Coaches, players, and parents should start adhering to the “three strikes rule” when it comes to concussions. This rule states that any player that has sustained three concussions in a single season must sit out for the rest of this season. I know this may seem extreme and I know how heartbreaking it could be to require someone to just stop doing what they love, especially after putting years and years of work into a sport or a team. Long term, however, I’m sure anyone would agree that sitting a season of a sport out would be preferable to long-lasting brain damage and chronic neurobehavioral impairment.
Concussions occur after a blow to the head with so much force that the brain moves and is smashed up against the side of the skull. While research into the molecular mechanisms underlining cellular damage from concussions is still ongoing, is it known that there are short-and-long term changes. Short term, there is an infux of ions in neurons, causing a large release of glutamate, which will have long-term depressive effects on brain cells. Additionally, the damaged cells that are working overtime to repair themselves require a lot of ATP (a cell’s energy molecule). To address this, the cell’s mitochondria (cellular component that makes ATP) works overtime to make ATP and eventually becomes dysfunctional, which often signals the cell to die.
Cells in the brain communicate through tracts of connected processes called dendrites and axons. These dendrites and axons are filled with scaffolding-like proteins called cytoskeletal structures that help keep the structural integrity of dendrites and axons intact. In concussion, these cytoskeletal components are damaged, interfering with the connections between cells and the signals that get sent in the brain. If these are not repaired, the neurons will cease to function and will die. Neurotransmitters like GABA and NMDA are also released in altered levels in concussed brains, which affects things like memory, neurodevelopment, learning, and vulnerability to disorders like anxiety and PTSD.
Long term, these changes can lead to neurodegeneration, which is never good. People with multiple concussions are also more susceptible to migraines, experience slower cognition and reaction time, and are more vulnerable to things like depression and anxiety. There also seems to be a correlation with concussions and the buildup of proteins like tau, which are implicated in diseases like Parkinson’s, Alzheimer’s, and ALS. Concussions can permanently change the white matter of the brain, which is how signals are sent, changing brain communication for the rest of someone’s life.
Scientists have found that it takes 7-10 days for the brain to heal itself in an ideal situation. During this healing process, the brain is extremely vulnerable and a subsequent concussion during this time could be absolutely devastating for a person’s brain. At the bare minimum, players should have to sit out from games and practice for 10 days and should be even more vigilant upon their return to avoid another concussion. Even if the brain is fully “healed,” permanent damage persists, which will be furthered with each subsequent concussion. This is where the “three strikes” rule comes in. Athletes of any sport and any level should not be put in situations that will cause lasting damage to their brain. It might seem like the end of the world to have to quit in the middle of a season but when the alternative is irreparable brain damage, the choice is pretty clear. No game, tournament, or event is worth jeopardizing the rest of your life over.