Concussions suffered by Tua Tagovailoa stress seriousness of brain trauma
The repeat concussions suffered by Miami Dolphins quarterback Tua Tagovailoa less than a week apart in September have brought the seriousness of traumatic brain injury back into the public eye and triggered scrutiny of the NFL’s concussion protocols. And the upcoming World Cup soccer competition, which begins Nov. 20, will likely include highly visible head injuries.
We asked David Howell, director of the Colorado Concussion Research Laboratory at the University of Colorado School of Medicine, to explain the latest science behind concussions and why a recently injured brain is more vulnerable to repeat injury.
The word concussion can evoke a variety of different images for different people. While concussions are most visible during high-profile sporting events, they can also occur on the playground, during the junior varsity football team practice or on the ski slope. The effects can be just as severe for children and teens as for high-profile athletes.
Concussion effects range from mild to severe, from short term to long term, and can affect many different facets of life. A concussion is defined as a traumatic brain injury caused by an impact to the head, resulting in an alteration of brain function. A concussion often leads to disruptions to everyday life — whether it be a job, academics, sports, physical activity or sleep. Given how unique people’s brains are and how differently they may respond to the injury, concussion recognition, diagnosis and treatment remain challenging.
As a result of the trauma to the brain, brain cells – or neurons – stop functioning as they typically do when healthy.
One main problem that arises following a concussion is an energy crisis of sorts. This occurs when the brain requires a large volume of energy, in the form of glucose delivered by blood flow to the brain, to restore the injured processes. The body also may have trouble delivering blood to the brain because of a brain blood flow disruption caused by the injury, at the very time the brain needs extra energy to restore the injured areas.
Concussions produce a wide range of signs and symptoms, such as problems with walking and balance, dizziness, mood changes and disruptions to sleep.
Some of the main signs that health care providers look for following an impact to the head or body include unsteadiness of gait, loss of consciousness, seizures or other concussion symptoms like headache, cognitive impairment or problems with vision or balance.
It is critical that if a concussion is suspected, individuals cease playing their sport or activity. A simple mantra of “If in doubt, sit them out” should always be applied.
Tagovailoa, who was carted off the field in late September 2022 after his second head injury in less than a week, serves as an example of how vulnerable the brain can be to additional trauma following an initial concussion.
Research shows that the rate of second concussions is highest in the immediate days following an initial concussion. In addition, recent studies have found that athletes who continue to play following a concussion experience longer recovery times and more severe symptoms.
Given the energy crisis described above that occurs following a head injury, the brain simply cannot handle the added and cumulative stress of two injuries occurring in short succession. A second insult to the brain is often simply too much for the brain to handle, and the brain will preserve its most basic functions, such as breathing.
This is why it is imperative that athletes who experience a concussion be removed from the field of play and allowed to recover fully. This allows for a gradual reintroduction to physical activity at first, and an appropriately safe return to play under medical care.
The first step following a concussion is to stop playing sports and to rest for a day or two. Sleep is critically important in the days following a concussion.
A myth that continues to persist is that a person should be woken up every hour following a concussion. This is simply not true. In fact, poor sleep after a concussion has been widely documented as being a predictor of poor outcomes, including longer recovery times and more severe anxiety, depression or cognitive symptoms.
Following a day or two of physical rest, people with a concussion should begin resuming light physical activity that does not provoke or exacerbate ongoing symptoms.
It is important to note that the effects of a concussion may also result in secondary conditions, such as anxiety or depression due to the biological, social or psychological effects of the injury.
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