By Roy Benaroch, MD, Emory University
Concussions in American football have occurred at an alarming rate, unleashing a devastating impact. About 3.8 million traumatic brain injuries occur yearly in the United States—these are mostly so-called “mild” injuries, like concussions, and up to 5.3 million Americans live with disabilities related to these injuries.
What Happens After a Concussion?
There are both immediate and delayed effects of concussion. Which symptoms occur depends on which cells are affected most.
In the immediate sense, a concussion is accompanied by a change in brain functioning. This change in functioning could be a complete loss of consciousness, or more typically a period of confusion or delirium, or trouble walking or remembering things.
Essentially, any brain function could be affected, from balance to eyesight to knowing how to take your football helmet off. The usual definition of a concussion requires that there be some immediate symptoms, but if these symptoms are subtle, they can be overlooked.
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What happens next? Brain cells can usually heal, given time and rest.
But the brain remains especially vulnerable after a concussion, while brain cells are already requiring lots of extra energy to heal. During this healing time, it is especially dangerous for players to return to the field.
Learn more about the science of concussions
The Dangerous Aftermath of a Concussion
In a high school football game in 2006, 17-year-old Cody Lehe took a helmet-to-helmet hit. No one noticed it much at the time, though later his mother said that both of the players “had their bells rung.”
Cody kept playing in the game, though the next week he continued to have headaches. One was bad enough that he asked to be taken to the doctor, which is something tough-guy Cody didn’t typically do.
A CT scan of his brain was normal. Although Cody continued to experience a bad headache, he returned to playing football.
During the next practice, Cody took a shoulder hit—by all accounts, a fairly routine blow. But he collapsed and nearly died on the way to the hospital, where he spent almost two months in the Intensive Care Unit.
Cody survived, but he can no longer walk and has significant memory problems.
What happened is called “second impact syndrome,” a second brain injury that occurs before the brain has recovered from a first concussion. It can be especially devastating for teenagers, who may be more vulnerable because of their still-developing anatomy.
Though Cody survived, second impact syndrome has a 90% mortality rate.
Important to note, second impact syndrome is not common. It captures headlines, but well-documented cases probably occur just a few times a year.
Concussions: A Widespread American Phenomenon
But widespread occurrences of concussions are very common. About 3.8 million traumatic brain injuries occur yearly in the United States. They are mostly “so-called mild” injuries like concussions. Up to 5.3 million Americans are living with disabilities related to these injuries.
An estimated one in 14 high school football players suffers a concussion during each football season.
Any player with any neurological symptoms following a hit during the game has received a concussion and needs to come out of the game or practice to be evaluated and treated. It is important to remember that other direct hits besides a direct blow to the head can cause a concussion. It is the change in the speed of the head’s movement that results in a concussion.
Remember that the brain is in the skull, the skull is in the head, and the head is attached to the rest of an athlete’s body. A sudden hit anywhere that changes the direction and speed of the head’s movement can damage the brain and result in a concussion, even if the head didn’t take a direct hit.
Why Aren’t Concussions Being Taken More Seriously?
Though there has been more media attention on concussions lately, in some ways, these stories don’t seem to be getting through to the people who need to hear it most: The athletes, and especially young athletes.
College football players, who ought to know better, report that they’ve had six suspected concussions and 21 “dings” for every concussion that’s been diagnosed. Getting a “ding,” “getting your bell rung” are all euphemisms for concussion. They perpetuate the idea that an athlete should continue to play.
After all, it’s just a “ding.” What’s clear is the vast majority of these injuries are not being evaluated, treated, or even tracked. But the great danger lies in the long-term effects of these mostly missed concussions, with serious consequences.
In the days and weeks after a concussion, symptoms depend on which area of the brain was damaged. None of this damage can be seen on a typical MRI or CT scan: It is damage on a microscopic, cellular level.
Depending on which cells are damaged, symptoms after a concussion can include problems with balance, trouble concentrating, difficulty sleeping, headaches, anxiety, or depression. Sometimes these symptoms can linger for weeks or even months.
Learn More: Inside the world of football
Risk Factors for Concussions
Certain athletes are more at risk for concussions; American football is the number one cause, with a 60% higher rate than the number two sport, lacrosse.
This high risk occurs even though women rarely play football. Females, we know, are more prone to a concussion, or at least more prone to reporting a concussion.
One theory about this is that women are more honest than men when it comes to self-diagnosis and reporting. When you look at high school soccer, which is played by both boys and girls, it’s the girls who lead the way in reported concussions, with a reported rate twice that of boys.
People with certain underlying medical conditions also seem to be at higher risk, including people with a history of migraine headaches or depression.
But the greatest single factor predicting future concussions in an athlete is whether the athlete has had previous concussions. There are multiple reasons for this.
Some people are genetically more vulnerable to concussion, and some, because of personality, education, or increased self-awareness of symptoms, are more likely to report a concussion.
Different athletes may have different styles of play, perhaps putting the more aggressive, physical players at greater risk. Past concussions, even if the symptoms have completely resolved, may leave some damage behind, predisposing the brain to more easily being damaged again.
Learn more about what probability has to do with deciding a football strategy
Downplaying the Impact of Concussions
Concussions, themselves, are a big deal; they can cause prolonged symptoms and disability. But until relatively recently, there wasn’t much media attention on sports concussions at all. Yet brain injuries and concussions had been a part of sports, specifically football, since the game was invented.
In 1905, President Theodore Roosevelt, a big sports fan, summoned the coaches of the largest college football teams to the White House to discuss the brutality and serious injuries that plagued the game. That year, there had been 19 deaths during games, and there was far less football played back then compared to now.
Though many reforms were put in place, football remained a physical and dangerous sport. However, the National Football League tried for many years to minimize the impact of concussions on the game.
In 1994, Dr. Elliot Pellman, who had recently been appointed as the chair of the National Football League’s new Mild Traumatic Brain Injury Committee, characterized concussions as no big deal, as an “occupational risk” of football.
Dr. Pellman had no experience with brain injury; he was a rheumatologist. But his viewpoint reinforced the boys-will-be-boys acceptance of brain injury as a normal part of sports.
Common Questions About Concussions In American Football
Every year there are at minimum 100-150 reported concussions in the NFL.
When the players collide, the blunt force whips the head back and rocks the brain into the skull, resulting in a concussion.
Yes. One of the most prominent pathologists researching the link between concussions and sports was attacked by the Mild Traumatic Brain Injury Committee (MTBI) run by the NFL in an attempt to discredit his work. The link was proven and it became clear what the NFL was doing.
The cornerback position is the most dangerous in football, resulting in the most concussions.
