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by Lisa Albergo reporting for AFANA from Chicago

Euphemistically called "seeing stars" or "getting your bell rung" can make concussion sound mildly amusing. We have all heard the expression "punch drunk" when referring to boxers who suffer slurred speech and other symptoms which resemble inebriation. In reality, there is nothing amusing about a blow to the head which causes injury to the brain. That is exactly what a concussion is - a traumatic brain injury or TBI. How a person is affected by such an injury depends partly on the area of the brain which is the most affected by a blow. Such injuries can occur in a number of ways - the head hitting the ground, a collision with another person or the constant pummeling two contestants inflict upon each other in a boxing ring. Even in soccer, which is primarily a non-contact sport, players are not immune with players who use their heads to make contact with the ball at risk for a concussion. The same can be said of baseball where, although the incidence may be lower than in other sports, players may still be at risk for collisions. This might occur for example if two outfielders collide while running with eyes only on a fly ball or batters and pitchers get hit with a ball traveling at great speed.

The brain is not solidly encased inside the skull. It is surrounded by fluid and therefore can move within the skull. A hard blow such as a collision, being hit with an object or hitting the head on a surface can cause the brain to be heavily compressed against the skull. Even football players - gridiron that is - can suffer such blows despite their helmets. While the helmets may protect them from skull fractures and facial injuries, they cannot prevent the crush of the brain tissue against the skull when they use their heads as battering rams, causing a sudden and hard hit. It is this severe crush which causes the TBI or concussion.

A person can suffer a concussion without losing consciousness. Immediate and visible signs of possible concussion are the appearance of being dazed with orientation difficulty, dizziness and/or blurred vision. It is the delayed effects - which might not appear for hours afterward - that can be of most concern. In recent times, with better medical research and technology, the long-term effects of multiple concussions sustained over a period of time have been documentted. The symptoms are varied, again depending on the area or areas of the brain which have been traumatized. Headaches, nausea, poor sleeping patterns, short-term memory loss, cognitive disorders and even personality disorders have all been chronicled long after the initial injuries were suffered and overcome. One of the most recent discoveries has been the development of chronic traumatic encephalopathy (CTE). While many medical experts have yet to prove a definitive link between concussions and CTE, which can only be diagnosed posthumously, there have been several high-profile cases in which former professional athletes died and it was discovered that they did suffer from CTE. Former Chicago Bear Dave Duerson and, more recently, NFL player Junior Seau both took their own lives. Autopsies on both positively identified CTE in their brain tissues. Former Bears' quarterback and teammate of Duerson's Jim McMahon was known for his ruthless physicality, even by NFL standards, and is now paying the price. Living with early onset dementia for a number of years, he does puzzles and reads to help his memory. There have been several other incidents involving current or past NFL players having brushes with the law with reports from friends or relatives that they were exhibiting signs of cognitive problems and personality changes.

In days gone by in Australian Football, a player who suffered a blow to the head would come off the ground and get checked out by trainers or medical staff and have a "spell" on the bench. A few quick tests were adminstered, for example being asked if they knew where they were, what day it was or correctly identifying how many fingers someone was holding up. If the player "passed" he would be allowed to return to the field of play. This is not the case now with better medical knowledge, treatments and tests. Medical staff and trainers at a sporting venue do not have the proper equipment to do thorough tests to fully determine how badly a player might be injured. Therefore, rules are now in place to keep the injured player off the ground and he sometimes be rested for a week or two until declared fully recovered. This is not just the case in Australian Rules Football. Several years ago, 100 past NFL players were surveyed. Many admitted to lying about how badly hurt they were after coming off the ground due to a heavy hit. As a result, they were allowed to return to the play, with some admitting they did so still feeling woozy or dazed and some with blurred vision.

Over the past decade, there have been a number of international symposiums on concussion in sports. The fourth one was held in Zurich in 2012 and another was held in Melbourne earlier this year. In attendance were medical experts and representatives from sports organizations. Presentations included the latest research, discussion of the alleged link between multiple concussions and CTE, the most current treatment protocols, and what could be done better in the future.

It is not only professional sports bodies in Australia and the USA who are better educated today and taking steps to ensure the safety of players. Codes all over the world and at all levels have or are implementing strict protocols for both the immediate treatment and post-injury monitoring of any player suspected of suffering a concussion. While such protocols may vary from one sport to another, from one country to another and from professional all the way down to children's leagues or school sports, the primary elements of all are:

  • immediate removal of the player from the field of play.
  • initial sideline assessment by a qualified trainer or medical professional.
  • further proper medical assessment as soon as possible.
  • appropriate treatment based on the above assessments. In years gone by, concussions were graded on a 1-2-3 basis, with 1 being the "bell-rung" hit and 3 being loss of consciousness. New protocols stipulate case by case assessment and treatment.
  • the player prohibited from returning to the field until cleared by a qualified medical professional, whether it be one week or several weeks on the sidelines, with a gradual return to exercise and or treatment, based on monitoring results during recovery.
  • should symptoms re-occur upon returning to play, the player is again immediately taken off and reassessed.

The legacy left by ignorance, bravado, lack of medical knowledge and inadequate treatment is a tragic one as evidenced by recent news stories including reports of NFL players and several Aussie Rules players filing law suits against the leagues due to post-career problems they have suffered. As long as contact sports are played, concussion will always be a risk. However, with better technology for detection and treatment, more stringent rules governing injury management and better awareness of the damage which can result by players, health professionals, coaches and officials, at least the injuries and long-term effects can be minimalized.


AFANA readers may be interested in an article published on a US website. The link is provided below:

Article last changed on Saturday, July 27, 2013 - 9:07 PM EDT


Its good to know that they don't allow the player to continue the game after suffering a blow to the head. I can't blame other players lying about how badly hurt they were after coming off the ground due to a heavy hit because they don't want to leave the game or they don't want to lose their career.
Posted by Lisa (not verified) on February 23, 2016

Hi Hyacinth,

As I said in closing, the legacy left by bravado and machismo is tragic. Better to admit you are hurt rather than play on. That is more of a risk to the career than coming off the ground.


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