The Nightmare That Keeps On Visiting
Why post-concussion syndrome and improper recovery are the scariest parts of an already scary injury
It’s no secret at this point that a concussion is a scary injury.
In fact, with every new bit of information that comes out about concussions, the exact nature of the injury gets a worse and worse look. Consider the information we’ve gathered over what a concussion actually is. Public opinion long considered a concussion to be, quite literally, a bruise on the brain. The speculation was that a concussion was caused by the brain slamming into the wall of the skull, causing a serious external injury to the brain.
The Phenomenon That Starts It All
It’s only recently that data was gathered refuting that common notion, although most of the public still seems to have that incorrect idea of what the situation behind a concussion is. In reality, a concussion is a phenomenon that is firstly caused by whiplash of the neck. When the neck compresses and releases, it creates a whiplash motion, which causes there to be a difference in velocity between the skull and the brain. In other words, the skull moves at a different speed than the brain, and the brain lags behind. Because the brain has a texture similar to Jell-O, this causes the tissue in the brain to be manipulated and stretched, which, put simply, isn’t good.
Studies at Stanford University have shown that when the tissue stretches, the most stretching tends to be along the corpus callosum, which is the band of nerve fibers that is located in the middle of the brain, right between the left and right cerebral hemispheres (or in colloquial terms, the left and right sides of the brain). In severe concussions, data has shown that the tissue in the middle of the brain is sometimes stretched to 50% its normal capacity. Over time, if an individual suffers several concussive blows, that tissue eventually dies away. Take a look at the difference between a normal brain and a brain suffering from chronic traumatic encephalopathy, more commonly known as CTE:
Notice that in the CTE-affected brain, there appear to be far wider cavities — especially in the middle of the brain, which is where the tissue tends to be injured the most. You can see that tissue has died away over time by a large scale, and advanced CTE has put that brain far beyond any repair. The quality of life of the individual whose brain that is would have almost certainly deteriorated due to the disease, especially in their later years. The head trauma they suffered would have created a never-ending nightmare for them, and the pain they would feel would get a lot worse than it felt when they initially took a blow to the head. That’s the tragedy of traumatic brain injury, especially when it becomes a recurring problem. After a certain point — it never gets better.
Why Recovery Is What Determines Your Future
Advanced CTE of that nature is never the product of one concussion. It’s the product of repeated brain injuries. By that, I don’t just mean several severe concussions, although that would definitely be a factor. I mean that CTE of that nature can even be the product of several sub-concussive blows, the kind of hits to the head that we often dismiss.
Let’s take a step back and look at a brain that has just suffered a concussion. The brain cannot regenerate like, say, the liver can. Once a brain cell has been damaged, it’s almost certainly lost forever. Still, you would be surprised how well the brain can heal from a single incident of mild traumatic brain injury (say, a mild degree of concussion) when it’s given enough time to recover.
The caveat, though, is the phrase “enough time to recover”. The recovery time needed for the brain to conclude its healing process will almost never be a matter of days, or a mere matter of a couple of weeks. It takes a long time for the brain to resume normal functionality after suffering an injury. That’s the thing about concussions that presents the greatest danger to the modern human being.
In the busy lives that make up today’s world, who has time to allow their brain to recover? Although it might sound ridiculous to suggest that people frequently prioritize their schedules over their brain when they suffer mild traumatic brain injury, it’s exactly what happens. If a student suffers a concussion, they take at most a few weeks off, and then return right back to school, trying to take on the stress, general mental effort that it requires to do schoolwork, and exposing themselves to the noise, light, and general chaos of the world around them. The same goes for a working adult: they will usually take at most a week or two before giving up on trying to give their brain the rest it needs.
Athletes are especially bad about giving themselves enough time to recover from concussions. An athlete cannot stand being injured. They have to wait to be fully diagnosed, then wait to be cleared for practice, and then wait for clearance to play… meaning that the recovery process is usually a long and painful endeavor. No athlete wants to be sitting on the sidelines watching their team play, and having to stay inactive in a dark room, without being able to even train or practice (let alone be with your teammates) is an extremely difficult situation to cope with. It means that the general mental pain from the social and physical withdrawal that recovery requires is about equivalent to the actual physical pain from headaches and migraines that the recipient of a concussion endures on a daily basis.
So, naturally, people who suffer concussions will do their best to jump back to a daily schedule as soon as possible. And in a lot of cases, people are actually convinced that it’s okay for them to do so. One of the most dangerous things about concussions is that symptoms usually (a) take time to actually manifest after the actual injury and (b) disappear before you’re actually healed. The truth is that even after you stop getting headaches for the most part, you’re probably still not done healing. A drop-off in symptoms can’t immediately be regarded as a sign that you’re fully recovered, because what it really means is just that the brain has entered the next stage of the healing process.
Of course, the problem here is that even doctors sometimes can’t accurately tell you when you’re recovered. Since the nature of the injury means that MRI and CT scans cannot show concussions, doctors have to resort to making clinical diagnoses of concussions. This means that they basically have to go off of the symptoms you’re presenting externally, such as diluted pupils, or the behavior you’re exhibiting, such as confusion or memory loss. This, suffice to say, is not an effective way to diagnose traumatic brain injury. It doesn’t tell doctors enough about the severity of the injury or give them any sense of what kind of timetable you’ll likely need for recovery. Because of that, inaccurate diagnoses and inaccurate decisions that a person is ready to resume a normal lifestyle are rampant. It’s not the fault of medical practitioners. Many individuals are working on ways to improve that problem by figuring out how to make accurate, quantifiable readings of concussions.
The issue with resuming a normal lifestyle while your brain is still trying to heal is that doing so puts a real wrench in the healing process. Your brain isn’t ready to have to try to work at peak functionality again, and it is too much strain to try and do so. Especially with athletes, this is extremely dangerous. If they take even a mild blow while their brain is still healing, they sustain second-impact syndrome. This is what leads to longer-term problems like CTE. Second-impact syndrome refers to injury sustained by an already injured brain. When this occurs, it interrupts the healing process so badly that the brain takes a significantly higher degree of permanent damage.
I am guilty of exposing myself to a situation that made things worse for me than it had to be. I once suffered a concussion in a hockey game where I was elbowed in the head and ending up smacking my head again on the ice when I fell. I sustained an obvious concussion, and as soon as I came to that realization, I realized that the injury would probably keep me from playing. Obviously, I was incredibly anxious to get back out there. As soon as my symptoms showed signs of tailing off, I jumped at what I saw was an opportunity and played a game the next day. I took a mild hit — one that normally wouldn’t have injured me — and ended up on the ice in double the pain. My symptoms took a dramatic upswing and I ended up taking months to recover. Even now, I still deal with mild problems that are remnants of my injury. It was a hard and vivid lesson.
Over time, repeated instances of second-impact syndrome put an individual’s future health in serious jeopardy. That’s why sub-concussive blows are so dangerous. Consider a soccer player who’s used to heading a ball all the time, or a hockey player who’s had his or her fair share of big collisions that leave them with some dizziness. When these blows are frequent, the brain is taking repeated injury. Even if those individual injuries are mild, the eventual cumulative effect can be devastating.
But the problem is not entirely out of your hands. If you sustain a concussion, take your time with your recovery. I know as well as you do that it can be incredibly stressful and frustrating to not be able to live your life the way you normally do. I understand as well as anyone the mental torture that accompanies the pain and the ever-present headaches. But you need to think in the long-term, and look out for yourself. Even after you start to notice your symptoms disappear, take extra time to make sure that they fully disappear and slowly integrate yourself back into a normal lifestyle instead of throwing yourself back into the craziness of life. Be safe, and don’t condemn yourself to a state of living that you don’t need to go through. Believe me, the short-term happiness you might gain by neglecting proper recovery isn’t worth it.
It’s rare for individuals who have suffered concussions to reach a state of life that is completely unmarked by their injury. You usually bear some scars for the rest of your life. You might suddenly notice that you have vertigo or terrible motion sickness. You might suddenly develop chronic migraines, light sensitivity, and randomly lose vision for a few seconds several times a day. Those are all things that I have gone through in post-concussion syndrome from an injury I suffered a long time ago. Any pain that you feel at the exact moment you take a blow to the head is usually nothing compared to the slog that you have to endure afterwards.
But, to anyone who’s going through it: you are strong enough to get through it. Stay true to yourself and be diligent about giving your brain the best recovery possible. Do it for both yourself and the people around you who care about you, and do what you can to make your future a happier one. I know that it’s a scary situation, but there are things you can do to make it easier on yourself in the long run. It doesn’t have to derail your life, and remember: nothing is more important than your brain. You might feel otherwise, but there just isn’t anything that should take a higher priority. Don’t expose yourself to situations that are going to put you in danger. You can get better and find yourself again, and there’s a big support network out there for you.
Post-concussion syndrome can be a nightmare, but, in the immortal words of good ol’ Albus Dumbledore: “Happiness can be found even in the darkest of times, if one only remembers to turn on the light.”
If you have any questions, would like any advice, or if you just need someone to talk to about what you’re going through, please reach out to me on Twitter. I’d be happy to be of any help. — PuckSniper84