The Bell Tolls for Outdated Sports Phrases: Dings and Rings Mean Mild Brain Injury

Symposium photo by Tonya Hines/Mayfield Clinic.

One of the sobering, underlying messages of UCNI’s recent symposium on sports-related head injuries crystallized for the audience when a high school wrestling coach asked a difficult and honest question. Should a student-athlete on his team who has experienced more than one concussion consider switching to a non-contact sport?

Neurocritical care experts from UCNI did not offer a clear-cut answer of yes or no. But against the backdrop of the medical profession’s growing understanding of concussions – which are in fact mild traumatic brain injuries – Lori Shutter, MD, Director of Neurocritical Care, acknowledged the validity of the coach’s question. Because multiple concussions add up, she said, a brain scan might be advisable. And the coach might want to speak with the student-athlete about his long-term goals in sports and life.

UCNI’s first symposium about sports-related head injury, “You Can’t Ice the Brain,” held April 23 at Xavier University’s Cintas Center, provided a wealth of information about concussions for its 175 registrants, who included athletic trainers, athletic directors, coaches, medical professionals, members of the ski patrol, and parents. Registrants were taught how to recognize and respond to a concussion or mild traumatic brain injury.

William Knight, MD, a neurointensivist with UCNI and the Mayfield Clinic, also advised the audience that research is rapidly shedding new light on traumatic brain injury and that what we know about concussions today could be outdated within five years.

In the meantime, UCNI experts say, parents, athletes, coaches and athletic trainers need to know that concussions are serious and that anyone who suffers a mild traumatic brain injury must be given an appropriate amount of time to recover. Recovery will vary according to the severity of the concussion and whether it has been preceded by one or more concussions.

Here are some important points that were made during the 4-hour event.

• 1.5 million traumatic brain injuries (TBIs) are treated in the United States each year. Of these, 70 to 90 percent are “mild” and are often referred to as concussions.
• Having your “bell rung” or “getting dinged” are euphemisms for what is actually a mild traumatic brain injury.
• A boxer who is knocked out has suffered a mild traumatic brain injury.
• 300,000 mild traumatic brain injuries occur each year in sports.
• The brain, which is contained with the rigid, bony skull, is the consistency of firm custard or tofu.
• The base of the skull is not smooth. It has sharp ridges, which can cause damage if the brain is subjected to force and sudden movement.
• Some of the complex, interconnected brain cells known as neurons are injured during a concussion.
• The brain needs time to recover after a concussion. The concussed brain is vulnerable to minor changes in intracranial pressure and to changes in blood flow.
• Athletes who suffer one concussion are at increased risk of having another.
• Repeated concussions are cumulative.
• Children and teens are more likely to suffer a concussion than adults. They also take longer to recover than adults.
• Sports with the most mild traumatic brain injuries are, for boys -- football, wrestling, soccer, basketball and baseball; for girls -- soccer, basketball, softball, field hockey and volleyball.
• 63 percent of all mild TBIs are related to football.
• TBIs are more common in game situation than in practice.
• At least 7 NFL players have retired because of concussions
• Six former NFL players who died in their 40s were found, during post-mortem brain examinations, to have tangles resembling those found in people with Alzheimer’s disease.

For more information about concussions, and for a complete list of the signs of a concussion, please visit: http://www.braintrauma.org/