How Many Fingers am I Holding Up?: The Truth About Concussion

I think we have all seen it before. That scene in various movies where somebody takes a hit to the head, and the coach comes over and asks “How many fingers am I holding up?” When they happen to guess correctly, that means they are still okay to keep playing. Of course, this practice is not widely accepted today, however, the theme behind these actions may still perseverate throughout our culture. I mean, who really knows when you’re actually good to go? It’s exactly this problem that leads to the ill effects that are becoming more and more common in many sports today, especially football.

The truth is it is actually very difficult to determine when a person can safely return to competition, and frankly the system we have in place right now isn’t really working. Many times, the physical symptoms of headache, dizziness, and nausea go away before the brain is actually done healing. If a person then returns to competition preemptively, they risk getting second impact syndrome which can result in severe brain damage and even death.

The brain contains many different neurons and glial cells that can pretty easily become damaged or stretched during a sudden impact. The damage to these neurons is what causes the symptoms seen in concussion, although sometimes the symptoms do not necessarily portray the full extent of the damage. In this case, the damage might not even show up on your typical MRI or CT scan. There are new imaging techniques that have recently become available called MRS, MRE, and DTI that are much better at visualizing the damage in a concussion, but right now they are still very uncommon. I think some research and development definitely needs to be done in order to make these techniques a little more common.

There definitely has been some steps in the right direction in the last decade. For one, I think many more people have been educated about concussions and their potential severity. This, however, is just the first step in preventing concussion. Now the scientists and researchers need to get some hard evidence to show what is really going on in a hard impact to the brain. There are new technologies that could make it possible to detect how hard a person gets hit in games like football and hockey, but the research hasn’t determined the physical threshold that when passed, a person must sit out. Obviously, there are also many ethical and legal questions that get raised when trying to implement something like this, but first we need to focus on getting the real data. Only then can we move in the right direction.

Concussions: Education Matters

How serious are concussions? Well, before taking this course, I was largely unaware of how dangerous concussions are. Of course I knew that they were not “good” for the brain, but I didn’t know the extent of their negative effects.

There are several immediate symptoms of concussions including vomiting, headaches, swelling of the brain, and decreased reaction time. But in addition to this, there are also long-term effects that may include decreased blood flow within the brain, memory loss, migraines, trouble sleeping, and water imbalances, just to name a few.

Since I have graduated from high school there has been increased discussion surrounding the topic of concussions within schools. It is extremely important for kids to understand the severity of a concussion since it can have life-threatening effects, especially if someone receives multiple concussions. Most importantly, the teenage brain isn’t fully developed, which is what causes most of my concern. Since there is not a lot known how concussions and how long it takes to recover from one, how do we really know when it is appropriate for a child to return to playing a sport? Because even after the symptoms appear to be gone, there may still be damage to the brain.

So the question remains, “Should sports be banned?” due to their degree of danger. Well the answer is of course not! Children need the exercise and it is a great way for them to form new friendships. But as a society, we need to be more educated about the serious effects of concussions, in order to better prevent them. For society to become more aware of the seriousness of concussions, there needs to be more research focused on better diagnosing and treating concussions, and also more time spent informing the public of the dangers of concussions.

Concussions and new-age parenting

Boom. Some 12 year old kid hits the ground after a nasty hit from the 130 pound ‘red striper’ from the next city over. He is a bit slow to get up and seems to be slightly confused on what exactly happened. He is pulled off the football field. What happens next is where society has shifted in the last couple of years. In a time not so long ago, the kid would be told to sit out a couple of plays and when he was ready to play again, to get get back in there. No questions asked. Just a hard hit that they need to shake off.

That is the complete opposite of what we are seeing today. A kid takes a hard hit to the head. They are immediately pulled off the field and a field test for a concussion is given. If he demonstrates any of the signs of a concussion, they won’t see action for the rest of the game. If the symptoms persist, a trip to the doctor is probably in their future in order to confirm the diagnosis. If serious enough, a few weeks of sitting out will probably be necessary in order to make sure they have recovered fully before be allowed to hit the field again.

As you can see, these are two completely different approaches to the same situation and they are only a few years apart. So what has changed in this short period of time? The first thing that has definitely led to a change in the opinion on how concussion like symptoms should be handled is the controversy that has arisen in the NFL. Lawsuits from former players are being filed against their former employer for the misinformation on what kind of risk they were taking with their brains while maintaining an NFL career. They alleged that their was intentional concealing of the dangers of concussions from the players and that it was common practice to rush players back to the field before they had fully recovered from their concussion symptoms. Once the presence of the lawsuits caught fire in the national media, the concussion debate picked up steam and has been a fairly regular topic of conversation ever since.

The article we had the chance to read in class went into great detail on the biochemical reactions post concussion, the techniques used to diagnosis/view the effects of concussion on various brain parts, and possible future directions for concussion research. The article also pointed to the fact that younger, developing brains seem to be affected more greatly by concussions in comparison to adult brains. It happens to be articles like this that are leading to what I like to call Helicopter parenting.

Growing up is supposed to be a formative time, where children have the opportunity to have fun, get into trouble, scuff their knees, play all day long, and not have to worry about some of the larger issues that trouble our world. But due to the arise of these new age parents, helicopter parents, these experiences are being slowly taken away from the kids. Parents today are consistently monitoring and hovering over their children’s actions and are preventing them from stepping any toe across the line they set. When I was growing up, I had one rule: be home when the streetlights turn on. I was allowed to run around the neighborhood with my pals, smack each other with sticks, climb trees, etc. and my parents were just happy that I was having fun. They cared, but understood that I needed the opportunity to grow up and have fun.

So how does that relate to the topic of concussions? Well, it first relates to how sports are handled at the youth level. Kids are being held out of contact sports at higher rate than ever before and it is do to these concussion concerns. Parents are not willing to chance the brains of their children for the opportunity for them to have some fun. Those that do them let play sports like football, hockey, etc., can sometimes be too cautious when it comes to their kid getting hit, and instantly jump to the conclusion of concussion. They think that every hit is concussion-level and hover over the safety of their kid.

Now, don’t get me wrong, I think concussions are a serious issue and the testing that we do for them currently is inadequate, but there is a line. I think to hover over your child and protect them from any sort of harm is only depriving them from the ability to handle challenges as they grow up. You need to allow them to have fun and to get hurt and learn how to deal with it. Communication between kid and parent can help on this front, so the child is aware of the harms and dangers of a concussion, but also to say that it is ok to get beat up here and there, and to not be concerned about every little thing and to have fun. Let kids be kids. Help them out when they need it.

That is all I have to say about that. Feel free to comment and to disagree with what I have to say.
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Concussions: Returning to Activity

Concussions have serious repercussions, however we have no standards for the diagnosis and especially the treatment of traumatic brain injuries. There is very little research regarding concussions and the damage done to the brain, however autopsies show that individuals who have suffered a number of concussions demonstrate a decrease in brain mass and function. Why then if concussions are so dangerous do we allow individuals who have suffered a traumatic brain injury to return to activity so soon? Individuals are deemed ‘fit’ to return to activity after they demonstrate a decrease in symptoms such as headaches. Although the symptoms are absent, the brain is still healing. By returning to activity too early, more damage can be done to the brain. How then are we supposed to know when it is safe to return to normal activity? Brain imaging can be useful in determining how “normal” the brain is but it is still not definitive and not to mention extremely expensive. The initial injury along with a lack of concrete evidence for return to activity can lead to a cycle of more injuries and further damage. Second impact syndrome is caused when a partially healed brain suffers a new injury, causing further damage and loss of function. A string of concussions over a lifetime can lead to CTE, a condition characterized by a loss of brain function and mass. The lack of knowledge and research has led to a lack of information and education necessary to stop early return to activity. When referring to returning to activity, I don’t just mean exercise and athletics, but academics as well. With traumatic brain injuries it is often difficult to stand the light, form complex sentences, or even think. Students who suffer a brain injury are often expected to return to school within a few days.

What then are we to do as a society about an individual’s early return to activity? For all students up through high school we could create a regulation stating that all children must wait a set amount of time before returning to activity. But then we come to the problem that each individual heals differently and therefore needs differing amounts of time to ‘sit out’ on normal activity. Do students return to academics before returning to the sport or activity that caused the concussion? Students could fall behind in class, however they could also fall behind while forced to attend with a concussion. Sports are also an integral part of our childhood so returning to play is important to those out with a concussion. If the star player of the team is out with a concussion, how long will the coach bench him/her before allowing the player to join the game? How long will said player WANT to sit out of the game if his/her future rides on a successful season or if he/she simply loves to play the game?

My classmates and I discussed concussions and their repercussions and still never came to a consensus. We as a society must make a change to the way we think about and treat those who have suffered a traumatic brain injury. How we must change however is still a mystery. One thing we can do is to encourage those who have suffered a concussion to wait just a little bit longer to return to activity. The damage caused by concussions will eventually heal, however continued damage can soon become irreversible. I ask you to become informed on the consequences of concussions and to share your new knowledge with those in your community. By becoming education on traumatic brain injury we can hopefully decrease the brain damage our students suffer from at the hand of a concussion.

Don’t Let Us Down: The Culture Behind Concussions in Sports

Due to many symptoms including nausea, sensitivity to bright lights, headache, and general ‘fogginess’, most athletes know right away when an impact is more serious than normal – and most likely resulting in concussion.

Without other physical symptoms, a lot of athletes decide to ignore the symptoms and opt to play, rather than let their teammates and coaches down.

Concussion symptoms are not seen by other people, so they tend to have a social stigma not unlike that of mental illness.  “Get over it, you can still play through that.  It really can’t be that bad.”  I’ve heard these quotes plus more from my small town sports teams.  The football coach still starts off the season telling the boys about how to be tough and references a certain player that was a year older than me who played through a broken elbow.  Now my little sister’s boyfriend decided not to go to the doctor for his concussion so he could still practice and play with his team.  Coaches with that machismo mentality along with the possibility of college scholarships and even the salaries and celebrity status that star professional athletes have all contribute to this idea of playing even with injuries.

All you really need to do is pretend you don’t feel dazed.

Concussions vary widely, and the prognosis depends on age and on the location and force of the injury. Most concussions resolve within a month, but more severe ones can have long-term complications, including problems with memory and concentration, particularly if subjected to continuing trauma. If an athlete incurs a second concussion before the first one has healed, the consequences may be compounded. Unfortunately, this culture behind continuing to play does not take into account long term effects from concussions.  Ignoring symptoms and not fully healing from concussions allows for the possibility of Second Impact Syndrome as well as Chronic Traumatic Encephalopathy (CTE) later in life.  Both of those syndromes include permanent brain damage and memory loss.

Many players from around my hometown who risked so many concussions in high school were not able to play in college due to symptoms – and more importantly had symptoms for a couple years that deterred them from performing their best in their academics.  Friends and family reported a more impulsive personality – that they just weren’t exactly the same person after the second concussions.

There is a lot of research being conducted on issues related to concussions as well as better education for athletes and parents on the symptoms and risks when involved in sports.  Even with all of that, there is still a particularly stubborn challenge: the “culture of resistance” among high school and college athletes, who may be inclined to shrug off the invisible injuries and return immediately to the field.  The long term risk is still not seen as important as the immediate game.

This is a call to action.  Our whole culture behind sports needs to change in a sense.  We need to teach athletes, coaches, parents, and school districts that their brain and whole life quality is more important than the risk of getting that next touchdown.

But educating athletes about concussions is one thing. Changing the convictions of a culture that values playing through pain is quite another.

Concussion: Just a brain “love tap”? or something more?

I know a girl (name undisclosed) in my high school that finished out her senior year with 9 total concussions. How does one pass through high school with an allowed amount of concussions like that? I know it is because he coach wanted her to be playing because he felt that she would be able to handle the stress. He simply put her back into play when she said that she would be able to. I also know it was partly her fault because in order to find her baseline, (through an impact test) she would intentionally not try her best in order to pass it easier if she did get a concussion. She would return to play without the necessary rest that she (and her brain) needed.

Although there was fault on both parties, she should not have been allowed to play after a couple concussions. We talked about second-impact-syndrome in class and the damage repeat concussions has on the brain. This is when the brain doesn’t have time to completely repair its axons (or reroute in some cases) and another impact causes potentially more damage than the first. Where we are at now in research implies that we cannot be certain when the correct time is to return to play, but the correct time is after symptoms reside. The brain may be undergoing repair long after a player returns to the field, rink, pitch, etc., which may lead to undesirable risks.

So why do we allow people to return to play so soon? It is because of a lack of knowledge. The topic of concussions is very recent in scientific literature and as of late, imaging and testing is generally expensive. Also, more expensive than what people want to pay if all their doctor tells them to do is “go home and rest and don’t do any physical activity”. Although the entire public should become aware of the severity of concussions, but parents and coaches alike should be the most concerned. I understand that there is not quite as much concern in the professional leagues like the NFL because their athletes are getting payed handsomely to ultimately dispose of their bodies (in an almost-literal sense). If they want to sacrifice their body for money, then so be it. BUT, they should be more informed with scientific literature and personal experiences of concussions should be mainstream commercials, like anti-tobacco ads are, to raise awareness of what athletes may be getting themselves into.

I don’t see any regulations on equipment happening soon, but within the next couple decades I think we will see new techniques enforced and encouraged in sports. i.e. tackling in football could be focused into a rugby-like fashion where the cranium is a little more valuable. Get to know, love, and cherish your melon. It’s important.

When Can it be Safe to Say a Concussion is Healed?

Concussions are growing in the public eye; there is new research, new worries and discoveries about how much about concussions has been ignored in the past, or simply not been known. Even as society learns more about concussions, there still lacks objective ways of telling when a concussion is healed (or even if there is one there in the first place).  Concussions have few signs that include headache, temporary loss of consciousness, confusions, nausea, fatigue, and a ringing in the ears ( Yet, these signs alone are often not enough to diagnose a concussion. Imaging can be done on the brain (CTs and MRIs are most common), but even then these images are not telling the whole story of what is going on in the brain. Often, diagnosing a concussion is reliant on how the patient describes how they are feeling, which has a level of subjectivity to it.  Even if the concussion is properly identified, there is still the question of when the brain will recover, and as every concussion is unique, and there is not really an objective source to learn when the brain has recovered. Thus often there is the question of when is the proper period of time to “return to play” and continue on with activity? These tests are also not objective, often relying on the patient to tell the truth of whether or not they are fully recovered.  There is something called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) which evaluates someone’s mental state and how well their neurocognitive skills relate pre and post-concussion (  This assessment an athlete will typically take at the beginning of the season in order to establish a baseline, and then must achieve a similar score after having had a concussion in order to show that their brain is working in the same way which it was before. But, if one was a dedicated sports player, couldn’t they just score lower on the test on purpose for the baseline in order to be able to pass it once they were concussed? Yes.  It is for this reason that whether or not a coach or doctor will consider a concussion healed is largely based off of how much information the patient is not sharing.  There are other ways to determine if a player is well enough to return to play, often involving various activities like running, or even walking without experiencing any symptoms.  Yet, if someone is determined to return to play, then it could be easy to say they were fine. The only problem with that is that the patient is risking further injury or brain damage.   With concussions, one is harmful, but a second one within a short period of time is severely disabling or fatal.  This event is referred to as second impact syndrome, and is largest risk of returning to play before the brain is totally healed.  Second impact syndrome can be dangerous for those who have been cleared to return to play if even though the patient no longer experiences symptoms, as the brain may not be fully healed yet, but there is no way to tell.  However, those that return to play too early run the risk of second impact syndrome, which is in my opinion too large a risk. Fortunately, second impact syndrome does not often occur, and there have been only a small number of recorded cases ( As knowledge of concussions has grown in science, the public eye has seem to have taken a larger interest, which is leading to larger awareness of the risks that people with concussions take by resuming with activities that may lead to further injury. Yet, the prevention of further injury is largely dependent on the patient, for the best way to currently identify when a concussion is healed is when someone feels their brain is properly functioning again.

Athletics and Concussions: Out With the Old and In With the New

Concussions within the athletic realm have certainly been a hot topic the past few years. The NFL, without a doubt, is the case study that we as a society have used as a lens to view this concern. With new rules, enhanced awareness, and severe penalties this organization has began to lay some groundwork to the knowledge that has become known about head injuries. Also, in Minnesota, the Minnesota State High School League has made similar awareness gains even in the short time since I graduated from high school. The impact that a head injury can do to an athlete cannot be understated. Athletes are continually putting their well being at risk to participate in the sport that they love. The questions that remain are… Is participating in athletics worth it? And, what can we do to address this issue?

To address the above questions, I will start with a few of my personal convictions… To start off, I believe that participating in athletics is own of the most enriching contributors to the character of an individual. In a sense, athletics give our first sense of what life is really about, that nothing is easily handed to you. If you put hard work in, you are bound to get out some results. Now I am certainly not advocating that if you work hard enough a state championship is heading your way, but rather that no matter what genetic predisposition you may be in, your desire to improve leads to hard work, and if you do indeed to choose to work hard, then lasting life lessons can be obtained. Our competitive nature is something that needs to be cherished. It is a driving factor to the advancements we make within our society.

Secondly, I will address some observations I have made about this issue throughout my athletic career. I believe that I was well informed of the dangers of a head injury. I believe my coaches, trainers, and family informed me of the severe impact that a concussion could have on my well-being. (To establish some credibility, I also participated in wrestling and football at the state and national levels, so I was indeed putting myself at risk when competing.) In the same light, I also witnessed some words said by coaches that infuriate me to no end. Things like… “As long as you don’t throw up you’re fine,” “You’re going to have to suck it up,” “Remember that the IMPACT test is to establish a baseline score, not to get every single answer correct, so there is no need to take you’re time,” to name a few. Now I don’t feel that these coaches don’t care about their athletes but I think it is more of a result of a generational gap. I believe that my parent’s generation grew up with a “rub some dirt on it,” mentality when it came to injuries. With limited knowledge about the severity of head injuries they also were treated medically as such. They were not nearly as educated about the subject, and, in turn, coach with that mentality. This conviction is one that clearly needs to be thrown out the window. We (I’m including myself because one day I hope to coach my own children) are ethically obligated to inform our athletes about the impact a concussion could have on their lives. I believe that we have taken the elementary steps to rid of the “toughen up” mentality and replace it with the “smart” mentality.

The fact of the matter is, we as a society will always be competing in athletics. It is in our nature to put ourselves (whether it be physically or mentally) on the line with an intention to succeed. I believe that continue enforcement, advanced awareness, and proper medical advice are how we need to address the issue of concussions. If an athlete sustains a concussion, the reality needs to be brought forward and from there the athlete can make his/her decision. I also believe that it is completely worth it. Competing in athletics has had a profound impact on the individual that I am today. Life lessons that are hard to come by can be obtained through the hard work we put into our sports and I wouldn’t trade it for anything.

Concussions: An Endless Research Field

It is a Saturday afternoon in October, and across the country fans and athletes are gearing up (both literally and figuratively) to watch or play an exciting game of football. I am in a coffee shop, as a blogger should be, spending my time thinking about the effects of sports, like football, on the brain. This past week, my neurochemistry class read an article about the neuroscience of concussions. It brought up an almost endless amount of both ethical and cultural questions concerning the education, prevention, and treatment of concussions in relation to large and culturally significant sports like football. But most importantly, we came to the conclusion that the brain, much like an angst-filled teenager, is highly misunderstood. Because of this, the answers to the diverse questions about concussions are very difficult to answer.

However, it is important to understand the questions surrounding the topic because they help bring awareness to the importance of effective treatment and the management of concussions. Furthermore, by understanding the questions, one is able to remain involved and inquisitive about the discoveries that are constantly being made in the field of neurochemistry and brain injuries.

A few of the topics currently being researched include:

  1. Defining and quantifying concussions and concussion symptoms

By being able to quantify and define the severity of a concussion, both treatment and management practices will be more specific to each individual and their injury. It will also allow for a better understanding of how long it takes the brain to heal and how long a person should rest during recovery.

2. Subconcussions and their potential neurological effects

It is known that a concussion does damage to the brain and requires time to heal. Further research is needed in the area of subconcussions because little is known about the damage that builds after several less serious hits to the head. It is also important to investigate the effects of different injury intervals on brain damage and recovery time.

3. The long-term effects following injury

Extensive knowledge has been gained just recently as more is learned about sports related injuries in aging players. CTE (Chronic Traumatic Encephalopathy) has been noted in players as they enter their 40s. Symptoms include those similar to that of Alzheimer’s Disease, and it is being realized that concussions are serious injuries with symptoms that can extend throughout a lifetime. More investigation is being made in this area to determine the extent of the long-lasting effects of concussions.

4. How to restore normal cellular physiology after head impacts

It is important to understand what happens to the brain during a concussion, but it is even more imperative to figure out the most efficient and beneficial way to restore the brain after an injury. Researchers are looking into brain plasticity and reorganization as well as the amount of time necessary to heal the brain.

While these are just a few of the almost infinite amount of questions in the area of concussions and the brain, they act as a general list of the largest areas of research. Many brain imaging techniques are being developed and more is learned every day about the brain. While football and concussions will seemingly be around forever, the way in which the injuries are handled is sure to change in the upcoming years.

Visit this link to read the article referred to in this post:

People Need to Understand What a Concussion Feels Like

Everything was black. I could feel weight being lifted off of me and I could feel that I was lying face down, I only became concerned when I rolled on to my back and still I could see only darkness. At this point my vision faded back in from the middle outward, flooding my brain with information. The referee was helping me up and I remember him asking me a simple question. “Are you OK?” Seems simple enough, but at the time I couldn’t put any words in my mouth, I just sort of grunted and began to jog back toward the huddle as I was supposed to be in the receiver rotation for a couple more plays. By this point it was clear to me that something was amiss, I just jogged past the huddle and back to our sideline. Seeing as I had come out of the rotation early an assistant coach walked over and asked what was wrong. Again, a simple question, and again I had no words. After I took of my helmet he asked what city we were in, I knew it was an away game but I couldn’t find the memory of where I had gotten off the bus just a few hours before, I glanced at the scoreboard and read off “New London.” He had seen enough. I sat out the rest of the game and although I didn’t know it at the time that would be the last time I wore football pads and took the field.

I went to the hospital later that night because my parents wanted to take me. The doctor basically told me I had a concussion and that I shouldn’t play contact sports ever again. He then gave me a prescription for standard prescription pain meds, and sent me on my way. I don’t remember really thinking anything for the next several days. It is all kind of a blur when I look back on it, I guess it was mostly a blur then as well. I went to class, hung out with my friends, took hydrocodone, and just sort of existed. There was really only one thing I could think about while I was sitting in class, when I wasn’t just drowsily daydreaming, that was the pain. My head hurt a lot, all the time, and after I ran out of medication it still hurt all the time, so I took OTC medication, a lot of it, for a long time. By the next spring I still got headaches from just running around during the tennis is season and to this day it still only takes some jarring or a heathy bump to bring back that familiar pressure an pounding behind my forehead.

I had no Idea at the time just how serious my injury was and the people around me couldn’t understand why I was complaining all the time. I looked fine and it had been months since the injury, so I just self-medicated and told myself everything was fine. It must be fine, I thought, that is what everyone was telling me. People need to be more educated on concussion and concussion symptoms, particularly if they or their family member has had one. I think it is absurd that a doctor just handed me hydrocodone and sent me home without telling me or my parents how serious an injury like this can be, and what the long term consequences can be like. Sure he told me not to play contact sports again, but if you were sixteen would you listen to him? On the car ride home from the hospital I was already thinking about what I would have to do to get back on the field, I brushed off his warning in a matter of minutes while I was still in immense pain. People need to have serious conversations with kids when they injure their brains and just give them an idea of the stakes. I am just glad my symptoms were so intense and so long lasting because I know that I would have suited up again in a heartbeat if I felt like I could. I know most young people, like me, have no sense of foresight and are only worried about their next competition, but you only have one brain and it is pretty important, I think even a sixteen year old boy can understand that.