Sports Concussions: A Growing Concern

By  //  August 21, 2012

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Sports Medicine

(VIDEO BY Vanderbilthealth)

BREVARD COUNTY • MELBOURNE, FLORIDA–The safety of sports, especially those of the contact type, has recently been closely scrutinized and received a lot of media attention. It has been suggested that the multiple concussions sustained by one of football’s all-time greats, Junior Seau, could have led to his suicide death (Peter K’s “Take”). 

Former NFL linebacker Junior Seau sustained multiple concussions during his playing days and committed suicide with a gun shot wound to the chest in 2012 at the age of 43.

In fact, in a recent interview, a former teammate of Seau’s, Gary Plummer said he had suffered at least 1000 concussions in his career and extrapolated the number up to 1500 (due to Seau’s longer career) when estimating the number of concussions Junior Seau may have had.  Plummer defended this position based on information he had learned at a concussion seminar when he played as an NFL middle linebacker.  Plummer said, “At the seminar we learned that seeing stars after a hit was considered a mild concussion.” As a result he estimated he had suffered at least 5 concussions per game. The truth, both Seau and Plummer probably suffered an inordinate amount of concussions because they were in a post-concussive state for most of their careers, increasing their risk of future concussions.

Heightened Awareness Of Danger Is Critical

Education on what defines a concussion, how they are identified and seeking out the appropriate professionals to manage this condition is critical.  Concussions are far more dangerous when they go undetected, and heightened public awareness and knowledge related to the seriousness of sports related concussion, especially among cognitively developing adolescents, must be improved.

History And Physical Key To Diagnosis

A concussion is a clinical syndrome characterized by immediate and transient post-traumatic impairment of neural functions, such as alteration of consciousness, disturbance of vision, or equilibrium.

Concussions occur in varying degrees from mild to moderate to severe, and there are many grading systems, which typically range from Grade 1 (mild), Grade 2 (moderate), and Grade 3 (Severe).  The human brain weighs about 3 pounds and floats suspended in a fluid-filled case of cerebrospinal fluid. Normally the fluid protects the brain, however, in the case of a forceful impact, the brain can be sheared in such a way to cause injury or even make contact with the skull.  The diagnosis of concussion can only be made by history and clinical exam. CT scans of the brain do not show any specific changes, so are not useful in the diagnosis. Many athletes who suffer from momentary confusion after a collision may not realize that they have sustained a concussion and commonly fail to report the event.  Here are some common symptoms:

  • Nausea
  • Balance problems or dizziness
  • Double or fuzzy vision
  • Sensitivity to light or noise
  • Headache
  • Fleeing sluggish, foggy or groggy
  • Concentration or membory problems
  • Confusion
  • Behavior or personality changes
  • Answers questions slowly

Return-To-Play Guidelines Determine Appropriate Treatment

Once the diagnosis of concussion has been made, the decision on the safe return to play must be made.  Premature return to play may put an athlete at risk for the rare event of “second-impact syndrome”. This can occur when an athlete, who has yet recovered from an initial concussion, sustains an even mild blow to the head resulting in brain swelling resulting in severe neurological injury or death. It is the concern for this event that developments of multiple “return-to-play” guidelines have been established.  A few governing bodies such as the Cantu (Concussion Grading System), Colorado Medical Society, and American Academy of Neurology have published guidelines that most sports medicine professionals adhere to in determining the appropriate treatment of an athlete sustaining a concussion.

Multiple Concussions May Have Serious Cumulative Effects

#12 TERRY BRADSHAW, who lead the Pittsburgh Steelers to four Super Bowl wins, disclosed that he’s suffering from the devastating impact of repeated concussions as a football player. Experts note that football players may experience as many as 15 concussions, on average, during their high school, college and professional playing careers.

The effect of concussions is cumulative in nature and results in making an athlete more susceptible to future concussions as a result of having a previous one.  In athletes who have had multiple concussions, even very small impacts can result in significant concussions with successive injuries.  A relatively common condition, post-concussive syndrome, can occur in athletes who sustain a significant concussion or multiple mild concussions. With post-concussion syndrome symptoms from a concussion do not resolve for months or years and can even become permanent. It is a condition characterized by symptoms such as headaches, dizziness, fatigue, cognitive impairment, or depression.  The long-term effects of concussions are just recently being understood and there is evidence that with multiple concussions there is a significantly increased risk of developing psychiatric and cognitive disorders.

Concussions Under Recognized And Reported

Only about 10% of the estimated 4 million sport-related concussions are reported every year. The lack of recognition of signs and symptoms of concussions are not the only factor involved in the under-reporting of an injury.  For many athletes, it is the fear of being pulled out or not being able to return to play that takes priority when a concussive injury occurs.  Unfortunately there have been obvious cases of concussive injuries that are ignored by the athletes, coaches, trainers, or even their parents with the hopes of not letting the team down or fear of missing an opportunity to play, potentially affecting the injured player’s future athletic opportunities.  Over the years, these cases have been sadly played out on the news with devastating consequences of severe neurological injury and even death.

More Research Needed To Prevent and Treat Concussions

Concussions are more common in sports classified as contact type, such as football, ice hockey, basketball, boxing, soccer, lacrosse, and gymnastics.  Due to the high impact contact between players, the incidence of concussions is highest in football and ice hockey.

Pittsburg Penguin star Sidney Crosby sustained a concussion as a result of hits to the head in back-to-back games during the 2010-11 NHL season, leaving him sidelined for ten and a half months. However, after playing eight games in the 2011–12 season, his concussion-like symptoms returned in December 2011, and he did not return until mid-March 2012.

Unfortunately, helmets and other types of headgear are not entirely effective, because they only protect the skull and brain from direct contact. They are unable to prevent the brain from contacting the inside of skull from forces involved when a concussion occurs.

As we are aware, concussions can cause severe acute and chronic debilitation for those who sustain these types of injuries. In Junior Seau’s case, the family has released his brain to science to be studied for the effects of multiple concussions.  The public attention given to this and other related tragedies in sports will hopefully bring about continued research leading to discovery of the consequences of this serious injury. Only with this information can we better identify ways in the future to prevent, protect, and treat athletes suffering concussions in sports.


Dr. Badolato

A Florida native, Dr. Stephen Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents’ Medical Center in Jacksonville. He is Board Certified and has fellowship training in Sports Medicine with a specializaation in non-operative musculoskeletal medicine.  Formerly a team physician at the Ohio state University, Dr. Badolato was also medical director for the world-renowned IMG Sports Academy in Bradenton, Florida.  Dr. Badolato can be reached at 321-253-2169.