Three Things You NEED to Know About Concussion

There’s been near constant press coverage of concussion (or MTBI) lately. Here are the three things you need to follow – for yourself and for your loved ones. Thanks to Arslan Visuals (!

24 thoughts on “Three Things You NEED to Know About Concussion

  1. Tragic news about Alex Zanardi’s accident:

    Gary, it’s been a while since you’ve posted … but your insights, perspective, and experience are always very informative. If you can share any details or perspective about Alex’s condition or outlook, that would be much appreciated. I’m not looking for insider information, just a way to better understand the details that are public.

  2. Gary, brilliant video, my wife used to work in the social care sector here in the UK, more specifically in the care of people with Dementia and or Alzheimer’s. I’m sure you are aware but there seemed to be at least 7 out of every ten being males, when talking to their families it quickly became apparent that nearly every one of these gentlemen had played football during the 1950’s / 1960’s when they used a very heavy ball that became medicine ball like when it was wet.

    I have always wondered whether some of the gentlemen actually had Dementia or they had another disease as they didn’t show typical signs of dementia., by that I mean they didn’t regress back to a point in their childhood but they showed all other typical symptoms ie: aggression, memory loss and quite severe depression.

    With regard to chronic traumatic encephalopathy do you think that mental health services & GP’s should be receiving more education to the exact symptoms of CTE?

    Also would you agree that professional sports governing bodies the world over should be collating their own data on the rise of mental health issues against the participation figures historically and submitting this to the researchers of CTE?

    • Thanks for the kind words, Andy. Much appreciated!

      As concerns chronic traumatic encephalopathy (CTE), we need to remember that for the moment definitive diagnosis requires microscopic examination of tissue. When the brain is the organ in question,that means an autopsy. Which means that CTE is only diagnosed postmortem. There IS a fairly classical set of symptoms that accompanies CTE (and you’ve done a marvelous job enumerating them!), but these are relatively nonspecific.

      This implies that much work needs to be, and is, being done to define markers for CTE that can be obtained while the patient is alive.

      Until then, I think the main lesson to be learned by primary health care providers is to do as thorough a history as possible concerning any and all past episodes of head trauma, even minor (and especially repetitive)in any patient with signs of cognitive dysfunction, especially if the age at presentation is surprisingly young.

      • Hi Gary, thanks very much for the reply & explanation, I didn’t realise before your reply that it could only be dianosed through post mortem.

        With regard to the position football ( Soccer ) authorities hold in researching brain injury I thought i’d share this link with you about a former England national team player, it makes interesting reading.

      • Thanks for the link, Andy.

        I’d forgotten to mention the organised sports thing. The more cross-sport cooperation ans data-sharing there is, the faster we’ll gain important clinical and epidemiological information!

  3. Doc Gary, I think it happens that people who have had concussions and who get behavioral or emotional changes from that, attribute the changes to other things, for example a relationship or a bad experience of some kind, and do not understand that the concussion is the reason. Just as you said a concussion may be mistaken for a traumatic experience by people. It is important with knowledge and awareness about concussions. Thank you for this video.

  4. Thank you for the video, doc. That was informative. Do you have any information on how safe or effective cycling helmets are? I read somewhere that there is not much difference between the cheaper ones and the more expensive ones.

    • There’s a fair amount of information available comparing what’s available, and looking at the effects of bicycle helmet use overall. As I remember there is a good UK site with comparative stuff between helmets.

  5. Wonder what you think of Kevin Ward’s death. wondering if he might have been concussed which lead to his on track behavior. He appears to have ‘charged’ Tony’s car i the video I’ve seen.

  6. Hi Gary,

    Very interesting and informative video. I myself have had a number of concussions. Mainly due to bicycle incidents. Helmets were not as common then as they are now (here in Stockholm most people wear a helmet when riding a bike).
    I can agree about most of the symptoms that you describe. When I was 16 I had a very serious concussion and now when I am 37 I can see how my behavior changed in the following years. I would say that the most apparent thing is the change from an extreme focus when reading and performing intellectuall task to a tendency towards absent mindness and short span of attention. This is something I have managed to cope with but I would say that it is quite apparent that the number of accidents that culminated with that huge blow to the head must have had an effect.

    Best Regards

  7. A very interesting and thought provoking video Dr.

    When you mentioned soccer and heading the ball I immediately thought of the English footballer Jeff Astle who died from a degenerative brain disease – he was a renowned header of the heavy leather footballs that were used during his playing career.

    I look forward to your future blogs and videos.

    Thank you for sharing your knowledge with us.

    Best wishes


  8. Dr Hartstein,
    I very much appreciate the effort you’ve made here. I have followed this issue for some time here in the US, and rarely do we get to see things laid out in a logical, sequential manner such as you’ve done here. I read Chris Nowinski’s book “Head Games: Football’s Concussion Crisis” and found it (and the later research done through his Sports Legacy Institute) to be illuminating and meaningful.

    However, in discussing his work with both players and fans, there is a big disconnect. Fans seem to feel that players “know the risks” and are therefore making a “personal choice” regarding injury risks. Players still seem inclined to ignore or downplay the research. I was wondering what insight you might have in changing these attitudes? It would seem that working with F1 drivers you certainly would have encountered similar attitudes.

    As a side note, you may already be aware that NASCAR is facing the same issue here. However, their approach has been to mandate drivers sign off on not holding NASCAR responsible. Drivers such as Bobby Allison are suffering from symptomology consistent with post-TBI and PCS (Post Concussive Syndrome) and yet get no relief from the sanctioning body.

    Looking forward very much to your next installment.

    • In terms of players “knowing the risks”, we need to remember that the guys who are now suffering from what looks like chronic traumatic encephalopathy (CTE) accumulated their concussions when MTBI was hardly considered to be a pathological state. Getting “dinged”, having one’s “bell rung” was what football players DID. It’s really only over the last 15 years or so that the dramatic consequences of concussion mismanagement have become apparent.

      Part of the problem in high level sports is the extreme competitiveness of the participants. This means they are highly motivated to continue play, and to obfuscate in terms of their symptoms. Education and awareness would appear to me to be key here. That’s why it’s so important that physicians be involved – in order to reliably reveal the OBJECTIVE signs of concussion, in order to make the proper management decisions. In F1 we explicitly tell the drivers that a decline over several seasons in BASELINE cognitive function will prompt discussion with them of the continuation of their careers. Mercifully, this hasn’t happened yet.

      In any event, societal/cultural norms about behaviours at risk for concussion will change, and will change dramatically I think. Professional athletes in 10 years or so will have grown up in a sporting environment that will by definition lessen concussion risk.

      I’m not a lawyer, but I think that sanctioning bodies that have consistently acted “reasonably and prudently” in terms of management of head injury (based on contemporaneous knowledge) probably don’t have much to worry about in terms of liability. As for those who played the ostrich, or worse, I think that their burden of liability will possibly cause some of them to have to close up shop. If I ran the NFL, I’d be shitting myself.

  9. Great video Gary.

    As somebody who doesn’t know more than Joe Average, videos like this are incredibly informative, eye opening and interesting.

    Thanks for taking the time, and I’ve signed your petition.

    Best wishes,


  10. Such a professional production Gary – thanks so much.

    From reading ‘Mild Traumatic Injury & Postconcussion Syndrome’ American Academy of Clinical Neuropsychology by Michael A McCrea I do know that in most patients the reported effects of a single concussion are partly determined by the symptoms people expect to experience and that other conditions such as depression esp with chronic benzodiazepine use actually have a much greater effect after 3 months. Malingering/exaggerating symptoms is also a big problem when litigation is involved.

    I was particularly interested to hear about the autopsy results from IED victims as it does seem to suggest physical brain damage, and that blast injuries may be more dangerous than single concussions in most people. Similarly the evidence about repeated heading of the ball in football in the UK plus soccer experience in the US does suggest that this may well be where the greatest risk lies.

    Thanks so much – must have taken hours and hours of work to put this together.

  11. Dr. H.,
    Terrific video. And how timely it is. I do not think I have seen the problem explained in that detail as you did.
    Last year, “Frontline” a series on US PBS featured a two hour show titled ” League of Denial”. I highly recommend it to anyone interested in thie subject of concussions and it’s aftermath. It will become apparent after viewing this what major forces are aligning to discredit what has been for a long ,long time, a hidden epidemic in the lives of elderly and some not so elderly, NFL players,
    It is similar to the forces denying the change of climate in the world.

    We know the deal. Deeply invested economic interests whose future depends on non disruptive forces changing the status quo. (Profits).

    What we are seeing, and as you so correctly pointed out, is the sea change coming in how things are being done.

    Only when the insurance industry starts getting involved will there be changes to how things are done. Be it helmet design, rule changes, player conduct, etc. But where does this leave Motorsport? Design changes in the cars? No more open wheel? There are plenty of Nascar drivers who have suffered concussions. Most recently, Dale Earnhardt Jr. sat out two races a few seasons ago due to concussions. But who is to say, he won’t be a dementia patient in his 60’s?

    What your video made clear, at least to me, is that there are many more unknowns than known, but these blows to the head are not to be trifled with.

    I used to play semi pro ice hockey and the helmets we wore then, 20 years ago, are no different than what is being worn today. Basically a hard shell to keep you from getting cut, nothing more.

    Who is to say that the incidence of dementia being seen today in our elderly population is not a result of some seemingly innocuous blows to the head many, many years ago during the course of living a life?

    Thanks again, Dr. H. Good stuff.

    • Thanks so much for your comment. Great points – I’m already glad I did the video!

      I agree totally that the insurance industry will no doubt be a primary force behind getting things solved . . . or of closing down contact sports until such time as this problem is sorted. But I think we’re only just seeing the tip of the iceberg of post-concussive problems, and I almost get the impression that the leagues are the only people so far who understand that their days are numbered. And they seem to have finally realised that an ostrich approach won’t make it go away. Soccer would appear to be following, although in the case of FIFA, they’re being dragged, kicking and screaming, into the 21st century of MTBI.

      As with all areas that are just being teased out, there are so many questions still unanswered. I’m fascinated by the question of thresholds. What is the interaction between FORCE and NUMBER OF REPETITIONS? At the lower end, is a lifetime of heel strikes during walking (remember, we’re not “made” to live to 80!) enough to damage the brain? How about jogging? What about the effect of genetics on that threshold? Are some people at greater risk? And if so, how do we define them and protect them BEFORE starting to accumulate damage?

      A possible contribution of lifelong sub concussive impacts to the head (even indirect of course) to society’s burden of dementia patients would be important to detect, as this would constitute one of the few potentially reversible factors contributing to this scourge.

      Thanks again Jan!

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