Heads up on concussions: separating the myths from the truths
By Alan G. Kulberg, MD
Understanding the diagnosis and treatment of head concussions, one of the most common traumas affecting millions of people each year, particularly during the fall sports season, requires separating some persistent myths from the essential truths.
Let’s start with the truths:
TRUTH: Concussions are far more common – and unreported – than many people realize. An estimated 1.6 to 3.8 million sports- and recreation-related concussions occur in the United States each year. Approximately one in every three people will sustain a concussion before age 21. Athletes often don’t report symptoms out of fear they won’t be able to participate in their sport. Concussions caused by everyday slips, falls and other accidents often are overlooked.
TRUTH: The short and longer-term symptoms of concussion are often invisible to others. Though most patients are able to return to normal activities within two to three weeks, for some the physical and cognitive disruption can persist for months. When symptoms are so subtle, patients may feel pressured to resume full activity earlier than they should.
TRUTH: The damage to the brain in a concussion is not visible by the commonly-used imaging techniques like X-rays, CT, or MRI scans. Proper diagnosis requires obtaining a detailed account of the incident which caused the injury and a thorough history, physical, neurological and cognitive examination. Only then can the full extent of the concussion – and the right treatment plan – be established.
TRUTH: Returning to normal activities without allowing the brain to heal properly can lead to a wide range of complications. These can include increased risk of serious injury in the event of a second concussion, as well as academic and mood challenges.
TRUTH: Effective concussion management is a team effort. Responsible treatment goes beyond the doctor and the patient. The patient’s family, teachers, coaches and others need to be brought into the loop on any academic and activity restrictions prescribed by the patient’s doctors.
And now to dispel a few myths:
MYTH: A concussion is always accompanied by a loss of consciousness. In fact, only about 1 in 10 patients with a concussion will have lost consciousness. That’s why it’s essential to take other early symptoms seriously, including headache, nausea, fatigue, balance problems, changes in vision, a sensitivity to light and noise, as well as cognitive symptoms like memory loss and slowed thinking.
MYTH: You need a bang on the head to get a concussion. In fact, anything that jars the head and causes a sudden shaking of the brain inside the skull can cause concussion, including whiplash in a car accident, the clash of shoulders in a contact sport or a simple fall on the ice, even if the head isn’t hit.
MYTH: Helmets prevent concussion. In fact, while helmets should always be worn in hard-contact sports to protect against head fractures and contusions, they don’t guard against concussion. The sudden jolting of the brain against the inside of the skull – helmet or no helmet – causes microscopic injury to brain cells.
MYTH: Concussions mainly happen in contact sports. In fact, while concussions rightfully are a common cause of concern in athletics, from youth leagues to professional sports, many concussions occur in everyday slips and falls and car accidents, but often are overlooked. Regardless of how the concussion happens, patients should understand they must return to a state of effective learning before returning to activity.
MYTH: Prolonged rest following a concussion is always the best approach to treatment. In fact, while complete physical and cognitive rest is important for those first 24 to 48 hours, “cocooning” a patient for longer than that can make matters worse, not only physically, but emotionally due to social isolation and falling behind in school, which can lead to anxiety and depression.
Alan G. Kulberg, MD, is the Medical Director of the Concussion Evaluation and Rehabilitation Clinic at Berkshire Medical Center.