Coach’s Corner: GBMWolverine discusses Concussions

Posted at 8:00am — 8/29/2010

GBMWolverine wishes to take a small but important detour from the typical site material. This article addresses a major worry of football at all levels, serious concussions.

First off, great team work by the staff to help put this article together. A great group effort.

By operational definition a concussion is an injury to the brain, brought about by impact many times referred to as a blunt impact. The brain area is the recipient of a force that may penetrate two layers of bone, a layer of jelly-like material (diploe layer) and several layers of membrane (meninges) before shocking the brain in an earthquake like event.

The impact and associated problems result from force and therein lies some (not all) of the problem. The greater the mass coupled with greater acceleration equals an increase in force. Players are bigger and move faster, delivering a bigger amount of net force compared to decades ago.

Football players have been concussion prone since the game began. In fact, the noted tough guy, Theodore Roosevelt, got tough and ordered the collegiate game to implement safety reform as a result of numerous deaths in the early 20th Century, or face banishment.

Helmets and other equipment improvements have helped, but the increase in brute force has neutralized much of the technological improvements. Why so? The parts of the human body affected cannot catch up with the great increase of applied force. Helmets have improved, but spinal cords, vertebrae and the soft tissue of the brain are what they were decades ago. Small peewee players that are well equipped actually have an advantage with limited mass and speed. That is not to imply that injuries cannot occur.

Moving beyond the physics and the physiology, the discussion turns to classification of concussions. Classification can provide some meaning to symptoms and timelines. Many groups use three levels or grades (1, 2, 3), some classify as simple or complex.

Grade 1 is the typical “you must have got your bell rung, but you seem ok now” scenario. The symptoms are typical; dazed, memory, dizzy, headaches, etc. but the symptoms disappear pretty quickly and certainly in less than one hour. The medical staff has a decision to make: hold out or put back in after the symptoms disappear for several minutes. The risk is that another concussion may happen soon after.

Grade 2 means the symptoms last past an hour or two. There is no protocol to return a player to competition in such condition. The player would be examined, evaluated and reexamined at least once the next day, perhaps more.

Grade three involves consciousness and is commonly called a knockout blow. The protocol is immediate ER admission and expert neurological assessment. Frequent follow-ups would be mandated. This injury could cause a player to miss weeks, if not longer.

When to come back is a serious point of contention and there appears to be no perfect, definitive answer as to when to allow a return to competition. Most verdicts will likely be conservative. Any return does not guarantee future wellbeing since there is always increased danger of another incident/event following quickly if a return to action is premature.

About 90% of athletes can return within seven days of a Grade 1 or 2 concussion.

Things have changed; spearing has long been eliminated as an accepted football technique and can result in serious sanctions. Players have been better educated as to concussions, and medical treatment is better at diagnosis and is more hesitant to reenter players prematurely. Players, however in a confused state may not give accurate or adequate feedback, leaving the assessment responsibility to the tending adult.

How many concussions are too many? There appears to be no definitive answer, although when an athlete accumulates 3 or more, things change.

Someday what is now a football helmet may be in a museum, replaced by some futuristic protection mechanism that better protects, the head, neck, and spine. Until then people will play football and the acceptance of risk becomes implicit, perhaps even explicit.

Here is to hoping there are fewer stories centered on serious injuries.

Written by GBMWolverine Staff

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