Reflecting on Concussion
It’s been over two years since my last concussion while playing hockey. I still have difficulty with focusing, remembering small details, and continually battling anxiety. Although I no longer have a concussion, I don’t feel exactly the same as I did before and that is exactly what has captivated me for over the past several years as a researcher.
I continually ask myself: Why is it that we can’t fully understand what happens in the brain during a concussion and subsequently after? What is the piece of the puzzle we are missing and how do we get people recovered to a point where they can get back to doing what they love without any consequences? How can we find a way to assess concussions that doesn’t rely on subjective symptom reporting or more importantly how do we educate people about brain injuries so that they make an informed decision? These are just some of questions that go through my head, and today I want to share some of my personal and coaching experience when it comes to concussions.
I think almost every athlete can say they have lied about aches or pains they have had occur in games or practices. Or have even played through broken bones, torn or sprained muscles or joints. I have to admit this is part of the team-first culture, where blocking shots, taking a hit to make the play, or playing through an injury is idolized. However, as I realize as I get older and more informed, there is a huge difference between those injuries and injuries to the brain.
The brain is truly extraordinary and makes it possible for us to do the things we love, have the ability to communicate, to learn, share joy and among many other things. It allows us to we achieve tasks like skating, or understanding situations and making decisions. This is all possible through many complex processes, with many thousands of connections, millions of neurons firing, tens of millions support cells and at an incredible speed. Oh and not to mention the complexity of how these neurons communicate with each other through neurotransmitters, neuropeptides, and through thousands of cascades. And yet sometimes we treat the brain as just another tool in our body, a sacrifice to the team, but when I think of it from another perspective I realize this is the wrong way to look at it! The brain is what gives us the team-first attitude, what helps us make the correct decisions, makes it possible to achieve specific skills and all at such a high speed. Without it functioning properly we are not who we promise our team-mates, family members or friends, to be the best we can be. And this is the perspective I now have taken on when I talk to young athletes who have sustained a milt traumatic brain injury. But is this enough to keep them from playing is yet to be seen.
Recently I became an assistant coach for a competitive female hockey team. One of the players was tripped up and hit her head on the end boards. She came off upset, emotional, in pain and clearly could have sustained a concussion. After the ice-clean (intermission) she came back out and wanted to play. And to be honest with all my knowledge about brain injuries I found it extremely difficult to tell her she needed to sit out the rest of the game. However I decided that I needed to follow through on everything I know and tell her she won’t get back on the ice. I found this experience to be really eye opening as it is difficult to tell an athlete they can’t go back out there and that they need to rest. Especially when its all they have known their whole life. Some quotes that come to mind include:
“Get knocked down, get back up.”
“No pain, no gain.”
“Sacrifice your body to win the game.”
But how can we change this? How can we ensure our trainers, who are responsible for pulling the players out of the game, feel comfortable and believe that it is the right decision? Or can we make the athletes realize they need to be more accountable for their own health and long-term development? Maybe it’s the combination of both?
I can’t say I have the answer, but I want to share some thoughts from my personal/ athletic opinion integrated with my researcher perspective on some ways to change this problem.
- We need mentors, we need people like Sidney Crosby or Jen Botterill speaking about their injuries and what they could have done or should have to prevent those months of symptoms. We all know that players are more likely to listen to those who have gone through similar situations, especially when it’s their idols. I can generally say I probably wouldn’t think about the injury any differently if a doctor, teacher came up and told me not to do something or to be honest about the injury… I mean they told me not to play through a torn tendon in my knee in playoffs (good luck with that one).
- Education – this one is huge, and you would be surprised despite the media constantly speaking about concussions… there lack of knowledge about the injury, symptoms, possible long term impact, what to do when you have a concussion, and what resources are available. One example of a recent partnership is between the Greater Toronto Hockey League (GTHL) and Holland Bloorview Kids Rehab Hospital Concussion Centre. This partnership is just an example of how leagues are hoping to educate their players, parents, referees and coaches!
- Education for the Parents – This is a grey zone. Parents do know they kids best but yet many parents may not understand the relatively ‘invisible’ injury or want their kids to succeed in their sport… resisting the temptation to pull them from the game. I think in general this one does come down to the education.
- Different approach to what the injury does!
- One way to do this is by stressing that sitting out right away may give you the chance to recover quicker and be back on the ice within a short time frame rather than playing through the injury and being sidelined for weeks, months and even for years in some cases.
- Your performance while you play is significantly impaired… your not the player you normally are. For example, a scout is watching you play and you aren’t playing your top game (even though you may feel you are), then you could be hurting your future career. Plus, you are likely hurting your team, this one is tough to understand but your role on a team is critical and if you can’t be the player you’re expected to be then it could be affecting the overall game.
- Trainers… this one is so critical. As you can tell, players are stubborn and they more than likely won’t report their injury and say they are okay. This is particularly important in children and youth as the brain is still developing well into adulthood. Many of the decisions made though out this time is may be based on impulse, lack the long term perspective and or even not fully realize the effect of the injury. But how do we help trainers?
- Strong support system – There is a need for well-educated advice from those specialized in sports-concussion that will back the decision a trainer made. Such as the GTHL link to the Concussion Centre, or a referral system to a doctor who has been educated on concussions.
- Coaches need to trust the trainer and have no input to what occurs– I have heard so many times the trainer getting in trouble because they pulled a child and the coaches getting angry and questioning the decision. This needs to be monitored as particularly when it comes to concussions the decision is difficult and is usually resisted by the players.
- Specialized concussion training. The brain is one of the most complex systems in our body, yet there is little time allocated to teaching about the brain, diagnosis, and rehabilitation. And this applies to doctors as well, where many medical schools only cover concussions in an hour or two in 4 years and then are expected to make decisions about this. Even physiotherapists have limited education which is rather concerning as the deal with many athletes. There is a need for courses that are required if you want to be making any decisions related to concussions!
I know that I am excited to see the changes ahead.
Karolina Urban is a member of the Holland Bloorview Kids Rehab Hospital Concussion Centre, mentioned in this blog post. The opinions expressed in this blog post are the author’s own.