Minimizing Concussion Isn’t Cool Anymore

It’s past time to move beyond stone-age minimization of concussion.

Posted May 12, 2014

My message in this post is simple—it’s time to stop minimizing the effects of concussion.

I have blogged about the effects of concussion here, at Scientific American, and at the Science and Entertainment Exchange. Concussion, what it means, the underlying physiology, and our societal response to it have also been central themes of my first 3 books. I care about concussion, not just as a neuroscientist, but also as someone who has had too many concussions in my own life (some from my “sport” activities of martial arts but also including a recent one arising from a car crash in January of 2014).

The main issue I want to address in this post is how we respond to people who have had a concussive event. Many of our societal responses are shaped by portrayal of sports-related concussion in the media. This really has been improving—mostly—in the last few years, but not enough.

When I read the recent issue (May 14, 2014) of Sports Illustrated and an article entitled “You gotta play hurt” by Brian Cazeneuve, I was stunned. The focus of the article was on the toughness of players in the NHL as exemplified by playing through injuries in the playoffs. The idea was to highlight the resolve of NHL players to play hurt.

Whether we should celebrate this toughness is a whole other issue that I’m not interested in debating here. But it’s at least a relatively safe debate when we are talking about cuts, bumps, and bruises. That is, so-called “bodily injuries”. It’s not a safe or acceptable debate when we are talking about brain injury.

In the SI article two incidents in particular are highlighted. One is the story of Tampa Bay Lightning forward Steve Stamkos who took an accidental knee to the head from Montreal Canadiens defenseman Alexie Emelin during game 3 of their first round series in the 2014 playoffs. Stamkos is described as “getting knocked silly” by the head impact but returning later in the game and playing out the remainder of the series.

The second relevant incident was the description of Montreal Canadiens great Maurice “The Rocket” Richard being knocked unconscious in game 7 of the 1952 Stanley Cup Playoff Semi-Final versus the Boston Bruins. Richard left the game briefly but came back to score the winning goal. The description of the state Richard was in (vision problems, dizziness, etc.) leaves no doubt that he had suffered a serious head injury.

I suggest strongly that both of these examples illustrate misguided “toughness” that should not be celebrated. This is despite the fact that I am a Montreal Canadiens supporter and greatly enjoy it when they beat the Boston Bruins and win Stanley Cups. My passion for my team does not trump my respect for the humanity of those who play the game. Articles like the recent one in Sports Illustrated unfortunately put the onus on supporting the wrong concept—play at all cost. Sports are not self-defense or war where action at all cost is entirely reasonable.

It’s time we stopped considering concussion—a “mild traumatic brain injury”—as something we play through, work around, and minimize. Despite the important advances that have been made, and which are captured in great and accessible writing such as found in “League of Denial” detailing concussion in the NFL, we clearly still have an awfully long way to go.

Despite that, we must change our response to concussion not just for the sake of how we treat and respond to adults but most importantly because of how this guides the perceptions and treatments for youth in sport and concussion management.

It is recognized that our perceptions around injuries like concussion affect the likelihood and extent of reporting symptoms related to brain injury. In this regard, every bit of education and appropriate messaging around concussion matter.  In the words of Johna K. Register-Mihalik and colleagues at WakeMed Health and Hospitals in Raleigh, N.C., “…concussion education initiatives should focus on improving attitudes and beliefs among athletes, coaches and parents to promote better care-seeking behaviours among young athletes.”

Put simply, “toughing out” and “playing through” a head injury is not okay. Returning to the title of this post, it’s not cool for those in other sports media to say players have had their “bell rung” and then celebrate it. It is also not okay to equate musculoskeletal injuries and head injuries. Musculoskeletal injuries themselves are huge and important issues. They can lead to permanent mobility disabilities and can greatly affect functional ability.

Even more deeply, though, brain injuries literally operate underneath everything that you can be and will ever be.

Brain injuries can change who you are. Let’s stop minimizing the risks and responses to concussion and let’s stop now.

© E. Paul Zehr (2014)