No one plans to “get their bell rung,” but unfortunately, the sports we participate in do increase our likelihood of experiencing a traumatic brain injury (TBI) like a concussion. How we respond in the immediate aftermath and over subsequent months can influence the outcome of this potentially debilitating injury.
RELATED: Fast Talk Episode 148—The Causes & Effects of Concussions and TBIs
Despite being “invisible” to outside observers, concussions are as real as a pulled hamstring or a broken bone and require equal respect and attention for optimal recovery.
What is a concussion?
The human brain is a soft mass inside a protective skull, cushioned and lubricated by a thin layer of fluid. Sudden, forceful, movements can cause brain tissue to collide with the inner surface of the skull, disrupting chemical and metabolic functions of brain cells. This is known as a concussion, and is considered a mild TBI.
Surprisingly, this damage can occur without a direct head impact; blows to the body can transmit enough force to cause brain tissue injury through a whiplash effect. Rotational forces that twist the brain can exacerbate the severity of the injury, highlighting the importance of helmet technologies like Mips, KinetiCore, and WaveCel, which aim to mitigate rotational impact forces.
Concussions should be suspected (even without a direct blow to the head) when these symptoms follow a traumatic event:
- Headache
- Confusion
- Memory loss
- Nausea
- Blurred vision
- Sensitivity to light
If someone shows signs of a concussion, it is critical to do an immediate assessment to determine if any urgent needs should be addressed. Even if immediate care is not needed, act objectively to ensure their safety and encourage prompt medical evaluation (though you may encounter resistance). This might involve calling medical help or actively assisting the injured individual to safety as they may not be able to negotiate roads or trails on their own.
It is imperative that suspected concussions are evaluated promptly by a doctor. However, diagnosing a concussion can be challenging, typically requiring a comprehensive neurological evaluation that assesses vision, hearing, strength, balance, reflexes, and other neurological functions that may be impaired. Additional tests, including memory assessments and MRI imaging, may also be necessary.
A challenge in this diagnostic process is that clinicians often rely on subjective judgments based on observed signs and symptoms. Baseline testing, particularly for athletes at risk of concussion, can greatly assist in diagnosing future concussions. These tests are often conducted via computer (e.g., ImPACT) or mobile app (C3Logix) and establish a pre-injury baseline against which subsequent assessments can be compared to aid in diagnosis.
Why athletes shouldn’t return to sport with a concussion
Following a concussion diagnosis, caution is imperative before returning to activity, primarily due to the risk of Second Impact Syndrome. This occurs when an athlete sustains another concussion shortly after the initial one, potentially leading to rapid brain swelling and severe consequences such as irreversible cognitive impairments or even death. Therefore, athletes should refrain from activities involving concussion risk until medically cleared to by their doctor.
Complicating matters further, concussions often result in cognitive impairments that increase the likelihood of subsequent injuries, manifested by reduced reaction time, balance, strength, and impaired decision-making abilities. Additionally, exercise often causes symptoms such as impaired heart rate and blood pressure response.
Recovering from a concussion
There are several things an athlete can do to aid their recovery from a concussion.
Take it slow
Initial rest is essential, but so is gradually returning to normal daily activities, while being mindful of symptoms. Concussion patients may need to adjust their daily activities to avoid overexertion that could exacerbate symptoms.
Do safe, easy exercise
Light exercise in a controlled environment can aid recovery by increasing blood flow to the brain and enhancing mood and physical function. Athletes must understand that this phase is about healing the brain rather than training the body. Walking or cycling on a stationary bike are safe exercises that provide physical benefits without risking a Second Impact Syndrome.
Feed the brain
Diet also plays a role in concussion recovery, with antioxidants from sources like blueberries and green tea, omega-3 fatty acids from fish and nuts, and brain-healthy vitamins from foods such as broccoli, citrus fruits, and leafy greens contributing to brain repair. [1] Additionally, supplementing with exogenous ketones like Beta-Hydroxybutyrate (BHB) or exogenous lactate can serve as alternative fuel sources for the brain during metabolic recovery. [2]
Reduce stress
Minimizing unnecessary stress on the brain is crucial for recovery. This involves prioritizing quality sleep and engaging in relaxation techniques such as yoga and meditation. Gradual reintroduction of stressors like reading, puzzles, work, and screen time should be based on symptom tolerance, with honesty and mindfulness guiding the process.
Returning to sport
The decision to return to sport should be guided by a medical professional capable of objectively assessing the athlete. Before resuming sports, all concussion symptoms should have completely resolved without medication. Athletes should have returned to their normal activities (including work or school) without symptoms, and cognitive function should be fully restored.
Athletes should follow a phased return to sport, gradually increasing intensity and the risk of further injury. For instance, cyclists may start with low-intensity indoor training before advancing to solo road rides and eventually group or off-road riding.
Similarly, runners might begin on treadmills before progressing to road and trail running. Note that athletes should remain asymptomatic during low-intensity activities before progressing to higher-intensity efforts.
Respecting the process is important
While it’s easy to underestimate the severity of concussions and mild TBIs, the potential consequences are profound and enduring. Recognizing these injuries and responding with appropriate medical care and caution can significantly improve recovery outcomes.
It may be frustrating to take a break from sport despite feeling physically fine, but by respecting the recovery process and prioritizing brain health, individuals can reduce the risk of long-term complications and promote overall well-being.
References
- Foods That Heal the Brain After Concussion: 8 Healthy Options [Internet]. Flint Rehab. 2020. Available from: https://www.flintrehab.com/foods-that-heal-the-brain-after-concussion/
- Daines SA. The Therapeutic Potential and Limitations of Ketones in Traumatic Brain Injury. Frontiers in Neurology. 2021 Oct 22;12.
