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Football Injuries: Concussions

November 22, 2011

Concussions are one of the top 10 most common injuries football players can sustain. But we largely misunderstand this injury.

For instance, a concussion is not a bruise to a brain caused when the head has a forceful impact with a hard surface like the ground or another player’s helmet as it is commonly believed. In fact, radiological scans don’t show swelling or bleeding. And the injury is usually a result of the head accelerating quickly and then being suddenly stopped or spun rapidly.

The injury occurs when this severe and violent trauma causes the brain cells to fire all their neurotransmitters due to the cells becoming depolarized, emitting an unhealthy flood of chemicals into the brain, which deadens receptors associated with memory and learning. This is why you see players suffering from a concussion confused, unconscious, nausea or with blurred vision.

Unfortunately, players who suffer one concussion are four times more likely to sustain a second one. Each further concussion results in future injuries occurring from less forceful blows and requiring more time than normal to recover.

That’s why all the recent energy from the NFL and college and high school leagues to protect their brains. Yet, brains remain vulnerable, and even the most ordinary collisions on the field can kill. And because teenagers brain tissue has not fully developed, they are highly susceptible to multiple hits to the head resulting in massive swelling and brain bleeds.

College football players are prone to some of the worst collisions, where lineman and linebackers suffer more impacts to the head during a game than any other player, but it’s the quarterback and the running back who suffer the hardest blows, according to a study released back in September.

The effects of concussions are long-term. In 2007, University of North Carolina’s Center for the Study of Retired Athletes studied the 595 retired NFL players who recall sustaining 3 or more concussions. Their study revealed that over twenty percent of those players suffer from depression.

How Do You Protect Players from Further Concussions?

Jason Smith of the Rams was out of the game against Cleveland due to a concussion he suffered in the Dallas game. This is Smith’s third concussion in as many seasons. Given the statement above about the susceptibility to further concussions after you’ve suffered just one concussion, should Jason Smith keep playing? I think it’s clear that for his safety and quality of life in the long term preventing further injuries by quitting is the best option. But will that happen? Unlikely. Playing through injuries, even a concussion, is sometimes part of the game.

Changing the rules of the game is another way to protect players. The league did just that on December 3, 2009, requiring players who exhibit any significant sign of concussion to be removed from the game or practice, barring them from even returning the same day.

Imposing standards on helmet construction is another area that needs to step up to help protect against concussions. The Standard Performance Specifications for Newly Constructed Helmets has virtually eliminated skull fractures, but helmet designers face a trade-off when it comes to design. Since helmets cannot get too large or heavy, they have to be made to withstand high impact and allow less violent forces to cause a concussion or made more softly to cushion against the kind of collisions that cause concussions while allowing larger impacts to crack the skull.

We could go back to leather helmets, which, according to a recent study, for college level players and below there is possible evidence that they provide slightly better protection. What do you think?

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.

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