BY JEFF FALK
Sometimes we don’t know as much as we think we know. Other times, we just plain over-think things.
And when the subject is the human brain, can anyone really blame us?
When I decided to do this piece about concussions in scholastic sports, I thought I knew what I was talking about. All I was really looking for was an expert to confirm what I already knew.
But what I discovered took me by surprise, knocked me aback, just a little bit. Concussions aren’t the biggest concern facing high school sports these days. Yet, I also came to realize that if they aren’t, what is?
Now, any trauma force to the brain should always be taken seriously. But when it comes to concussions in high school sports, any so-called ‘crisis’ may be over blown.
That’s the stance of Penn State Milton S. Hershey Medical Center physician Dr. Robert Harbaugh. The data on this isn’t definitive and there are two sides to every story, but Harbaugh says the problem may not be as big as we’ve made it.
“I think what’s happened, the whole idea of concussions as a concern was downplayed for a long time,” said Harbaugh, during a recent phone interview. “To take a concussion seriously is absolutely the right thing to do. I think there’s been a lot of progress made in this area. Where I think we’ve gone way over the line is to think that if you play football, at the age of 60, you’re destined to have dementia. That it’s inevitable. You hear those crazy things.
“There’s no more crisis in concussions now than there was 30 years ago,” continued Harbaugh. “Just the opposite. I do worry that we have a health crisis in this country, and it’s childhood obesity. I think the message is: Concussions need to be taken seriously. Right now, the best data out there suggests that playing contact sports does not increase your likelihood of dementia later on.”
Harbaugh is the director of the Penn State Hershey’s Neuroscience Institute. Harbaugh has also served on the NFL’s Head, Neck and Spine Committee.
“The short-term response is almost always a full recovery,” said Harbaugh. “People will often be better in a day or two. Others, it may be closer to a week. What’s created a concern was: Can a concussion or a series of sub-concussive blows lead to long-term effects?’ There’s still an awful lot of controversy about it.
“In one study, playing clarinet in the high school band was as dangerous as playing linebacker in football,” added Harbaugh. “We’ve made it a crisis, when it really isn’t.”
In the United States, the frequency of concussions in football – around 47,000 annually – is second only in sports to bicycling – around 85,000 annually. Baseball and softball is third, followed by basketball, water sports, soccer, skateboarding and horseback riding.
“Car accidents do cause brain injuries, everything from concussions to death,” said Harbaugh. ‘Sports are the leading cause of concussions in the United States. If you look at most sports, more concussions come from riding bicycles, just because the number of people riding bicycles. The highest rate is in equestrian sports. A fall from a horse is a bad fall. Football gets a lot of attention. But it depends on how you count them.
“If you look at sports, gender specific rates of concussions are higher in women’s sports,” Harbaugh added. “One of the theories why is the neck musculature of men and women.”
For many years, in scholastic sports like football and soccer, the head was coached to be used as a tool, a weapon. Obviously the risk of concussion rises in contact sports like wrestling, lacrosse and ice hockey.
“The old definition of a concussion was a loss of consciousness due to trauma to the brain,” said Harbaugh. “That definition is out of date. Now it’s the loss of any function of the brain, any change in neurological activity.
“The brain is pretty rugged,” continued Harbaugh. “It’s encased in bone. It’s surrounded by fluids. There’s a lot in place to protect the brain.”
Other studies have suggested that the long-term effects of concussions and sub-concussive blows can lead to things like dementia, ALS, Alzheimer’s Disease, Parkinson’s Disease, epilepsy, depression, anxiety and memory loss.
“There are a number of theories on sub-concussive blows,” said Harbaugh. “There have been a series of NFL players, who ten to 20 years after finishing their NFL careers, developed symptoms. On an examination of the brain, they had a condition similar to one seen in boxers, sort of like ‘punch drunk’. A lot of this is still way up in the air. We don’t know what happens in that ten to 20 years from a player’s retirement. There’s a lot of unanswered questions. There are some people who just shouldn’t be playing contact sports for genetic reasons.
“I had three concussions playing football,” Harbaugh continued. “Now I’m not sure my colleagues would agree, but I don’t think I’ve had any long-term effects. The question becomes: ‘What are all the factors that lead to late neurological decline?’.”
Harbaugh also stressed that concussions are both preventable and treatable.
“There’s a lot of stuff that can be done,” said Harbaugh. “If someone has one concussion and you send them back too soon, they’re more susceptible to a second concussion. Rules need to be enforced, things like ‘head-to-head contact’. In the very recent past, players didn’t want to admit that they had any problems. You wanted to get right back into the game. I think that’s changed. Players are more aware now. I think that’s been a positive development.
“Most people get better in a couple of days,” Harbaugh continued. “They may have dizziness, headaches or fatigue. Rest – both mentally and physically – until the symptoms are gone, and then they can slowly get back into things.”
In the human condition, the brain is the control center for sleep, thinking, movement, hunger and thirst. It is also connected to every other main organ in the body.
“Concussions need to be taken seriously,” said Harbaugh. “Players who sustain them should not be put right back into games. But this isn’t a crisis. There aren’t a lot more concussions now. And I think anything that curtails physical activity is a negative, because it can lead to childhood obesity.”