A bump during a match, a fall on the field, a hard tackle. Athletes and parents often ignore these off if there is no cut, no bruise and the player says they feel fine. But neurologists say the brain doesn’t always show what has happened to it, and the effects of repeated knocks can build up quietly.
We spoke to two neurologists about what even a minor head injury does to the brain, why repeated concussions are a bigger worry, which symptoms athletes should never ignore, and how to return to play safely.
What a blow to the head does to the brain
The brain is a very delicate organ, protected by the skull and bathed in fluid which acts as a cushion. “A blow to the head can cause the brain to move around inside the skull and this movement can temporarily disrupt its normal function resulting in a concussion or other forms of traumatic brain injury,” explains Dr. Aniruddha More, Consultant Neurologist, Jupiter Hospital, Thane.
“An injury that looks quite minor externally can still have an effect on the brain and the absence of any visible injury does not mean that the brain is unharmed,” Dr. More adds.
Why repeated concussions are a bigger concern
Repeated concussions, Dr. More says, are a bigger concern as the brain may not have had a full opportunity to heal from the first injury. “If someone goes back to sport too soon and takes another blow, they may end up with a much longer list of symptoms and a much more difficult recovery,” he explains.
According to the expert, it is absolutely vital to bear in mind that not every repeat concussion will result in permanent damage, but multiple concussions should never be ignored.
Symptoms athletes should watch for
“Headaches, dizziness, nausea, blurred vision, light and sound sensitivity, confusion and difficulty with concentration are some of the more common symptoms,” Dr. More says, adding that some people may also experience memory problems, a strange kind of fatigue, irritability or disturbed sleep.
“The symptoms may not present themselves immediately after the injury,” he cautions. “Any athlete who is experiencing any of these symptoms should stop playing and have them assessed medically rather than just carry on,” Dr. More adds.
Memory, concentration and thinking
Yes, Dr. More says, repeated head injuries can have an impact on cognitive function (memory, attention, processing speed, concentration etc) particularly if the recovery is incomplete. “Some people may find themselves struggling with day to day activities and may notice a deterioration in their academic or professional performance,” he explains.
If the symptoms are persistent, the expert says that a neurological assessment is then required to determine the extent of the injury and to inform the rehabilitation process.
The long-term concern
“Repeated head impacts especially in contact sports such as boxing, football and rugby have raised concerns about their long term effect on the brain,” says Dr. Sheetal Goyal, Consultant Neurologist, Wockhardt Hospitals, Mumbai Central. “There is research which has linked a history of repeated head trauma to a number of neurological and cognitive issues,” she says.
“CTE is a progressive brain disease linked to repeated head impacts, which may or may not result in a concussion,” Dr. Goyal explains, referring to Chronic Traumatic Encephalopathy. “It is characterised by the abnormal build-up of a protein called tau in the brain, which can have an effect on the function of the neurons,” she says. “Some people with CTE have been found to have changes in behaviour, memory, mood and cognition,” Dr. Goyal adds.
“It is worth bearing in mind that not everyone who has suffered a number of head impacts will go on to develop CTE and the precise relationship between the number of impacts and the resultant long term outcome is still under investigation,” she says. “It has only ever been identified in the brain after death so it cannot at present be diagnosed in a living person. That’s why prevention of repeated head trauma is so important,” Dr. Goyal explains.
How long before an athlete returns to play?
“There is no set recovery time for everyone,” Dr. Goyal says. “Recovery will be dictated by the nature of the injury, the symptoms and the individual’s general health,” she explains. “An athlete should never return to play simply on the basis of feeling better. They should be medically assessed and go through a phased, supervised return to sport,” she advises.
“This will normally start with some light activity and progress through to more intensive exercise, sport-specific drills and then full training, as long as the symptoms don’t reappear,” Dr. Goyal says. “Medical clearance is a must prior to returning to competitive play,” she adds.
Preventing the next injury
“Awareness and early reporting are key,” Dr. Goyal says. “An athlete should never be encouraged to go on playing after a head injury is suspected. Coaches need to be able to spot the signs of concussion and get the player out of the game and assessed by a doctor,” she explains.
“Risk can be reduced through the use of appropriate protective equipment, adherence to the relevant sport specific safety rules, better playing technique and sufficient recovery time,” she says. “The emphasis should be on protecting brain health rather than getting the player back in the game as quickly as possible,” Dr. Goyal concludes.
In a nutshell, a knock to the head that leaves no mark can still leave its mark on the brain. Stopping play at the first sign of trouble, getting checked by a doctor and returning to the field only after proper clearance can protect an athlete far more than any trophy is worth. For coaches, parents and players alike, the safest rule is simple: when in doubt, sit it out.