Concussions: What Happens When You Hit Your Head?

A Legend Disappears

dave-duerson.jpg

Dave Duerson played for the famed '85 Chicago Bears team, winning the last Superbowl the city has seen. A third-round pick out of Notre Dame in the 1983 draft, Duerson shuffled his way into legend status playing in four Pro Bowls, winning the Superbowl again, this time with the New York Giants, and finally ending his career with the Arizona Cardinals.

Duerson had a great career and a good life, or so it seemed. He became a successful businessman and even entered the Harvard executive program, where he would jet-set to Cambridge, Massachusetts for months at a time to attend class and schmooze with other entrepreneurs. He bought himself a mansion in Highland Park, IL, right near Michael Jordan and placed his NFL number '22' along the driveway, displaying his fortune and legend status for all the world to see.

However, things began to unravel. 

Not long after all his success, he experienced divorce, lost his business, and had his mansion foreclosed on. There were drastic shifts in his personality becoming increasingly depressed and extremely temperamental, even snapping at his wife Alicia and sending her to the ER with cuts to her head, dizziness, and pain. Duerson was charged with several misdemeanor counts and later pleaded guilty to domestic battery. 

After the divorce, he fled to Florida where he hid out alone for months at a time, only returning to Chicago to visit his kids. Duerson would continually suffer from ravaging headaches and unsettling dizzy spells. His once photographic memory was shot, often having to ask for directions in the city he lived in for decades, and his health additionally suffered when he could no longer sleep. At first he chalked this all up to aging but became increasingly concerned as time went on.   

Things were not looking good for Duerson, but he wasn't one to give up. 

That is until February 17th, 2011. 

Tragedy

On the night of February 17th in his beachfront Florida condo, Duerson closed his curtains, laid a shrine of framed medals and an American flag in honor of his father (a WWII vet), and then laid in bed naked where he placed a sheet over his body. He proceeded to take a revolver and shoot himself in the chest. 

At 3 pm the next day, his body was found lifeless on the bed. Only one big pool of blood beneath him showed any evidence of anything amiss---the rest of his house was immaculate. The Miami-Dade police force stated they had never seen a suicide executed so well and so meticulously. 

Right before his death, Duerson sent out texts to friends and family asking that his brain be examined for chronic traumatic encephalopathy, a degenerative disease tied to depression, dementia, and suicide. And most likely caused by concussions

Just Part of the Game?

Duerson played football for decades, and had multiple minor concussions but was never hit hard enough to knock him out cold. How is it that he suffered so fantastically if he was never 'badly' injured? New research is shining a light on the major effects of  even the slightest hits to the brain. 

The Research

Patrick Bellgowan is a researcher at the University of Tulsa's Laureate Institute for Brain Research where he scans the brains of college football players and compares them to non-players.

Dr. Patrick Bellgowan

Dr. Patrick Bellgowan

Bellgowan's research specifically focuses on the hippocampus, a part of the brain that plays an important role in memory formation and emotional control. It's well known that the hippocampus can be very sensitive to brain injury and that shrinkage of the region is considered a hallmark of Alzheimer's disease as well as correspond with Chronic Traumatic Encephalopathy; a neurodegenerative disease considered linked to football, boxing, and other contact sports.

Nevertheless, what Bellgowan found in his research astounded him so much he double checked the results, believing the scanners to be broken. Despite his previous knowledge of brain injuries, this new information was stunning.  In a group of 25 college football players with NO history of concussions, the hippocampus's were on average 14 percent smaller than those of the control group who had never played any contact sports. 

If a football player without any history of concussions can have a hippocampus 14 percent smaller than the control, what about the football players who actually received concussions? Well, the football players who received at least 1 concussion, on average, had a 25 percent hippocampal shrinkage compared to the control group. 

To put this number into perspective, Bellgowan says that this number of 25% is:

 

"....A LARGER DIFFERENCE IN VOLUME THAN THE VARIATIONS

SCIENTISTS HAVE OBSERVED BETWEEN THE BRAINS OF HEALTHY PEOPLE AND

PATIENTS SUFFERING FROM ALZHEIMER'S OR SEVERE DEPRESSION."

In essence, these kids' brains were showing the same amount of damage as someone suffering from Alzheimer's disease. And diseases like Alzheimer's will often present with hippocampal shrinkage years or even decades before symptoms present themselves---so are these scans predicting these young men's fate? Are they destined to end up with a neurological disease?

The research being conducted by Bellgowan is just the tip of the iceberg of what is being examined in the whole scientific community related to brain injury and concussions. Not only is research pointing towards a higher risk of Alzheimer's, ALS, Parkinson's and other neurological disorders, but these brain injuries are showing how they are emphatically changing one's personality; concussions and subconscious blows to the head can alter mood, cognition, and behavior causing structural damage to the brain. 

The amount of investigation on the subject is startling, enough to make you want to wear a helmet while going to the toilet. And even if you were the kid who hated sports, but was forced to play for good 'sportsmanship' ---even you, if you got hit on the head or accidentally got smacked by the ball can have some damage to your brain. Scared yet?

 

A Review of the Findings

There have been so many reviews and research done on brain injuries, I've decided to present some of the findings below. Get a cup of coffee or some wine and beer for this one, it's going to take a while. If you are someone who likes to skim text, I bolded the most important takeaways from each study.

  • One study found that teens with a history of concussions are more than three times as likely to suffer from depression as teens who have never had a concussion. 
  • Another study published in PLOS ONE by Jeffery J Bazarian from the University of Rochester found that the effects of traumatic brain injury last for months after the initial trauma. "There is a valid concern that six months of no-contact rest may not be enough for some players." After observing the brains of ten Division III University of Rochester football players before the start of the 2011 season, at the conclusion of the season and after six months of no contact rest found that their brains were still not fully recovered. 
  • A different study funded by the National Institutes of Health and published in the journal Neurology looked at 50 concussed patients compared to 50 healthy people. They also found that the brains of those suffering concussions showed abnormalities 4 months later, even after their symptoms had already eased to some degree.
  • Research published in the Journal of Neurotrauma looked at retired professional football players that compared the number of concussions sustained during their careers and health problems associated with hormonal deficiency. They found that repeated concussions and mild brain trauma can result in reduced levels of growth hormones, gonadotropin, and testosterone, causing disorders such as metabolic syndrome, erectile dysfunction and overall poor quality of life. 
  • According to the University of Pittsburgh's Brain Trauma Research Center, more than 300,000 sports-related concussions occur annually in the U.S., and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19 percent per year of play. More than 62,000 concussions are sustained each year in high school contact sports. Among football players, 34% have had one concussion and 20 percent have endured multiple. 
  • A Study at McGill University in Montreal found that 60% of college soccer players reported symptoms of a concussion at least once during the season. The study also reports that the concussion rates of soccer players were comparable to that of football players.
  • Another study found that concussions are likely caused by many hits over time and not from a single blow to the head, as commonly believed. Which is how a player like Dave Duerson was able to sustain traumatic brain injuries even though he never had a real "concussion."
  • Research presented at the American Association for the Advancement of Science found that damage to the brain caused by a concussion can last for decades after the original head trauma. Even when symptoms of a concussion appear to have disappeared, the brain is still not yet healed. There is abnormal brain wave activity for years after a concussion, as well as partial wasting away of the motor pathways which can lead to significant attention problems.
  • A report found in the Journal of Sport Medicine found that loss of consciousness is NOT an important predictor to how bad a concussion is. People who experience no loss of consciousness may have the same or worse head trauma as those who do experience a loss of consciousness. 
  • Researchers looked at the number and cause of concussions reported among soccer players of 100 high schools across the U.S. between 2005 and 2014. They calculated there were 627 concussions among girls and 442 among boys. The rates of concussions in girls' and boys'high school soccer had risen over the nine-year study period and is the second leading cause of head injury among female athletes. It's important to note that most of the head injuries were caused by body contact between players and not necessarily heading the ball.
  • A study out of the University of Illinois asked  90 college-aged athletes (male and female) to complete a series of tests which measure cognitive dexterity while the researchers measured the electrical activity in their brains. The athletes played a myriad of sports, even track. About half of athletes had been given at least one diagnosis of a concussion and the other half had no previous concussions. Many of the injuries occurred years earlier, and none of the students had any lingering symptoms, and each student performed adequately in college. In the actual testing, the concussed students performed just as well as the uninjured athletes. BUT, when researchers looked at the electrical activity of the brains of those who were previously injured, they found they showed noticeably less activity in portions of the brain associated with attention. It's speculated that as a result of the injury, they were most likely devoting a greater percentage of their total mental reserves to each task than the uninjured students. Could this accelerate the process of declining mental reserves as we age?
  • Dr. Broglio from the University of Illinois found that collegiate athletes who suffered concussions years in the past now displayed small deficits in their balance or walked slightly different than uninjured athletes. They kept both feet on the ground as if attempting to steady oneself with each step. 
  • The Medical Journal of Pediatrics reported that around 375,000 children and teenagers are treated in hospital emergency rooms each year for basketball-related injuries. Notably, the amount seeking care for head trauma is on the rise. These numbers are high and still leave out the many thousands injured who are treated at clinics by athletic trainers, family doctors, and pediatricians.

  • Teenagers who have suffered a traumatic brain injury such as a concussion have a significantly higher risk of attempting suicide, being bullied, becoming bullies themselves, using alcohol or marijuana, engaging in antisocial behavior, being prescribed anxiety and/or depression meds and seeking help for mental health issues from crisis help lines. 

Okay, you get the point. There are TONS of studies regarding brain trauma and concussions, and I could go on for 15 more pages, but I'm sure you're done with that bottle of wine by now. 

The NFL and the Boogyman

Concussions have been in the news a lot recently, with reports of NFL players falling prey to their injuries 20 years after playing in the league. Men like Duerson and Junior Seau committed suicide by shooting themselves in the chest in order to preserve their brains for research.

Even Hollywood is getting in on the action, with a new movie creatively called, "Concussion" which hits movie screens this year and chronicles the efforts of forensic pathologist Bennet Omalu on his discovery of a new disease plaguing football players. He famously investigated the brain of Pittsburgh Steeler's player Mike Webster, who suffered a similar fate as Duerson. Living like a vagabond later in life, Webster was a drug addict who became severely depressed and eventually attempted suicide.  The similarities between these football player's lives and their ultimate demise were too familiar. Omalu knew that something was amiss and had to find out what it was.  

Dr. Bennet Omalu

Dr. Bennet Omalu

Despite normal MRI and CT scans, lack of contusions, regular folds of gray matter and lack of shrinkage, Omalu had to further investigate these football player's brains more than ever before. It didn't make sense; how can they sustain so many head injuries, suffer from emotional, temperamental and cognitive changes, yet show up normal on all these tests? 

After months and months of endless slicing, probing, staining and microscopic research he finally discovered what was plaguing all these athletes: large accumulations of tau proteins. A kind of sludge, clogging up the brain, killing cells in the regions responsible for mood, emotions, and executive functioning. This is why people with traumatic brain injuries go nuts.

Literally the NFL's boogie monster, the organization took to Mafia-like tactics in order to sweep under the rug the damage being done by the sport. Omalu was accused of fraud by the NFL, threatened and even taunted with claims that he was practicing "Vodoo." 

This stuff is very scary, but the scariest part is how concussions (and bad ones) are not soley relegated to professional realms of football players or boxers. Any one of us can get a concussion, and we don't have to be knocked unconscious to be vulnerable to its effects. Whether it be a car accident, fall, spill, workplace injury or banging your head against your cabinet, they can all lead to concussions and its ensuing effects.

 

The brain. The most miraculous part of our body allows us to touch, feel, hear, see and love. But it's also the most tender organ, vulnerable to the outside world. Basically just a spongy mass of tissue surrounded by fluid, it moves independently of the skull, suspended in space. 

 

Every time you hit your head your brain smashes against the inside of your skull. Helmets don't protect against concussions, they just keep your skull from cracking open (which is good, but not good enough). Just imagine what happens when a football player gets rocked to the ground.  Watch Greenbay Packer's player Jermichael Finley as he struggles to stand up and walk after getting hit in the head during a play.

And concussions simply aren't bruises to the brain. They are worse. They're a disruption of the intricate signals and chemical systems that constitute normal brain function. And you don't have to lose consciousness to have a concussion. Just because you don't see stars or hear buzzing in your ears, does not mean you're free from suffering a traumatic brain injury. 

What's worse is that having one concussion significantly increases your risk of having another. And multiple concussions are associated with an increased risk of post-concussion syndrome----where symptoms persist for years or decades, possibly forever altering brain chemistry.

Concussions happen in all sports

Concussions happen in all sports

Concussions and Our Kids

A lot of attention has been given to the professional sports leagues, but this doesn't mean that head injuries are relegated to their stature. Head injuries can happen to anyone, especially anyone playing a contact sport, meaning most sports. Kids are the most defenseless to head injuries, with more vulnerability and much more to lose.

But if you think the majority of head injuries happen to boys, think again. Female athletes are TWICE as likely to get a concussion while playing soccer (a sport many consider to be safe), lacrosse or ice hockey. And the next time you think cheerleading is a harmless activity spent on the sidelines, it's probably the most dangerous of them all. In 2011, 37,000 cheerleaders were taken to the ER, many from being dropped, kicked or hit in the skull from aerial maneuvers. And you know their bows aren't protecting their skulls from cracking open. 

                                      Cheerleaders are just as vulnerable to head injuries.

                                      Cheerleaders are just as vulnerable to head injuries.

Robert Cantu is a Colombia and Harvard-trained neurosurgeon who recently published, "Concussions and our Kids." Cantu owns a practice outside Boston treating kids and their concussions on a daily basis. According to Cantu, 90% of kids who have concussions heal fine with proper rest and precautions, but it's the other 10% we should be extremely worried about:

"For reasons not understood, though, the remaining 10 percent contract the malaise called post-concussion syndrome, or PCS. Every day in his office at this suburban hospital a half-hour west of Boston, he sees boys and girls with some of the 26 symptoms on the PCS checklist. Fatigue, dizziness, memory failure; lightheadedness, nausea, lack of focus: these can linger indefinitely in shifting clusters, costing patients a year of school or even more. The bigger blow, however, is to their mental development. 'There's an epidemic of kids whose normal trajectory is permanently stunted by head injury,' says Cantu. Over time, some 'pass grades again and are thought of as fine, but might have been superior instead of average."

The stories surrounding young athletes is startling, with boys dropping dead at the age of 17 from brain hemorrhages---their brain just too vulnerable for another hit.

Even minor blows to the head, a little knock, can be dangerous.  If you already have a history of concussions, it sets off a cascade of worry, leading to brain loss, seizures, and death. This is called Second Impact Syndrome and only occurs to kids under the age of 25. While still being researched and not completely understood, it's thought to be due to the immaturity of the nervous system, an inability to handle the flux of ions and salts that a developed brain can. 

 

The brain needs rest

What's more, most athletes aren't given proper rest. Not only is physical rest crucial for the brain after a concussion, but so is mental rest. It's imperative to avoid all kinds of cognitive exertion. It may be hard to do nothing for days (including no video games, no reading, no television, no phones, no computers), but a failure of fully letting the brain rest sets you up for future concussions and post-concussion syndrome. 

And to make it worse, it's difficult to notice these negative effects to the brain. Many practitioners use symptoms, such as headaches, as diagnostic indicators of the amount of rest a player would need. However, symptoms can be useless when it comes to diagnosing and treating a concussion, especially when most concussions go un-noticed.

 

The Stages of Injury

  • Stage one of the disease is asymptomatic, an insidious killer that preys on these athletes. Many of the only symptoms only include a lack in attention----something that many teenagers and young folks are accused of. 
  • Stage two of the disease, around one's 40's, symptoms come about quicker and with more force. Loss of short term recall, loss of judgement, planning and coordination. This is a whole different kind of mid-life crisis. Depression comes into play as well as temperament changes, a lack in patience and frequent bursts of anger. 
  • Stage 3 comes along in your 50s with the brain shrinking in major centers. The Amygdala (emotion) and the hippocampus (memory) see deficits. 
  • Last but not least, the end stage. This is where you see dementia, ALS, Parkinson's, etc. Sufferers from CTE can live in an Alzheimer's like confusion and distress for decades.


Symptoms

Do you have a child that plays sports or do you yourself love a good game of badminton (why not?). If you are worried about your loved one (yourself included) how can you notice the symptoms of a concussion in order to fully treat one? Here are some of the common signs:

  • Mild to moderate headaches.
  • Drowsiness, dizziness or loss of balance.
  • Nausea or vomiting.
  • Changes in mood (restless, sad or irritable).
  • Trouble thinking, remembering things or concentrating.
  • Ringing in ears.
  • Short term loss of newly learned skills.
  • Changes in sleep patterns. 

Remember: You do NOT have to be knocked unconscious to have a concussion. 

 

What Can We Do About a Concussion Once It's Already Happened?

If you've read this far, chances are this topic is hitting close to home. Either you or someone you know has suffered a concussion and are worried about the long-term effects. It's good to know, however, that 90% of athletes will be fine with proper rest and treatment. 

But what do you do if you've already had one or more concussions? Are there any preventative steps you can take to help your brain heal faster?

Eat for your brain

That's right, nutrition plays a huge role in brain health, and you may have heard that fish oils are good for your brain, or Omega 3's will help prevent Alzheimer's.The same rings true for concussions. Give your brain and body as many resources available to help itself heal. A concussion is a big stew of inflammation, so stay away from foods that further add fire to the flame.

Stay Away From These Foods: Anything fried, sugar, caffeine, alcohol, artificial colors and flavors (those are in most processed foods), vegetable oils (canola, safflower, sunflower, soy, corn, etc) refined carbohydrates (white and powdery stuff). This may sound restrictive, but if you have a concussion, it is imperative to start eating healthy.

Brain Foods: Coconut oil, avocado, grass fed butter, omega 3's, wild caught salmon, grass fed beef, nuts, seeds, all the vegetables, chicken liver, eggs.

The idea is to reduce the inflammation in the body and provide your brain with the necessary fats and nutrients it needs.

In the Journal of Neurotrauma, a study found that supplementing with DHA (Omega 3) immediately following a concussion, at 1000IU per day, may counteract the related cognitive decay, but they also found that supplementing before injury can protect the brain from even more deleterious effects. Remember that quality is key to any supplement and herb.

 

Chinese Medicine and Concussions

Acupuncture and Chinese medicine are also strategies to help recover from concussions. Even the U.S. Military is deploying what they call "battlefield acupuncture" to help soldiers better recover from concussions in the field of action.

Developed by Air Force physician Col. Richard Niemtzow, battlefield acupuncture is being utilized for those who have suffered IED attacks, gun battles, and bombs. 

"It (acupuncture) relaxes me a lot. I always feel good after the treatment," Williams said. "The headache is gone. There's still some ringing in my ear, and I'm still working on the balance. But hopefully this week, I'll return to full duty, get back to my Marines."

Stuessi has treated 50 patients with acupuncture, at the specialist Concussion Restoration Care Center at Camp Leatherneck, and describes the results as "phenomenal." After one treatment, patients are often getting a full night's sleep and the headache is greatly reduced in intensity."

Acupuncture is allowing these soldiers to rest, something invaluable when you are trying to heal the brain. It's also noninvasive and allows the nervous system to "reset", turning off the "fight or flight" mode that most soldiers live in for years at a time. 

After concussions, the brain and body become severely imbalanced; the brain requires nutrients and oxygen from the blood, but during a concussion there is a contradictory response. The very time your brain needs more nutrients and oxygen, the body decreases the blood flow to the brain. This is where acupuncture and herbal medicine come into play, increasing blood flow and nutrition to the area. 

Acupuncture being performed on a Veteran 

Acupuncture being performed on a Veteran 

Acupuncture is also able to reduce the pain of headaches, returning patients to feeling how they did pre-injury. It's an important step in treatment allowing a drug free option for injuries that may last years, decades, even a lifetime. The side-effects of taking drugs on a daily basis for the rest of your life should be greatly considered, and acupucnture is a technique that offers pain-relief with no side-effects.

Acupuncture is not the only modality within Chinese medicine which can help those suffering concussions. Herbal medicine is another important factor when it comes to healing and protecting the brain. 

Herbs such as Bacopa monieri and Ginkgo biloba are great to be used as adjunct therapies as well as turmeric, drinking lots of green tea, and resveratrol. Bacopa is a plant used in Ayurvedic medicine for thousands of years and is mentioned in ancient Ayurvedic texts including one dating back to the 6th century. In this text, Bacopa was recommended to support cognitive (mental) performance and to help with concentration. Two randomized, placebo-controlled trials have looked into the effects of Bacopa extract. It found that in healthy volunteers between 18 and 60 years of age, it had a positive effect on mental performance. The maximum benefit was shown after 12 weeks. The speed of processing information as well as the rate of learning and memory all increased. In participants aged 55 to 70 years, Bacopa significantly supported healthy memory function.

Herbs like turmeric and green tea extract show promising results in animal trials. While these compounds are not necessarily known for their ability to enhance brain circulation, they have been shown to decrease CRP (C-Reactive Protein), an indicator of inflammation. Decreasing inflammation may be how these important herbs function. 

More research is always needed, and the quality of the herbs you use makes all the difference. Most of what you find on the market shelves won't get you the needed therapeutic effect, or won't work at all. This is why it's imperative to see an herbal practitioner who can get you the highest quality herbs with clinical knowledge. 

f you are interested in learning more about herbs for brain function and concussion, you can contact me here

Prevention

The most important aspect to treating a concussion is not getting one in the first place. Or, if you do get one, being properly treated and knowing when to rest and when to keep you out of harm's way.

It was once unthinkable to know exactly how many more hits your head could take in a season, or if it's really okay to start playing again after one, two or three weeks. But technology is changing quickly, and there are some amazing new innovations taking stage in the health world. You can find some of these technologies here and here.

Until technology catches up with your son playing football in Ohio or your daughter cheerleading in Minnesota, the best you can do is make sure your loved one is properly cared for, nutritionally and on the field. Every hit, even seemingly minor ones, can majorly affect your brain. Let's help prevent future Dave Duerson's and Mike Webster's from having to take their lives in order to overcome their brain battles. Prevention starts with education, so let's start talking. 

 

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