I’ve been thinking about this blog for a while. In fact, I’ve asked for a lot of people’s input on this to figure out what may be a good way to address this topic. One blog post will likely not cover this, but it’s going to be a start. The topic is concussions in sports. It certainly covers concussions across the board, but as we see a new school year starting, sports are gearing back up to full swing. And in this country, the biggest of these sports is football.
So let’s be honest. I have nothing against football. I didn’t play when I was younger, I’m not really interested in watching it now. It’s a part of world though, and as such, I have had patients who have played or are playing the sport. And let’s be honest, concussions happen more often than people want to admit. In fact, Maroon et al estimate that 1.6-3.8 million people experience sport- and recreation-related concussions annually in the USA. In that, on average 300 mild traumatic brain injuries occur PER MONTH among active US Military. In short, this is a major health care crisis in the US.1 So what does this mean?
Aside from the fact that FOUR congressional hearings have been convened, we have regular media coverage of people like Jim McMahon who suffered gravely from his time in football with the Chicago Bears. Jim’s one of the fortunate ones who’s found Upper Cervical treatments through our friend and mentor Dr Scott Rosa.
But just like Jim McMahon, 15% of individuals who suffer a concussion will experience prolonged and intractable physical, cognitive, emotional and/or sleep disturbances known as Postconcussion Syndrome (PCS).
Post Concussion Syndrome
There are a lot of symptoms that fall under the heading for PCS including:
- chronic headaches
- sleep disturbances
- personality changes
- sensitivity to light and noise
- deficits in short-term memory, problem solving & general academic function
While there are not common radiographic findings (x-ray, MRI, CT), there are some advanced tests that find increases in inflammation of the brain, as well as other brain chemicals such as glutamate and aspartate.
All of these conditions are big concerns for an individual. But what about a parent of an athlete? I reached out to my cousin, Diana. Her husband is the head football coach at a high school in Ohio, where football is a big deal. Her two sons are playing football. In fact, when the boys were still in Junior high school, they were bigger than some of the upper classman at the high school!! It helps that mom and dad are both highly athletic, tall and strong! Diana fully understands the inherent risks associated with the sport, but she also knows how much her boys love it. Her husband is very particular when it comes to safety of boys. But when I asked her about the subject of concussion, she noted that the trainer’s biggest precaution for the boys was keeping well hydrated for their Two-a-Day’s. Good advice so you don’t get light headed, but lacking when it comes to concussion concerns.
She told me a story about how her son Jordan went to a training camp and brought his own helmet. Another player had forgotten his helmet one day, and Jordan was asked to take his helmet off. He was bull rushed by the other player!! Thankfully Jordan was quick on his feet and kept his footing, but what if he wasn’t? What if he had been one of these 3.8 million injuries, and one of the quiet ones at that? What if he started suffering from PCS? Let’s just say Diana was not a happy camper and came out of her seat!! Her husband had 2 athletes out for concussion for doing the same thing at a different camp. Why is safety getting bypassed?
Potential Mechanism of a Concussion Injury
Without getting too technical, there are a couple of different ways the spine, spinal cord and brain stem can be injured to trigger a concussion, or worse lead to Chronic Traumatic Encephalopathy.
- Axial loading directly down the spine.2
- This occurs when the crown of the head is used in a head-first tackle, removing the curve of the spine initially which loses the energy-absorbing elastic component of the spine. When the limits of the protective gear are met, the head actually reverses direction causing a compressive load on the neck and torso
- When this occurs 750-1000 pounds of force are applied to the neck
- It is estimated that this happens within 11 milliseconds
- Cervical Spine buckling
- During axial loading, the individual cervical vertebrae have been shown to move counter normal motion, moving opposite each other to relieve the load
- These injuries occur when the quarterback gets sacked from behind.
- While not as traumatic as a car whiplash, similar compressive forces are noted.
- Pressure Gradient Injuries
- All of the above physical traumas illustrate some sort of extreme range of motion of the neck at very high speeds.
- These traumas can lead to severe increased pressure in the spinal cord as the spinal canal changes shape rapidly.
- The normally protective cerebral spinal fluid can actually be a cause of trauma to the sensitive neural tissue
It should be noted that many sports have similar effects on the spine, as diving into a pool could be traumatic if done incorrectly. The research has shown that injuries really depend on the impact location of the head and the orientation of the cervical spine at the time of impact.(2) This certainly sounds like a need for having your head on straight before playing a contact sport!
Chronic Traumatic Encephalopathy
Chronic Traumatic Encephalopathy (CTE) is a progressive neurodegenerative disease associated with repetitive head trauma. While this will be a topic for another blog post, it should be noted that among 202 deceased former football players, 87% of them were diagnosed with CTE. Of the 14 who only played high school football, 3 of them were diagnosed with CTE. Let’s just say the number goes up from there.
As noted above, one of the biggest risks for injury in the neck depends on the position of the head and neck during impact. Two things immediately come to mind:
- Proper form while practicing & playing
- Precise alignment of the head and neck
If your cervical spine has not been checked for an Upper Cervical subluxation, you may be at risk for an injury to spine while playing contact sports. We can all agree that playing football with proper equipment is a great way to enjoy the game. Doing so with your head on straight on top of that is even better!!
Schedule a consultation with Upper Cervical Specialist Dr. Frederic Schurger.
Dr. Schurger’s office is located in Springfield, IL and services Berlin, Mechanicsburg, Taylorville, Pana, Petersburg, Loami, Athens, Lincoln, Divernon, Decatur, Forsyth, Monticello, Havana, Virginia IL, Kilbourne , Waverly, Franklin IL, Mt.Pulaski, Clinton, Chatham, Jerome, Rochester, Arthur, Sherman, Riverton, New Berlin, Pleasant Plains, Auburn IL, Glenarm, Tuscola, Arcola, Mattoon, Sullivan, Lovington, Chicago and outlying suburbs.
- Concussion Update: Immunoexcitotoxicity, the common etiology of Postconcussion Syndrome, Chron Traumatic Encephalopathy and Posttraumatic Stress Disorder, Smith et al:The Craniocervical Syndrome & MRI. Basel, Karger, 2015, pp 22-32 DOI 10.1159/000365468
- Cervical Spine Funcational Anatomy and the Cbiomechanics of injury due to compressive loading, Swartz et al, J Athletic Training, 2005;40(3):155-161