With the 2014 Sochi Olympics over, attention has quickly turned to the unbelievable geo-political events happening in the Crimean peninsula at this time. More than usual, the Paralympics, which run March 7-16th, 2014, are being overshadowed. Before we get started on this last blog, I wish Canada’s 54 athletes competing in Sochi’s Paralympics, amidst human-rights scrutiny, partial boycotts and cows wandering into town, the very best of all performances coming together for them in competiton.
The Olympic Legacy. There always is one, whether it’s top notch training facilities, a knockout aquatic centre, war, or a giant debt. Unfortunately for some, the Sochi legacy will be concussion sideffects that might outlast speaking tours or sponsorship contracts.
Continuing with the last instalment of this three-part concussion series is what happens long-term after concussions. Before you think this is all doom and gloom, please remember that based on what we know at present, 80-90% of concussions take 7-10 days to heal. What lies ahead (pun intended) is for those 28,000 or more people per year who don’t fall squarely into that category.
Legacy #1: Time Off
At the beginning of the Olympics, Canadian researchers published a study where enhanced MRI technology was used to show that university hockey players with concussions sustained bleeds in their brains. Where there is blood, there is tissue damage and torn nerves. Concussions cause tissue damage. This study went on to continue imaging the brains of concussed hockey players throughout their recovery in order to determine what sort of time interval tissue healing really took. It was remarkably consistent with the athlete’s report of concussion symptoms, such as fogginess, confusion and lethargy. Symptoms tell us to rest. Listen up!
In a study where a physician specialising in concussion was on-hand to assess and diagnose concussions sustained during an entire hockey season, concussion incidence was seven times higher than any previous report. A brain injury happened in 36.5% of the hockey games in a season. Concussions are frequent. And that’s just hockey. If I were a betting woman, I would say that concussion prevalence numbers 5 years from now will be bigger; not because there will be more concussions, but because there will be fewer undiagnosed ones.
Legacy #2: Depression
Traumatic brain injury (TBI) is associated with a higher incidence of depression. The majority of individuals who suffer a TBI are juveniles and young adults, and thus, the risk of a lifetime of depressive complications is a significant concern. The cause of concussion-related depression might be brain cells’ tendency to over-react to stress, infection and injury after an initial concussion. That the human brain tends to naturally inflame with age is an additional factor explaining perhaps why mental health problems related to concussion show up sometimes many decades after the original injury.
Legacy #3: Chronic Pain
A review of long-term studies of people with mild and more traumatic brain injuries published by the American Medical Association asserts that “Chronic pain is a common complication of TBI. It is independent of psychologicdisorders such as PTSD and depression and is common even among patients with apparently minor injuries to the brain.”, and “Patients who appear clinically to have less severe brain injuries may in fact develop more pain symptoms.” Wonder why that back isn’t healing very quickly? Consider the role of a past head injury.
Concussion Legacy #4: Chronic Traumatic Encephalopathy
Chronic Traumatic Encephalopathy (CTE), was originally referred to as punch-drunk syndrome, and associated with people who have sustained multiple concussions over the course of a lifetime. It continues to be poorly understood. Modern CTE is defined by gait disorders, speech slowing, and behavioural symptoms including mood disorder (mainly depression), paranoia, agitation, social withdrawal, poor judgement and aggression. Cognitive impairment tends to emerge later and reportedly progresses over time. As with many issues relating to concussion, there is lack of operational criteria to confirm either a clinical or pathological diagnosis of CTE, which currently limits researchers’ ability to assess for this condition and put numbers on incidence.
Concussion is a spectrum, with acute injury at one end and degenerative symptoms at the other. But it’s not a set path, and a lot has yet to be learned. One concussion might lead to all these legacies, or none. The take-home message from this three-part series is that concussion is legitimate, its effects deserve respect and rest, and the magnitude of its impact merits that we re-examine the rules of our games.
Throughout this 3-part series I have conveniently used the Olympics and athletes as a focal point to discuss concussion. However, I did not want to conclude before acknowledging that another body of people who represent their countries – military forces – who are also subjected to repeated blows to the head and concussions throughout their training and service. In a tragically ironic twist on Lest We Forget, they come home with the same symptoms.
Let’s at least make a push for that which we can control – the rules and management of head injuries at play. Peace begins at home.
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Ashley M. Fenn, John C. Gensel, Yan Huang, Phillip G. Popovich, Jonathan Lifshitz, Jonathan P. Godbout. Immune Activation Promotes Depression 1 Month After Diffuse Brain Injury: A Role for Primed Microglia. Biological Psychiatry, 2013; DOI: 10.1016/j.biopsych.2013.10.014