Getting a knock to the head is a hot topic right now.
First, we had the movie Concussion at the beginning of this year, which looked at how the ramifications of repeated small concussions are still being found out to this day, especially as it pertains to NFL players.
Next, more than 70 health experts, academics and sports coaches signed an open letter for the government calling on tackling to be completely banned in school rugby.
In March, boxer Nick Blackwell was put in a medically induced coma due to a head injury suffered during his fight with Chris Eubank, Jr. Earlier this week, he announced his retirement on Twitter with a post that read, “No, that’s me done.”
And, last week, Portuguese MMA fighter Joao Carvalho tragically died following head injuries sustained at an MMA fight in Dublin this month.
Evidently, taking shots to the skull is not good.
The word concussion comes from the Latin for ‘shake violently,’ but it’s been used to describe a traumatic brain injury since the 1540s. We know what the word means, but why is a concussion so serious, and what exactly happens when you get one?
To get some answers, we spoke to Dr. Hiren Patel, a consultant neurosurgeon based at Salford Royal Hospital.
He started off by laying down a definition of what a concussion is:
We don’t know that. We just don’t know exactly. It’s a transient misfiring of the brain cells, neurons…whatever you want to call it. That’s what a concussion is. It’s transient because more often than not people recover.
If you’ve ever been on the end of a ping to the noggin, you’ll likely feel temporarily dazed and confused. But there’s also the chance you could be orientated, with open eyes, and obeying commands – which is why a concussion is sometimes tricky to diagnose.
What doctors are keen to do is put someone in a scanner and give him or her a whack to the head to find out more. It seems extreme, but as Dr. Patel puts it: “That would be perfect if you want to understand what’s happening. However, that’s not the reality.”
The neurosurgeon is quick to provide some more clarity with a roadwork analogy, which goes like this:
If you were to load Google maps and look at any city, you’d see a huge network of roads. Imagine you’ve got to get home to see the girlfriend, go to cross fit, or watch the new episode of Better Call Saul.
Unfortunately, there’s been a crash on the main road you use to get from the office to your house.
It’s not a big deal in the grand scheme of things, but the disruption it causes in your brain – the effort of working out a new route – is massive.
Dr. Patel continues:
So everything get’s backed up and it becomes slow. You’re sat in the car for an hour and you’ve got a headache. You’re frustrated, tired, angry, dehydrated and nauseous and it’s purely because of a little disruption in what is normally a very well oiled network. Once that disruption clears everything is back down to normal.
That’s the best analogy you’re going to get for concussion. When you’re completely sparked out things aren’t any clearer.
There is no hard and fast answer. You could argue that it takes it to a more serious level if they’ve lost consciousness. But even after a blackout, many people would have a normal scan.
In reality, doctors learn of head injuries after an accident and figure out what’s happened from what we tell them.
We extrapolate from what we’re told and scans and try to make sense of what’s taken place. It’s only when I push a person to their limit with neuropsychology tests – to challenge their memory and how they process information – that deficits might come out.
Take, for instance, Nick Blackwell and his week long medically induced coma.
Blackwell will have been perhaps confused, disorientated, agitated and even combatant. In an effort to get him into the scanner safely, they may have put him to sleep. They’d have done the scan and realized he has a contusion on the brain and because he’s asleep, they will have put a pressure monitor in. They would have elected to keep him asleep for the simple purpose of resting his brain.
As for Blackwell’s retirement at the tender age of 25, it was probably a smart move. Once you’ve had one concussion, you’re more likely to suffer another. And although one or two bumps to the head are okay, repeated concussions are something else entirely.
The current literature suggests that your risk of degenerative brain conditions like Alzheimer’s and Parkinson’s is much higher.
Dr. Patel adds:
There’s no question that Muhammad Ali’s Parkinson’s was caused by his boxing. He is a prime, living example of that. That is what people with multiple concussions are at risk of suffering. When he had that fight against Larry Holmes when he was 39, that was a fight too far for him. He didn’t need that fight.
This brings us to the movie Concussion. In the film, Will Smith plays Dr. Bennet Omalu, a Nigerian neuropathologist who coined the phrase Chronic Traumatic Encephalopathy (CTE). Dr. Omalu discovered the condition after examining the brain of former pro football player Mike Webster.
Dr. Patel continues:
This is a slow burn disease. That’s the problem. You could have a 20-year career and you wouldn’t know about a problem until you were 45 when possibly depression, alcoholism, anxiety and memory were starting to become a problem.
For victims of multiple blows to the head, the presence of these symptoms can be devastating.
In 2007, the Canadian professional wrestler Chris Benoit murdered his wife and seven-year-old son before killing himself. Tests were carried out on Benoit’s brain by neurosurgeon Dr. Julian Bailes, who said Benoit’s brain was so severely damaged it resembled that of an 85-year-old Alzheimer’s patient.
What, then, does a neurosurgeon think about the debate we’re having in rugby-playing schools in this country? Are children in danger of suffering permanent damage?
Technically, they are at risk, but I don’t know what the incidence rate of concussion is in young children. I suspect it’s pretty low. In rugby league or college football it’s probably around 10 per cent per year. But these are semi-professional athletes. A 12-year-old running around the pitch once a week… whether that fits into the same category I don’t know.
It’s a fair point, as a kid’s team will have only two superstars who are big and burly. That’s very diluted in 13 people playing rugby and a teenager certainly isn’t up against 13 bulked-up professionals. However, in youth rugby, tackles were found to be responsible for up to two thirds (64 per cent) of all injuries and 87 per cent of concussions.
In the end, many problems arise in sport because of the inherent macho element.
If I’m a professional rugby player, and I’m the star player, but I take a knock, they still want me on the pitch. That part of the culture of sport is still there and quite widely expected. Just look at how iconic that image of England footballer Terry Butcher and his bloodied bandaged head is.
Professional athletes are considered to be commodities. They’re worth a certain amount of money until they can no longer play.
As soon as coaches and players recognise the fact that for the short term coming off is probably better because of the long-term consequences, we’ll start seeing a change. But, a lot of players will try and shake it off and carry on regardless.
As Dr. Patel was walking me to the reception he mentioned that the majority of his patients are victims of falls, assaults, or road traffic accidents. It’s uncommon for a neurosurgeon to see an athlete – most sports players don’t go back into play after a concussion, they rest their brain…or at least they should.