Living with Chronic Pain
5 Lies about Concussions They Never Tell You
This past week I spent some time communicating with two world experts on traumatic brain injury and concussion. Both have researched and published extensively in the field of concussion assessment and treatment. One of the experts, Dr. Robert Thatcher, conducted the first known study of professional living football players and their brain images utilizing a qEEG and brain SPECT imaging. The following points are my own based on my conversation with the experts and review of the literature this past week. If you are a parent of a child suffering from a concussion, further investigate these points before you return your child to active contact play.
- Using cognitive baseline tests (having the athlete perform different tasks and measuring their cognitive performance) pre injury is a good measure to assist with return to play decisions. This isn’t something that the literature supports. In fact, there is more evidence that the brain is able to “allocate other neural resources” or use other parts of the brain to complete tasks once injury has occurred. Others have stated that NFL players often fake “bad” or do poorly on baseline tests so that once brain injured and working at their maximum the poor performance will be the same. There is also some research that athletes perform poorly on cognitive baseline testing if they have a physical injury to another part of their body not including the head. This research is consistent with the findings that individuals with physical pain may have compromised cognitive functioning. Cognitive baseline testing may be measuring many things that have nothing to do with return-to-play decisions after a traumatic brain injury.
- Ask the player - measures are accurate and should be a big part of the return to play decision. Likely not. Players want to play. They will mostly lie about their injury and symptoms. You can’t depend on them.
- If a traditional “scan” at a hospital consisting of X-ray or MRI show no injury, then no brain injury occurred. These methods are reported to be quite accurate at picking up significant structural damage, but do not identify more mild or moderate brain injury that can lead to significant lifetime symptoms.
- If there truly are no symptoms for 7 days or 14 days, then the player can return to contact. We don’t know. I cannot find any research that would support this. Just because the symptoms aren’t there doesn’t mean the brain is healed.
- Return to play guidelines should be the same for all players. We now see more research on the genetic link to concussion and repeated injury. The research is very technical here, but it does look like if one is prone to concussion, there may be a need to consider that a specific gene makes one more prone to head injury. Until we know for sure, extreme caution is suggested.
Parents need to step up and ask questions if it is suggested that their child return to active contact or play in less than 6 weeks after a concussion. We do have accurate methods to better measure the potential injury and need to recover fully before returning. Unfortunately, most health care providers advising players, coaches, and parents don’t know what they don’t know. Stop using statements such as “upper body injury” or “blow to the head” and call it what it is.