WESTBOROUGH, MA – The greater Boston area has its first white Christmas in a few years. This makes it easy to seek out local mountain skiing and riding – especially during the school break. Riders are especially eager to check out all the changes made to the local terrain park in terms of added features, jumps, and rails. The trouble with this is that in the early season the depth and texture of the snow may not yield midseason quality nor readiness to safely attack the hill. Injury is all too often the result of the build up of excitement, excessive speed and lack of familiarity with terrain during early season practice runs. I have already seen an uptick in the number of concussion cases in my practice most of which will recover and heal normally. How are concussions impacted by the history of prior concussions?
DOES THE NUMBER OF CONCUSSIONS IMPACT RECOVERY ?
Yes. In August 2013, I published a blog that described the current return to play protocols. It is now understood that an accumulation of concussions can lead to a serious degenerative disorder called chronic traumatic encephalopathy or CTE. The risk of this may be diminished by allowing the brain to fully recover before returning to the field of play. This means no formal exertion and very limited cognitive exertion too. The NFL and NHL have both paid out large sums of money to settle the lawsuits of athlete’s suffering from a host of symptoms thought to linked to repeated concussions during play. The end product of CTE is death. The Boston University School of Medicine in collaboration with the Sports Legacy Institute is conducting extensive research on the donated brains of professional athletes. One stunning discovery was the presence of CTE in the brain of an 18-year-old boy who died from an unrelated cause.
When can an athlete start return to play? The answer to this question depends upon the duration and intensity of symptoms. The consensus is that an athlete should be symptom free before returning to any form of exertion. It has been shown that the subtle cognitive effects of concussion can last 7-10 days or longer. Certainly a person with a high number of prior concussions will have a recovery that can differ from the first injury athlete. An athlete with 3 or more prior concussions may be symptomatic for weeks – a condition known as postconcussion syndriome. Athlete’s do not need to be rendered unconscious by their injuries we now realize. This was once thought to be an essential element of concussion and it has been dispelled now as new protocols and greater understanding of brain injury are emerging.
ROTATION AND SHEER
In fact, a concussion can occur from any force or trauma being applied to the brain. This creates secondary force or energy within the skull that puts strain on tissue and white matter fibers – interconnections between important regions of the brain. Changes in cognitive functioning occur when these myelinated fibers are stretched such as when an athlete is concussed. The snowboarder who rides a rail only to catch the tip of his board can be thrown forward with enough force to begin the physiological cascade of strain and sheer that results in transient cellular numbing. If these fibers are stretched to the point of breaking, then the cell bodies to which they transmit their vital neurochemical messages will die leaving a penumbra of necrotic tissue often seen in more serious traumatic brain injury. Chronic traumatic encephalopathy results in a growing number of these necrotic or dead areas in the brain coupled with the presence of destructive proteins found in the brain’s of patients suffering with Alzheimer’s Disease.
Athlete’s need to know the terrain at which they intend to ride. Trail maps prevent skiers from becoming lost so to will terrain maps reveal each feature a boarder must navigate as they ride. Safety and common sense dictate a slow start to each new season along with care to fully prepare for hazards and new features. Resort operators can be expected to post terrain changes and ground rules for skiers and boarders as they change from year to year. Elite athletes push themselves in order to reacher higher heights and set new records. When they become injured great care should be taken to educate them about the long terms risk of repeated concussions, postconcussion syndrome, and CTE.
Sefton, M (2013) Return to play. http://www.concussionassessment.wordpress.com. https://concussionassessment.wordpress.com/return-to-play/