Photo: situnek34 (flickr)
The first Major League Baseball player was diagnosed this week with a concussion-related disease called traumatic encephalopathy.
Cincinnati Reds player Ryan Freel committed suicide one year ago this month and a post-mortem investigation found he had the progressive degenerative brain disease that has been found in several deceased NFL players.
Athletes in every contact sport are at risk, and research out just last week from the Indiana University School of Medicine indicates multiple smaller hits can also affect the brain.
How Concussions Happen
Hugh Jackson has been playing football since he was in seventh grade. He’s now a senior defensive end and full back at Bloomington High School North.
But he hasn’t made it through all those years of tackling without some injuries. After several hard hits during a practice earlier this year, he says didn’t feel right.
“At first I didn’t want to tell anyone,” Jackson says. “I just wanted to keep on playing. They always tell you fight through the pain and I just didn’t want to sit out.”
Then it got worse.
“I noticed I started to get dizzy and my teammates noticed my eyes were wandering and everything,” he says.
After another hit, Jackson blacked out. A trainer sent him to the hospital with a concussion.
Here’s what happened medically.
Jackson was hit with enough force that his brain shifted and hit the side of his skull.
Take a look at this imaging of mice brains from the National Institutes of Health. It shows what researchers believe also happens in human brains.
Shortly after a head injury, parts of the brain’s protective lining start to break down. As a defense mechanism, cells in the brain called microglia start to expand, trying to plug up the holes.
The swelling can cause headaches or unconsciousness.
“Sometimes yes, you feel it right away,” says Dr. Matthew Reeves, a sports medicine physician with IU Health Southern Indiana Physicians, says. “Typically the loss of consciousness, the amnesia or the seizure, being dazed or confused,” Reeves says. “These typically are immediate and may be short-lived. The headache and the dizziness and all these types of symptoms tend to creep on late, minute, hours, even the next day.”
Indiana Law Addresses Treatment, Not Prevention
Much of the recent attention surrounding concussions has been geared toward football, and for good reason. Researchers estimate high school athletes experience between 130,000 and 300,000 concussions per year. Of those, nearly 30 percent of concussions happen in football. Soccer has the second highest rate with 16 percent of all concussions, followed closely by basketball at 15 percent.
That’s why the state legislature implemented a new law last year requiring schools to tell parents about the possible risk of concussion in all sports. And if an athlete is suspected of having a concussion, he’s not allowed to return to play until he’s received a written clearance.
A clearance, the Indiana High School Athletic Association Commissioner Bobby Cox says, only a licensed health professional can provide.
“That has to be done by a certified athletic trainer or a doctor and there’s a lot of reasons why. Coaches aren’t qualified to do that,” Cox says. “I hate to say this, but coaches may want the star player back in the ballgame and maybe the star player doesn’t need to be put back in the ballgame.”
But while schools can reprimand coaches for not following the law, there are no legal consequences if a coach puts an athlete back in. And much of the time, there’s not a licensed health professional on hand.
“Many of our rural schools struggle with having somebody at a even their varsity event, let alone sub-varsity events,” Cox says.
But Dr. Reeves warns if an athlete doesn’t get the proper clearance before returning to play, there could be serious consequences for the player’s health.
“If you’re suffering the effects of the first concussion and you get a second blow to the head or blow causing concussion symptoms, the brain has lost its ability to self-regulate from the first injury,” Reeves says. “The second injury goes into a catastrophic brain swelling.”
In the worst cases, that can lead to a coma. In lesser severe cases, athletes can keep experiencing concussive symptoms—headaches and nausea for weeks.
“That’s why you follow the adage when in doubt, sit them out. It’s just plain and simple,” Reeves says.
Proposed Rules Aim To Reduce Head Injuries
“You can’t prevent concussions. I think that’s a fallacy.” -Bobby Cox, IHSAA Commissioner
But most of the rules at the high school level only help treat concussions. As more research comes out, schools and sports organizations are in discussions about how to be more proactive to minimize the risk of concussion in the first place.
“You can’t prevent concussions. I think that’s a fallacy,” Cox says. “But what you can do in regard to interscholastic athletics is you can look at the rules codes within all our sports and look at things that can be tweaked, things that can be passed, things that can be modified to improve the safety of the game.”
That can include making certain contact illegal or minimizing the amount of hits athletes take in practice.
But coaches will also have to convince athletes to take it easy, and that could prove difficult.
Jackson’s concussion was actually the second he’s had. The first was during a lacrosse game his freshman year.
Doctors tell him if he has another concussion, he may have to quit contact sports for good. But he’s working to earn a spot on a Big 10 football team, and Jackson says that’s not something he’s ready to give up.
“There’s lots of risks you have to take to make big steps in life,” he says.