Ep. 043 – Concussion

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Good morning and welcome to Episode 043 of the Train Your Brain Podcast with Dr. Michael Trayford. It’s Monday again, so this is our weekly, 30-minute episode. (Tuesday through Sunday we produce five-minute episodes with daily tips.) Every episode of the Train Your Brain Podcast provides advice for helping you to improve the function of your brain.

In Episode 043, your host Dr. Trayford shares some sobering information about the real dangers of concussions. One could say that our society has become far too casual regarding concussions. There is nothing minor about brain trauma. Please listen to learn more and become educated about brain safety in its truest form.

If you have any concerns regarding the information and applications discussed in this podcast, please consult your physician and a doctor who is experienced in functional neurology. Michael Trayford DC, DACNB is available for consultation by calling (828) 708-5274. Thanks for listening.

I always love these episodes, because we get to explore the information in depth. It gives us a chance to discuss topics and look at the things I do every day in clinical practice. Today’s topic is very near and dear to my heart. It’s something I’ve been working with for nearly two decades now and something is essentially grossly under investigated and under treated in the healthcare arena as we know it.
There’s a lot of controversy and positioning and misunderstanding when it comes to concussions.

This topic focuses on concussion, mild traumatic brain injury and mild traumatic encephalopathy.

When it comes to these types of brain injuries, concussion is the best place to begin. It’s important to understand that this is a massive topic with a lot to look at regarding investigation, treatment and aftercare. We’re just going to scratch the surface today.

This is something that really gets me going because we see really incredible outcomes for people with concussions at APEX Brain Centers. You also need to understand that there are some short comings with regards to concussion intervention as we know it, which can also be associated with inappropriate reporting, assessment and other factors.

Right of the bat, what are we looking at in terms of concussion. From a technical standpoint it’s essentially a traumatic brain injury. It is also known as mild traumatic brain injury or mTBI. Mild Traumatic Brain Injury is a term that is used for concussion; in my opinion there really is no such thing as mild traumatic brain injury.

Jason: I was just going to say that. How can you describe a brain injury as mild? It seems like all brain injuries would be considered serious!

If your brain is shaken up enough to cause the symptoms of a concussion, then there’s nothing mild about it.

What is a concussion? It’s a traumatic brain injury that alters the way your brain functions. Something happens and what happens at a cellular level in the brain is not that well understood at this point in time. We know there is inflammation and an increase in certain types of white blood cells that come to the area of injury.
On a larger scale, it basically alters the way your brain functions with many different results. Some of the obvious issues include headache, dizziness and possibly even experiencing a spinning sensation like vertigo.

Typically, pain and balance are the first problems people feel. You might get a bell ringer, or blow to the head in sports, or hitting your head hard on something. Right off the bat you might feel some pain or wooziness, which in itself is significant. However there is a whole host of other symptoms that occur.

Jason: Yeah sports and just having kids at home. One of my big fears is that concussions happen when my kids fall or hit their heads. All I know to do, and maybe you can straighten me out on this, I’ve heard doctors say, Look in the person’s eyes and don’t let them go to sleep.

But I don’t know what I’m looking for in their eyes. But I know it’s important not to go to sleep.

Yeah it is, but really the bottom line is that these things require immediate attention. The average person shouldn’t be taking this type of care into their own hands.

There is this culture of not investigating these things. People get bumps to the head all the time and do nothing about it, this sort of culture of non-reporting in particular with regard to sports.

Jason: It’s hard to know where the line is when you hit your head hard.

It’s important to understand that no two hits to the head are the same. They’re like snowflakes. We have seen people that have been hit from behind in a motor vehicle accident at 5 MPH, that have had significant concussion and whiplash injuries that mimic the symptoms of concussion.

We had a client of ours about six months ago that was involved in an accident where he went through an intersection and was broad sided by a van going around 60 Miles per hour. They were launched through the air and his head ended up going through the windshield of another car.

Although there was no break in his skull or exterior damage to his head, he had pressure on his brain from a hematoma, which is a collection of blood and fluid inside the brain. Within three weeks he was back to his normal self. He didn’t have any persistent symptoms of what was going on. He didn’t come to us for a concussion, he came to us for something else.

This just happened to get in the way of him starting his care with us. So that became first priority for us, and those symptoms quickly subsided. Regardless we kept track of and kept our eyes on him. He healed much quicker than someone taking a fender bender at five miles per hour.

Jason: Now I’m a lover, not a fighter Dr. Trayford, but you know back in the day, back in high school when you know kids are rambunctious and getting in fights. Now I never got in a fight, and I always avoided getting into a fight because I’ve heard horror stories where someone punches someone else and they die. While we would not recommend fighting, even that very situation is kind of a common place thing among young people. But I wouldn’t even want to do that.

Well you look at certain things, the culture is changing and there are children these days that want to knock each other out. There’s actually a game out there called the knockout game. Where they go up to unsuspecting people in public and try to knock them out.

It’s really disturbing, because they have no understanding how this can impact someone’s life. If the damage and swelling is severe enough it can actually impact brain stem functions that control breathing and heart rate and cause a person to die. You absolutely could kill somebody.

When it comes to sports, now more and more the competition is intense and you see young children that are being exposed to these things on a regular basis. That’s really where sports come into play.

When we look at the statistics in this arena, some of them are rather amazing. Some of them are compiled around the CDC and other reputable sources. The first question I like to know is how many concussions per year. These are the types of things I like to know. Are they going up or down?

On average, in any given year there are 2.3 to 2.6-million concussions in this country.

Keep in mind that these are reported concussions. You could probably triple or quadruple that number, because so many concussions are going uninvestigated or unreported.

Now with athletes, sports like football are a primary source for males to suffer a concussion. There is a 75% of concussion in football. Female athletes playing soccer have a 50% chance of concussion. The numbers go up to 80% during a game, versus practice.

This is a result of the fact that in the game you’re going all out, you’re putting all reasons for hesitation aside, so you can score those goals and win the game for your team.

So there are some big challenges there. Particularly with kids that are looking to establish their dominance in a sport or looking to move up, or show that they are the best at what they do.

Now there are also indications that females are twice as likely to sustain a concussion versus males. We’re not quite sure why this is. That’s why rules are different in some women’s sports like lacrosse.

It’s also worth considering, that there’s quite a bit of research going on with people that have a learning disorder, like attention deficit disorder. Their outcomes after a concussion are much worse than someone that does not have a learning disorder. So there are these pre-existing conditions, their outcomes after concussion are likely going to be much worse.

Now that’s significant. When you think about it, why do a lot of kids get into sports, or why do their parents put them into sports?

Jason: Yeah, it’s try to curb some of that behavior right?

They intend to let them run it out, get their defiance down. But they are also more prone to suffer a concussion and then have lesser outcomes after suffering one.

Headaches and dizziness are the initial symptoms. However, visual and cognitive problems, tension focus, and memory issues are also likely.

When we start looking into things like CTE and chronic brain injury, we start seeing things like anxiety, depression and emotional deregulation.

The misconception many people have is that suffer a concussion you need to be knocked out. It’s estimated that 15% of the time people are actually knocked out. This explains why things often go unreported.

My gross estimates from what I’ve seen in my practice is that probably half of all concussions go unreported. That’s significant.

It’s also estimated that up to 47% of athletes don’t report feeling anything after a concussive blow. So that connects directly with how these concussions can go unreported.

Jason: In boxing or MMA it’s just another day right.

A typical boxers punch to the head is estimated at about 20 miles per hour. In a football tackle happens at about 25 MPH.

There’s a lot that can go on with concussion and the symptoms. You might have also heard about post-concussion syndrome basically is when symptoms persists after a concussion. The estimate is 17%, but based on my clinical experience it’s probably more like 25%.

This is part of why I think the concussion investigation and reporting is inadequate. It lends itself to the culture of not reporting. The young athlete suffers a blow to the head, they want to stay in the game, the coach wants them to stay in the game, and maybe even their parents want them to stay in the game to score that goal or make that big play.

We wrote a blog post a while back about the culture of non-reporting in sports.
Listeners with children in athletics need to understand this culture of non-reporting. You need to understand that coaches and trainers, in many cases the child’s best interest are top of their mind. So either the investigation at that sidelines is not what it needs to be. Or they’re being put back in because they need to make that next play and they are disregarding the symptoms related to having a concussion.

Jason: When I was in middle school my best friend played football. He got injured and was hurt on the field. It was serious. The coach was standing over him telling him to get up.

It can be heated in sports when at the top of people’s minds is winning that game. I should say though that it is getting better. Particularly in professional sports where the cameras are rolling. But it’s still happening where Quarterbacks are going back into the game after a concussion. We saw it just last year in the Michigan game where the quarterback went back in and the coach came under fire because of it.

These are things that need to be taken seriously. Understand that this culture of non-reporting happens. In some cases even the children aren’t telling you what they are feeling because they want to go back into the game. And ourselves. The adults.
We have a hit to the head, most people ignore symptoms.

In my opinion one of the biggest problems is the “Sit and Wait” approach. Which is not good.

What happens is that we wait to see if someone is going to develop symptoms.

Jason: What are they waiting for exactly?

It’s because honestly the health care system is designed to excel in the critical care arena. The healthcare system in this country is likely second to none. So if you have a hematoma or something life threatening. We can do these things to take care of someone and get them stable.

But what happens when someone has one of these injuries, that are these silent injuries. Where we don’t see them on an MRI or any type of laboratory test. We need to find a way to look at them.

There is a type of testing coming out called Diffusion Tenser Imaging, also known as DTI. It’s a type of imagine like an MRI or CAT scan where were can look at tracts in the brain to see if there is any type of disruption due to a brain injury.

If someone is hit from behind in a car accident, we can use DTI to see if there’s any disruption in the brain as a result of that.

We’re still a ways off before we can image that accurate and do it in the mainstream medical technology. In the meantime we need to look at eye motions, smell, reflexes. We need to look at how people walk and use cognitive testing.

That’s one of the biggest problems is cognitive challenges after the concussion.
So for that 15% of the population with post concussion syndrome, we need to find ways to help them because they have cognitive issues that keep them from doing things like taking tests in school, doing well at their job and other life skills.

Jason: Real fast then. Is it dangerous at all to go to sleep after a concussion?

There’s not a lot of understanding behind that. What’s important to keep in mind is that if the injury is more severe than a concussion. If the brain injury has caused a hematoma that is putting pressure on the brain and you go to sleep you could end up having pressure on vital brain areas that affect heart rate and blood pressure.

I want to touch briefly on CTE. The NFL has touched on this issue in the upcoming movie Concussion. There are some big things happening there. The culture is changing there and it’s been a long hard fought battle that’s going to take some time to resolve.

The bottom line is there has been evidence about CTE, which is due to repeated injuries to the brain. It’s a progressive, degenerative disease, found primarily in people with a history or repetitive brain trauma. So basically, it’s concussions with or without symptoms.

While you see it more in sports like football, hockey and soccer, you also see veterans with chronic exposure to blast injuries caused by blast waves affecting their brain.

In CTE, we find them post-mortem, and they are common in people that have suffered repetitive brain injuries. With CTE we also gain more information from the study related to the movie concussion. It’s also being handled by institutions, like Frontline and Boston University, that are controlling the brain bank that actually houses the brains of NFL players that have donated their brains to science after death.

The vast majority of these brains are showing symptoms of CTE.

Approximately 95% of people who donated their brains show CTE. The fact is these people are having repetitive brain injuries. On average a profession football player averages 900 to 1500 blows to the head in a season. How’s that for a statistic.

These chronic repetitive hits in the head do something. Now they’re finding symptoms of CTE in 79% of professional players.

Could you imagine if 79% of the population had a communicable disease, like the measles? It would shut the entire country down. Even if it was 5% of the population it would be considered a mass epidemic and the organizations that manage these situations would be doing all they could to reduce these dangers happening or people developing this type of condition.

Here we are showing 80 to 96% of these players with symptoms of the disease and no one is doing anything about it. While they may talk about how the occurrence of concussion is coming down; if you go back to week one of the NFL season.

And I’m a sports fan. I love the NFL, I grew up a Giants Fan.
Obviously things need to be done.

TIP :Get checked out after a blow to the head.
This is leading directly from what we talked out. You need to get checked out after any blow to the head. Whether you are 2, 20 or 80 you need to get checked out after a hit to the head.

Now when most people go to get checked out after a hit to the head. They might go to their primary physician. Who may take an ophthalmoscope, which is the light they shine in your eyes, and they may look at your pupil dilation.

If you pupils dilate, they might say you are fine. In my opinion it shouldn’t end there. I’ve done quite a bit of writing on concussion. One of the articles I wrote talked about certain things in the eyes that should be looked at after a blow to the head.

Now it would be great if we could have baseline functions on everyone. So we knew after a blow to the head that this or that looked different, better or worse. We want to look at how the eyes move, how they hold a target. Do they move fast or slow. How your eyes and head can separate their movements from each other.

We also want to look at how your body moves and how you walk. Is your balance and coordination off. We can measure a lot of these things.

We want to look at cognitive functions as well. There are a lot of sideline tests that can be done. There are SCAT tests, another type of tests. These are really only one-dimensional types of investigations that might not reveal if your brain has been injured.

I think these tests are good for general screening purposes but often times they’re not administered at the appropriate times or in the appropriate manner.

Also there usually haven’t been baselines done to help us understand the difference in behavior. In a perfect world we could do pre and post screenings on everyone. We could go into schools and look at eye and cognitive functions. So when you or your youth athlete does take a blow to the head we could take a look at what happened.
Then we could work to improve that particular problem and we’d have a way to measure progress through the course of rehabilitation.

So keep in mind that you need to be checked out after a blow to the head, regardless of whether or not you were knocked out. Only around 15% of people with a concussion actually lose consciousness. Particularly if you have headaches, eye problems or emotional, cognitive and behavioral issues that we talked about.

Links for this episode:

To read more about the Michigan Quarterback click here.

To read Dr. Trayford’s blog post on the issue of non-reporting in sports click here.

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