Playing just 15 minutes after suffering a concussion can make you 11 times more likely to have persistent symptoms.

Introduction:

Concussions have garnered increasing attention in recent years, with growing awareness of their potential long-term consequences. Yet, in certain sports cultures, there persists a notion that playing through a concussion is not only acceptable but admirable. In this blog post, we delve into the risks associated with playing through a concussion and explore why safety should always be the top priority.

Understanding Concussions:

Before diving into the discussion of playing through a concussion, let's first understand what a concussion is. A concussion is a mild traumatic brain injury that occurs when the brain is jolted or twisted inside the skull. This can happen due to a blow to the head, a sudden jolt, or a violent shaking or abrupt hit to the head or body. Concussions can result in a range of symptoms, including headache, dizziness, confusion, nausea, sensitivity to light and noise, and changes in mood or behavior.

The Dangers of Playing Through a Concussion:

Playing through a concussion is risky for several reasons. First and foremost, sustaining another blow to the head while already concussed can lead to second impact syndrome, a rare but potentially fatal condition characterized by rapid brain swelling. Additionally, continuing to play with a concussion can significantly prolong recovery time and increase the likelihood of experiencing persistent symptoms, such as headaches, memory problems, and difficulty concentrating. Moreover, ignoring the signs of a concussion and pushing through the pain can exacerbate the injury and cause long-term damage to the brain. The main reason most athletes play through concussion symptoms is to not lose playing time as athletes love to play. But this mindset is much more likely to keep you out of the game longer than if you would have stopped playing right away. In 2020, Charek, Daniel; Elbin, R.J.; et al. conducted a notable study examining the impact of playing through concussion symptoms and its impact on recovery time. This study involved three distinct groups: the removal group, the short playgroup, and the long playgroup. Participants in the removal group were immediately taken out of the game upon sustaining a concussion. Those in the short playgroup continued playing for 15 minutes or less after experiencing a concussion, while participants in the long playgroup played for more than 15 minutes. The study meticulously tracked each athlete's symptoms, neurocognitive performance, and overall recovery time, yielding compelling results.

Immediate Removal Group: Average recovery time was 18.98 days

Short Play Group: Was 5.43 times more likely to have persistent symptoms with an average recovery time of 28.42 days.

Long Play Group: Was 11.76 times more likely to have persistent symptoms with an average recovery time of 44.09 days.

How can continuing to play prolong my recovery so much?

The reason we believe that continuing to play after sustaining a concussion, even for a brief period, can significantly impact an athlete's recovery is primarily due to the cellular changes that occur in the brain following the injury. The diagram below illustrates the neurometabolic cascade of a concussion. As depicted, immediately after the injury, there is a rapid alteration in the brain tissue's chemistry, particularly evident in the increased levels of calcium.

It is crucial to highlight the significance of calcium in this context. Following a concussion, there is a substantial surge of calcium in the brain, which does not return to normal levels until approximately the third-day post-injury. The issue arises because an excess of calcium can be toxic to brain cells, exacerbating brain trauma. The hypothesis is that by persisting in physical activity after sustaining a concussion, individuals are continuously introducing more calcium into the injured area, thereby perpetuating brain trauma and contributing to an extended recovery period.

The Importance of Recognizing Concussion Symptoms:

Recognizing the symptoms of a concussion is crucial for ensuring prompt and appropriate medical attention. Athletes, coaches, parents, and officials should be educated about the signs of a concussion and encouraged to take them seriously. Some common symptoms include headache, dizziness, confusion, memory problems, nausea, vomiting, sensitivity to light and noise, and changes in mood or behavior. Suppose any of these symptoms are present after a head injury. In that case, it is essential to seek medical evaluation and refrain from returning to play until cleared by a qualified healthcare professional. While most concussions don’t require emergency attention, some situations do need immediate care. Call 9-1-1 or seek emergency medical attention if you experience any of the following red flag symptoms. They could indicate a more serious injury.

Red Flag Symptoms

Prolonged Loss of consciousness
Significant Headache (10 out of 10 pain)
Repeated vomiting (more than 2x)
Slurred speech
Seizures
Lack of Coordination
Stumbling / Loss of Balance
Numbness or weakness in the arms or legs
Inability to recognize people or places
Inability to be awakened

Changing the Culture:

In many sports cultures, there is a prevailing mentality that toughness is synonymous with playing through pain and injury. This mindset can be dangerous when it comes to concussions, as it encourages athletes to ignore their symptoms and put themselves at risk of further harm. Changing this culture requires a shift in attitudes and behaviors at all levels of sports, from youth leagues to the professional ranks. Coaches, parents, and athletes must prioritize safety.

Conclusion:

Playing through a concussion is not safe, plain and simple. The risks far outweigh any potential benefits, and athletes who sustain head injuries should always err on the side of caution and seek appropriate medical attention. By recognizing the signs of a concussion, prioritizing safety, and working to change the culture surrounding head injuries in sports, we can help protect the health and well-being of athletes at all levels. Remember, when it comes to concussions when in doubt sit them out.

References:

Charek, D. E. R. J. ; et al. (2020). Preliminary Evidence of a Dose-response for Continuing to Play on Recovery Time after Concussion. Journal of Head Trauma Rehabilitation, 35(2), 85–91. https://doi.org/10.1097/HTR.0000000000000476.Preliminary

Giza, C. C., & Hovda, D. A. (2014). The New Neurometabolic Cascade of Concussion. Neurosurgery, 75(0 4), S24. https://doi.org/10.1227/NEU.0000000000000505

The Risks of Continuing to Play After Suffering a Concussion. How it Can Keep You Out Longer…