The Enigma of Sports-Related Concussions

     A concussion is a form of traumatic brain injury (TBI) that is clinically defined as a physical insult to the head, causing the brain to bounce, so to speak, against the skull. This sudden disruption in neurological functioning typically results in a brief period of disorientation as well as a myriad of symptoms related to cognition and mood: for example, difficulty concentrating, memory problems, slower processing speed, irritability, trouble sleeping, excessive fatigue and heightened anxiety. Although symptoms typically begin to resolve within weeks of the injury, 15 to 20 percent of patients continue to have symptoms, particularly related to cognition, for up to a year following the injury.

     Between 2001 and 2009 more than 2.5 million individuals below the age of 20 were treated for a sports-related concussion. Moreover, 9.9 percent of female NCAA athletes and 13.3 percent of male NCAA athletes reported experiencing a concussion at some point in their collegiate career. However, the question of just how common concussions are remains difficult to answer. These statistics, for example, do not include those who did not seek immediate medical attention or those who informally consulted a friend or family member with medical expertise, among others.

     Over the past decade, the number of reported concussions has continued to climb. Between 2007 and 2010, for example, the CDC reported a 56 percent increase in the number of TBIs, which reflects not only an increase in incidence but also in awareness. The recent spotlight on sports-related concussions has sparked the implementation of baseline testing at many institutions, enhanced training for coaches regarding both prevention and response and reduced contact in practices.

     Yet sports-related concussions remain somewhat of an enigma. We have reached a point at which we know that they exist, recognize that they are a problem, but still do not understand them. One reason for this may be our terminology. Although concussions are defined as mild TBIs, meaning that they are not life-threatening and damage may or may not be evident on neurological scans, concussions are often anything but mild. Concussions present a sudden and unforeseen, not to mention unwelcome, disruption in an individual’s life. Moreover, initial assessments of the injury’s severity do not necessarily predict the course of recovery. Symptoms may be relatively short-lived or persistent. Concussions are a dynamic process with continually evolving sequelae that manifest differently in each individual.

     Furthermore, there is a somewhat paradoxical nature to the injury. Despite the growing public awareness regarding concussions, they remain an invisible injury. What happens when you are not okay but do not have a visible wound? What if you look “normal” but feel out of sorts? Many of the symptoms of concussions, particularly those that are more long-lasting, are hidden. Only the individual truly knows how he or she feels, and thus an injured individual may feel pressure to mask the injury’s effects and quickly return to “normal.”

     For the 480,000 NCAA athletes, as well as the two percent of the population that lives with a TBI-related disability, concussions are an often-discussed yet seldom-understood phenomenon. This issue is not limited to football or lacrosse, or even sports for that matter. Concussions occur both on and off the field, initiating a complex and often tumultuous journey toward recovery that demands our attention.

     Sources: American Psychiatric Association, Brain Injury Association of America, Centers for Disease Control and Prevention, National Collegiate Athletic Association

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