Cameron Tidd
Definition and Background
By definition, a concussion is a brain injury in which the brain is concussed inside of the skull (Zeigler). More simply put, a concussion is whenever the brain is shaken and moves around inside the skull. Concussions are mostly commonly the cause of a direct impact to the head or the result of a whiplash motion in which the brain is concussed through the acceleration motion of the head when it is snapped forwards or backwards (Zeigler). The most common settings for a concussion are a motor vehicle accident or by an athlete in sport. For young people ages 15 to 24 years, sports are second to motor vehicle crashes as the leading cause of traumatic brain injury (Gessel). An estimated 300,000 sport-related traumatic brain injuries occur in the United States annually, and of those injuries, concussions dominate the spectrum (Gessel). Also, the number of students participating in high school and collegiate sports is only increasing, therefore, the number of concussions is projected to increase. Sports with higher risk of concussion include collision sports, such as American football or hockey (Zeigler). In sports that both sexes play in, such as soccer or basketball, both high school and collegiate level girls are seen to have higher rates of concussions compared to boys in the same sport (Gessel). Although girls are seen to have higher rates of concussions, the causes of the concussions are often different. For example, in basketball, more boys are seen to sustain a concussion while rebounding or chasing loose balls, while more girls are seen to sustain concussions while defending or ball handling (Gessel). Causes of concussion vary from sport to sport. In American football, the most common cause is by head to head contact, while in baseball, it is more likely for the athlete to be concussed by getting hit in the head by the ball (Zeigler). The reasons for girls having a higher rate of sustaining a concussion are unknown, but cultural explanations likely play a role. Society has tended to be more protective of female athletes, therefore, this may lead parents or coaches to treat possible head injuries of females more seriously (Gessel). Also, because boys are often under societal pressure to be “tougher” than girls, it is very likely that boys tend to try and play through injuries or avoid reporting the injuries to parents or coaches (Gessel).
One of the biggest issues when dealing with concussions is the process of diagnosing one. It is very common for one to receive a concussion and not even know because the symptoms are not always apparent. The symptoms of a concussion can be somatic, cognitive, emotional, physical, and/or behavioral (Zeigler). More specifically, they include headache, dizziness, nausea, slurred speech, memory loss, sensitivity to light, and more (Zeigler). Another issue with dealing with concussions in athletes is that they are often pushed back into sport too quickly. Once symptoms are noticed, the athlete needs to be immediately pulled from activity and evaluated by a professional (Zeigler). Also, it has always been difficult to diagnose concussions because they leave no physical trace of damage on the brain, so a CT scan or MRI will not help at all. Fortunately, there are now a number of concussion assessment tools and protocols, including baseline testing, to help diagnose a concussion more accurately (Zeigler). Concussion diagnosis and treatment knowledge has progressed substantially over recent years, but there is still much room for improvement in the methods of concussion prevention.
Historical Context
Historically, there has been issues with concussions being under-reported because there is often not any apparent signs or symptoms of a concussion (Zeigler). It is not outlandish for an athlete to continue to compete without noticing they have received a concussion. Because some symptoms of concussions are also very common for anyone, such as a headache, it is easy to assume that there is nothing else wrong if the symptom quickly goes away. Underestimating the seriousness of the injury is common, but also, pressure to not be withdrawn from competition is likely more of an issue, especially in the higher levels of athletics (Gessel). As an athlete, the idea of possibly risking the success of a team is very undesirable. In collegiate and professional level sports especially, unreported concussions and head injuries are inevitable. The increase in competitiveness also brings with it a greater need for an athlete to be healthy and on the field. Also, the higher level of competition brings a higher risk of injury because of the increased physicality (Gessel). In a study of over 1500 varsity football players in Milwaukee, Wisconsin, 15.3% of respondents reported sustaining a concussion during their previous season; of those, only 47.3% of players reported their injury (McCrea). The most common reasonings for a player to not report their injury were not thinking the injury was serious enough to warrant medical attention, motivation not to be withheld from competition, and lack of awareness of probable concussion (McCrea). Overall, the history behind the issue of unreported concussions lies within the lack of education that athletes have about the possible risks of not treating with a concussion correctly.
The changes in the protocols and procedures behind concussion prevention have been the reason for the difference in concussion awareness over recent years. Going all the way back to 1904, President Theodore Roosevelt threatened to ban American football because of the risks and the negative media attention in medical literature that it was receiving (Cantu 83). In 1904 alone, there were 19 athletes killed or paralyzed from injuries sustained in American football, and this led to the formation of the National Collegiate Athletic Association (NCAA), a governing body to establish rules for safer athletic competition (Cantu 83). Fatalities in American football peaked in 1954 at 30, but between 1931 and 1986, at least 819 deaths were directly attributed to American football, most of which from head injury (Cantu 83). Concussion prevention starts with knowing what a concussion is. Historically, concussions were obvious if the athlete had a loss of consciousness, but when there was no evidence of unconsciousness, it was much more difficult to recognize (Cantu 83). When American football first began, players were unaware of the possible head injuries and did not wear any protection. As the issue progressed, players then were required to wear helmets. The development of helmets began with leather and has progressed to today, where players’ helmets are made of a hard, plastic shell and a padded interior, to reduce the impact of a hit on the head. The only issue is that helmets may greatly reduce the impact of a hit on the player’s head, but they cannot stop a player’s brain from being concussed or moving around inside the skull. Because of this, concussion prevention has now led to the education on keeping a player’s head away from the contact. Avoiding contact to the head in American football is executed by a player using their hands or shoulder to hit another player. Although this is about as safe as American football will get, avoiding contact to the head will only reduce the amount of head injuries. They will still be prevalent because there will be instances where players will accidentally hit with their head, or they will still receive a whiplash-type motion, similar to a car accident, which can also cause head injuries, like concussions.
Figure 1: Modern version of helmets intended to best protect football players from concussion (AP).
Controversy
The biggest controversy within concussions and head injuries is the risk that comes along with the effects of multiple concussions. These effects can result from returning to sport too quickly and/or the occurrence of multiple concussions in one person. If an athlete attempts to return to sport before they have completely healed from a concussion, then they are at risk of a life-threatening condition called second impact syndrome (Zeigler). Second impact syndrome, as implied, occurs when the athlete sustains a second impact to the brain before the initial brain injury has healed (Zeigler). More specifically, the second impact results in rapid swelling within the skull, increasing the intracranial pressure and compromising the brain stem (Zeigler). The time from second impact to brain stem failure is only minutes, so the response time has to be immediate. The fatal devastation is mostly seen among children and adolescent athletes because it is not common to see medicine professionals on the sidelines in youth sports (Zeigler).
Sustaining multiple concussions during an athletic career can be detrimental to an athlete’s life after sports. Athletes may be able to recover from a concussion and go back to playing their sport, but the result of multiple concussions can lead to permanent brain damage (Zeigler). The most common condition that many athletes receiving multiple concussions have is chronic traumatic encephalopathy (CTE). CTE was introduced as a clinicopathological construct for the neurodegeneration associated with football and wrestling (DeKosky). Because each concussion is different for every athlete, there is no way to put a limit on when an athlete should stop playing sports because of a certain amount of concussions. The only thing that is known is that recurrent concussions almost always take longer to recover from and have more severe symptoms (Zeigler). Other possible long-term conditions resulting from concussions are Alzheimer’s disease, Parkinson’s disease, or amnesia (Dekosky). An example of a victim of multiple concussions is former Philadelphia Eagles safety, Andre Waters. In December 2005, Waters died of a self-inflicted shotgun blast to the head at only 44-years-old (Goldberg 337). Waters’ brain was then used for an autopsy by forensic neuropathologist Bennet Omalu. Omalu said that his brain resembled that of an octogenarian Alzheimer’s patient and that the brain damage was caused by successive concussions her suffered playing football (Goldberg 337). In 1994, Waters told the Philadelphia Inquirer that he had lost count of the number of concussions he had suffered from at 15 (Goldberg 337). This, among other cases, triggered a “concussion summit” by the NFL to discuss the ethical, legal, and clinical issues relating to concussions (Goldberg 338).
Figure 2: Former Chicago Bears running back Mike Adamle, left, speaks in support of the Dave Duerson Act to prevent CTE by banning contact football for children under the age of 12 in Illinois (AP).
Relation to Politics of Health
Concussions can be related to politics of health because of the long-term effects of concussions and how they are a result of the history of an athlete. Historical trauma refers to trauma experienced over time and the impact that it has later on (Mohatt 128). Because the long-term effects of concussions are most commonly tied with multiple cases of head injury, the events of the concussions can be traumatic to an individual. The many cases of suicide by former athletes, including Andre Waters, are a result of the numerous concussions they had received. The traumatic event(s) that the athletes experienced were the many impacts to the head, causing headaches and nausea. As the successive concussions got worse and worse for the athlete, the harder it was to live a normal life without dealing with the symptoms. Later in their lives, the athletes who committed suicide were suffering from the traumatic events in the sense that they experienced memory loss and mental instability because their brains were permanently damaged. Athletes, like Andre Waters, could not mentally withstand the suffering they were going through because of their head injuries, and they decided that ridding of the trauma from concussions was more valuable than life.
Bibliography
Zeigler, Terry. “What Is a Concussion?” Sports Injuries, Treatment and Performance Information, SportsMD, 11 Mar. 2018.
DeKosky, Steven T, et al. “Traumatic Brain Injury – Football, Warfare, and Long-Term Effects.” The New England Journal of Medicine, 30 Sept. 2010.
Goldberg, Daniel S. “Concussions, Professional Sports, and Conflicts of Interest: Why the National Football League’s Current Policies Are Bad for Its (Players’) Health.” Springer, 2009.
McCrea, Michael, et al. “Unreported Concussion in High School Football Players: Implications for Prevention.” Clinical Journal of Sport Medicine, Jan. 2004.
Gessel, Luke M, et al. “Concussions Among United States High School and Collegiate Athletes.” Journal of Athletic Training, Dec. 2007.
Cantu, Robert C. “Reflections on Head Injuries in Sport and the Concussion Controversy.” Clinical Journal of Sport Medicine, 1997, p. 83.
Mohatt, Nathaniel Vincent, et al. “Historical Trauma as Public Narrative: A Conceptual Review of How History Impacts Present-Day Health.” Social Science and Medicine, 31 Jan. 2014.
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