We've all seen it happen: an athlete gets a hard hit from an opponent, falls to the ground and is temporarily knocked out. Those knockouts, more properly called concussions, seem to be pretty memorable events to a spectator during sporting events... and to the athlete!

But concussions are not limited to players of the NHL or other major league sports. They can happen to young people as well from playing everything from ultimate frisbee to rugby. They are also a serious consequence of a game called Locker Boxing, also known as "Helmets and Gloves" — a game that is being played by some teens in hockey and lacrosse leagues across Canada and elsewhere.

In these secret locker-room boxing matches, participants wear hockey gloves and helmets and square off until a helmet is knocked off. In severe cases, the fights will last until one of the opponents ends up with a concussion and unconscious on the floor.

We've all heard of concussions, but what exactly are they? In medical terms, a concussion is an injury to the brain that results in a temporary loss of normal brain function like memory, judgment, reflexes, speech, balance and/or muscle coordination.

 

Did You Know? A concussion is a type of mild traumatic brain injury. Neurologists, doctors who specialize in the nervous system (the spinal cord and the brain), claim that although one concussion will likely not have permanent effects, repeated concussions, especially those occurring in a short time frame, may permanently damage brain function.

Okay, simple enough, concussions are caused by head trauma, but how does this happen? Isn't the skull supposed to protect the brain?

This question doesn't have a simple answer. The brain is essentially composed of a mass of folded soft tissue which "floats" in a jelly-like fluid (cerebrospinal fluid or CSF) within the skull. It is connected to the skull through soft "strings" of connective tissue which, along with CSF, help prevent the brain from being slammed into the skull bones with too much force during normal movements like running, nodding, or even 'head-banging.'

 

Did You Know? The total volume of cerebrospinal fluid is between 125-150 mL. 400-500 mL of CSF is produced every day! However, forceful or sudden movements, such as being hit in the head, can result in the brain getting slammed into the skull with excessive force. The brain doesn't just hit the front of the skull, it will also rebound contacting the back of the skull resulting in two bruises on the brain.

The skull itself is made up of eight bones, and although these cranial bones are smooth on the outside, they are rather rough and pointy inside the skull. When the brain hits these bones, the damage can be more severe than a bruise; blood vessels can be torn, and nerve fibers can be pulled.

 

Did You Know? Concussions may or may not involve a loss of consciousness. The most common symptom are headaches and are found in 81% of athletes.   Concussions can be mild, moderate, or severe, depending on if and how long the person loses consciousness or memory. Depending on the severity, a player can bounce right back into their game right after their hit or be set back from their sport for at least a month!

In the case of a severe concussion, or a second concussion that occurs directly after the first one, the brain can swell. Because the brain is confined, as it swells it gets 'smushed' up against the skull. This pressure compresses blood vessels, preventing enough blood, and consequently adequate oxygen and glucose, from being delivered to areas of the brain. If this continues for long enough, it can even lead to a stroke.

 

Did You Know? Concussions are graded based on severity, from grade 1 (mild) to grade 3 (severe). Clearly, concussions can be quite serious. So then, how can they be treated? Currently, the only treatment is rest. Just as a bruise on a knee takes time to heal, a bruise on the brain requires the same thing. As often happens, inadequately taken recovery time leads to more severe damage.

And just because you wear a helmet, that doesn't protect you from a concussion either. In fact, there's not a single helmet out there right now that is designed to significantly prevent a concussion from happening. As NFL's John Madden once said "...he's down but how much more can he possibly take?..."

Learn More!

The National Brain and Spinal Cord Injury Prevention Foundation

www.thinkfirst.ca

National Centre for Injury Prevention and Control: Tool Kit for Coaches on Concussions in High School

www.cdc.gov

The Canadian Academy of Sports Medicine

www.casm-acms.org/forms/statements/Concussion.pdf

About Kids Health: Helmets for Injury Prevention

About Kids Health

Susie Riegel just completed her BSc in Chemistry at the University of Calgary and is currently working on her MSc at Dalhousie University in Halifax, Nova Scotia.

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