Inside The Brain Of A Concussion Expert
By John Rezell, Executive Editor of SportsEvents Magazine
One-on-One features an interview with an influential member of the sports community concerning a specific topic. This month, Dr. Michael D. Lewis, founder of the Brain Health Education and Research Institute, discusses the basics of concussions.
If numbers make your head spin, please take proper precautions before attempting to wrap your brain around these statistics:
The Concussion Legacy Foundation reports that the CDC estimates there are 3.8 million concussions in the United States each year, and just one in six — about 17 percent — is diagnosed.
That’s a lot of head-banging.
Sports concussions have grabbed plenty of headlines recently as former NFL players, boxers, soccer players and other athletes have come forward to discuss their long-term health problems from head trauma.
While many sports fans can recall images of a horrific collision involving the head, everyone involved in sports at any level should know the basics of concussions so they can be on the lookout and be prepared to react. Recognition of a concussion can save a life, as well as weeks, months and sometimes years of misery.
“In basic terms, a concussion is a bruising of the brain,” Lewis said. “In medicine, we break it down a little bit into a primary and secondary phase or injury. That primary phase is the mechanism, whether it is hitting your head on the basketball floor or an elbow to your head playing soccer or a head against the windshield in a car crash.”
While the most violent head traumas manage to catch our attention, less dramatic hits to the head can often slip by unnoticed.
“That’s the primary injury but what’s not appreciated necessarily by the general public is that is just the beginning,” Lewis said. “There is a whole secondary injury, or secondary phase, to a head injury even when the primary injury the might not be apparent … where it didn’t seem like it was that big of an event and the person might not even notice anything wrong.”
Not all concussions have immediate symptoms obvious to the individual receiving the blow or someone observing that individual.
“They might not even notice the primary event but the secondary event sets off this biochemical cascade that continues to cause damage,” Lewis said. “It’s like a fire that’s burning in a house that the fire department seems to have put out but it’s smoldering underneath. A lot of that inflammation is mediated so what can happen is that you get a chronic condition inflammation that continues to burn in the brain and causes symptoms.”
Four Areas To Watch
Concussion symptoms — that might not be immediately apparent — fall into four categories: cognitive, physical, emotional and sleep.
“The cognitive or thinking or memory type of symptoms are where people will typically complain they just aren’t thinking clearly, maybe feeling like they slowed down,” Lewis said. “One term very commonly used is a brain fog, where you feel like you have a bad head cold but don’t have a runny nose and where everything feels like your head is stuffed with cotton. It makes it difficult to concentrate and makes it difficult to remember things. It can be short-term memory is more of an issue.”
Physical symptoms are much easier to diagnose.
“On the physical side, it can be headaches, it can be blurred vision or it could be nausea and vomiting early on right after the injury if it is more serious of an injury,” Lewis said. “What we see more commonly is an acute sensitivity to light or noise. So for a kid going back to school, the noise and the stimulation of, say, the lunchtime cafeteria can be just completely overwhelming to a teenage student or even younger.”
Fatigue and exhaustion are other physical symptoms.
“One of the things I see,” Lewis said, “is exhaustion. Just feeling tired, with no energy, even after minimal exertion. That can be a teenager, too. I saw a 17-year-old patient who had an injury for a couple years and is still struggling to get back to normal and he just says he wants to take a nap all the time. He wakes up tired and it just doesn’t get better during the day.”
The emotional side is sometimes an area someone other than the patient can notice.
“A third area is the emotional side, or mood, irritability and nervousness,” Lewis said. “Anxiety is a big issue, and can even lead to depression.”
The final symptom concerns sleep.
“The last one that sort of ties in with the others is issues with sleep, whether sleeping too much or not being able to get to sleep or not waking up feeling rested,” Lewis said. “It kind of goes with that energy thing.”
Reacting quickly to a head injury can make a difference.
“The most important thing with anybody, an adult or kid, is get the person out of harm’s way,” Lewis said. “Coaches are getting better about being aware of when there is a big hit or someone bangs their head on the floor playing volleyball or whatever. Those should be pretty obvious. …
“But I go as far as saying it is a parent’s responsibility if you are watching the game — and referees, the coach and everyone else misses something because their focus is on the action and maybe it is something off to the side — a parent should speak up and stop the game if necessary and get the kid out of harm’s way because you don’t want another injury to compound … the first one. That is by far the most important.”
While it might be difficult to find the confidence to intervene during an event, it’s important to look out for all athletes. No one knows an individual better than a parent. Staying vigilant about symptoms is key.
“If a kid says to you they don’t feel right, that there’s something wrong, you really need to listen to them,” Lewis said. “Get them evaluated. Sometimes kids won’t be able to express what is wrong but you need to look at those four areas remembering the cognitive area, the physical area of headaches and dizziness and sensitivity to light and noise, the emotional — how do you know when a teenager is moody is a little big of a trick, but parents typically will know.
“So a kid who is usually very calm, very pleasant and then has emotional outbursts — they may not understand it themselves, but a parent will notice what’s going on. And of course the fourth one, the sleep issues, if they are just sleeping all the time, which is more than a teenager would typically want to sleep, those are areas where you can be concerned.”
Combine the tremendous frequency of head traumas with what little experts really know about them, and the need to know symptoms and react is crucial. While experts say the majority of concussion patients will recover quickly, often within two weeks, a head injury just as easily can lead to much longer recovery.
“Everything you read from the CDC website and the NIH and so on will say eighty percent get better in two weeks,” Lewis said. “What is left unstated is, yeah, what about the other twenty percent? And, oh, by the way, if you are looking at three to four million concussions a year, twenty percent of four million is a lot of people.”
If you do the math, that’s 800,000 people who could struggle beyond two weeks in recovery. There is no way to know which recovery time a patient can expect to experience, one of the many unanswered questions about concussions.
“Medicine doesn’t have any answers for that,” Lewis said. “There is no standard care, number one, for concussion. Modern medicine won’t even agree on what is a concussion, and what’s the definition of a concussion and how you treat a concussion. There is no standard for that, let alone how you help someone recover.
“Modern mainstream medicine, which translates into what is covered by insurance, only recognizes symptoms and drugs to cover up the symptoms. It doesn’t get into the underlying issue of how you actually get the brain to heal so the symptoms will go away. That’s when you get into integrative or even holistic or alternative medicine that tend to have a better impact than the accepted insurance-based medical system that we have that has absolutely no answers whatsoever.”
Many pro, college and high school programs have trainers who initiate a baseline test before a season starts to use if a head trauma occurs. The effectiveness of those programs appear encouraging but aren’t verified. Lewis said the baseline test isn’t necessarily an answer for youth sports.
“One of those issues is how valid are those tests the younger you get?” Lewis said. “In my opinion there is no more valid test than a mother saying something is wrong, especially the younger the kid is. Again, there is not a single set diagnostic test out there yet. Certainly there is a lot of money and science going into this to figure things out but we aren’t there yet.”
Learning about concussion symptoms is important for anyone in sports. Lewis has a book coming out this fall titled “When Brains Collide” that could be a valuable resource.
“It’s what every athlete and parent should know about concussion and head injuries,” Lewis said.