āYou are supposed to be tough. You are supposed to play through pain. You are not supposed to cry. We are taught that early on in the game as kids. Tough sport. Brutal sport. Itās like the gladiator. People want to see the big hits. They wind up on Sports Center. And as a player, you donāt want to admit you are injured.ā -Hall of Fame running back Eric Dickerson
American football is one of most watched sports in the United States. One might even say it is a symbol of the country. I know it is my favorite sport to watch. I love the intensity of the game, the competitiveness, the strength and courage of the players, and I too love the ābig hitsā. But I am just a spectator. I am not the player. Although I might cringe when I see a big hit, my life is not affected by its outcome. What are the outcomes? Sometimes itās a minor injury, while other times itās a serious one. And sometimes itās a concussion.
Strong impact to the brain jolts the brain from position and causes the brain to experience a blunt force at the sight of impact and an opposing force on the other side of the head. The sudden force causes the axon of the neurons in the brain to stretch. Ultimately, a concussion results from an increase in activity of excitatory amino acids (glutamate) as well as an influx of calcium ions and efflux of potassium in the neuron. This shift leads to changes in neuronal physiology. Na+-K+ pumps need to work over time in order to restore calcium and potassium concentrations back to normal. The Na+-K+ pump requires energy to function (in the form of ATP), which is obtained through the metabolism of glucose. Thus, when a Na+-K+ pump needs to work harder to restore ion concentrations, the pump demands more energy, and glucose metabolism is increased. Hypermetabolism puts the cell in an energy crisis, which makes the cell vulnerable to a second injury and increases the time necessary for full recovery. Allowing time to recover is imperative for a concussed brain to heal. In fact, repeated injuries occurring within a time frame that doesnāt allow for the brain to recover leads to larger anatomical and behavioral impairments in the brain in the long run.
As scientists have become more aware of the dangers that concussions present to players, ethical questions are raised. Should players be allowed to participate in a sport that has the potential of being so detrimental? Is it a personās right to participate in activities that have proven to be risky? Are parents putting their children in danger by enrolling them in activities where concussions are common? What duty does a medical doctor or athletic trainer have in limiting play for a player who has obtained a concussion?
In my opinion, the last question is one of the most difficult questions to answer. It is imperative that a player allows time for their brain to heal after they experience a concussion, as two repeated concussions are far worse than two isolated concussions. But have you ever talked to a football player before, during, or after a game? Their passion for the game and competitiveness to win often determines whether or not they can play rather than their awareness of what their body actually needs. It is not uncommon for a player to ignore concussive symptoms (as well as other injuries) so they can continue playing the game. Besides, arenāt football players SUPPOSED to be tough? As running back Erik Dickerson said, players are āsupposedā to be strong, to endure pain, to push themselves beyond their limits.
Therefore, it is a combination of competitiveness and pride that pushes players to return to the game before they are ready. And unfortunately, there are not many quantitative, concrete ways for doctors and trainers to assess a concussion, especially in the first, critical assessment on the field. Instead, they rely on the player to be honest and assess their abilities themselves.
Personally, I couldnāt imagine life without sports (especially football). Sports are important for a personās health as well as teaching them teamwork, accountability, perseverance, sportsmanship, hard work, and so much more. To avoid the potential dangers of concussions, I feel that education is one of the most important things we can do to avoid the repercussions that might occur in repeated concussions. By informing players of the seriousness that these repercussions could have in the long run, players might become more willing to allow themselves to heal before returning to play. Hopefully, this would also dissipate the negative stigma that follows players who DO allow themselves to heal properly.
I do believe people have a right to participate in dangerous activities and do not think it would be reasonable to take such activities away. Think of all the worldly activities people participate in that have the potential to be dangerous! However, I also feel that players have a responsibility to themselves (as well as their friends and families) to be aware of what their body needs, and this includes allowing time for their brains to heal after a concussion.