists laid the groundwork for the concussions discussion. But the public didn’t really grasp the story until they started reading tragic tales of retired professional athletes whose brains—and lives—had deteriorated due to repeated on-field head injuries. First came the reports of horrific signs of degeneration in the autopsied brains of former pro athletes with strong concussion histories who had later committed suicide or who had suffered from dementia. Other troubling studies followed, including one in 2010 that pointed to sports-related brain trauma as a possible risk factor for the neurodegenerative brain disease amyotrophic lateral sclerosis, or ALS. One of the examined brains was that of Wally Hilgenberg, a Minnesota Vikings linebacker in the 1970s who died of ALS in 2008.
Suddenly pro athletes were taking themselves out of play for long stretches of time to let their brains heal—players like Minnesota Twins first baseman Justin Morneau and Minnesota Wild defenseman Nick Schultz, who both sat out the end of their seasons last year. Minnesota sports fans were overwhelmingly supportive—a reaction that suggests former macho attitudes toward sports injuries may be shifting.
One of the biggest shifts has occurred among youth coaches. “Coaches have become much more enlightened about the seriousness of concussions,” says King. “They’re becoming acutely aware that the idea that ‘it’s all part of the game’ is not true.”
Dave Ziebarth, head football coach at St. Thomas Academy in Mendota Heights, is one of those enlightened coaches. He’s a stickler about keeping players with suspected head injuries off the field until they receive medical clearance. Any coach who doesn’t do that today would be “a complete idiot,” he says.
Ziebarth, whose teams typically experience five to seven concussions a season, requires players to take an online baseline test each fall. Any player with a suspected concussion must retake the test. “They have to get back to the baseline they started with before they play again,” says Ziebarth.
One of Ziebarth’s challenges is getting injured players to admit their symptoms— kids dread not being able to play. “But that attitude is turning around,” says Ziebarth. “They’re starting to understand that if the injury is caught early, they’ll be out for a shorter time.”
Parents are beginning to understand the repercussions, too. Only once did a father give Ziebarth trouble for a benching decision. “He argued with me for a little bit, but then he settled down,” recalls Ziebarth. “He later said he had been emotional because he knew how much his son wanted to play. But then he realized it was in his son’s interest to wait until he had healed.”