A mounting body of medical evidence shows that incurring successive concussions greatly complicates recovery, a development that has neurologists and neuropsychiatrists seeking remedies and safeguards against the effects of cumulative mild traumatic brain injury.
Studies also show that still-developing younger brains react differently to concussions than do adult brains. Dr. Matthew Grady, a pediatric sports medicine specialist at the Children's Hospital of Philadelphia, cites typical recovery times from a first concussion of three to five days for professional athletes, 10 to 14 days for college athletes, one to three weeks for high-school athletes, and two to four weeks at the middle school level. He adds that it takes a greater force to cause an initial concussion in an adolescent's brain, but that the brain also takes significantly longer to heal.
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"Concussions take longer to heal in the teenage population," he says. "We're not sure why [yet], but it's well-documented." There is also a growing recognition in the neurological community of the negative implications of concussions on the ability to perform cognitive tasks such as schoolwork, which have been shown to worsen and prolong symptoms.
The case of Pittsburgh Penguins hockey superstar Sidney Crosby illustrates the troubling and often puzzling cumulative effects of head trauma.
After sustaining an initial concussion (but very likely not the first he had ever suffered), in a Jan. 1, 2011, game against Washington, Crosby returned to the ice four days later and was driven head-first into the boards and knocked out of action. Originally thought to be out for a week, Crosby ended up suffering a variety of symptoms, including headaches, nausea, and the inability to drive a car or watch television. He did not return to the ice until 10 months later, in late November 2011. After suffering a recurrence of symptoms a month later, Crosby was limited to playing in just 22 of Pittsburgh's 82 games in the 2011-12 season as a result of his ongoing symptoms.
Grady says that one key to limiting the effects of concussions is adhering to strict guidelines regarding when players are cleared to resume contact sports. "Concussions are going to occur," he says, "but we're hoping that people won't sustain a second concussion after not [yet] fully recovering from the first." He adds, somewhat ominously, "the second injury carries a much greater risk of severity of injury."
Changes in Concussion Care
The prevailing macho culture of contact sports does not naturally lend itself to accurate reporting and/or diagnosis of concussions, particularly in the win-now culture of competitive team sports. Diagnosis of concussions is primarily drawn from two standpoints:
- clearly observable indications of effects and
- self-reported symptoms.
The physically observable indications of a concussive hit include: an inability to recall simple details like the day of the week, the locale, the opposing team and to follow simple instructions; changes in appearance including glassy eyes and signs of a confused look; and changes in mood or personality. Self-reported symptoms typically include headaches, nausea, sleep disturbances, ringing in the ears and balance issues, to name a few.
What has become abundantly clear to concussion researchers is the importance of limiting post-concussion cognitive activities and affording the brain an opportunity to heal organically. This involves getting as much sleep as possible and forgoing activities such as going to school, doing homework, watching television and playing video games.
Grady recommends following a doctor-monitored, incremental approach to returning to the field of play, beginning with a sufficient period of rest, a gradual resumption of normal activities and non-contact sporting activities, and then participation in contact sports. Progression through the various stages is contingent upon the absence of a recurrence of prior symptoms.
The importance of employing sufficient caution and restraint in the treatment of concussions cannot be overstated, experts say. The hope is that the days of telling concussed athletes "You just got your bell rung!" and sending them back out onto the field or the ice may one day seem as antiquated as the wearing of leather football helmets without face masks, which was standard through the late 1950s.
