Concussions-let us talk about it

Boxing picLately the topic of concussion is in the news again. Concussions are been increasingly recognized both on and off sports fields. A concussion may be defined as any traumatic brain injury (usually mild) that disrupts brain function. A point to emphasize here is that loss of consciousness is not mandatory for a concussion to occur. Let me explain this with the aid of an example from the sport of boxing. As a ringside physician I sometimes witness a knockout (KO). In a sudden dramatic KO the boxer falls to the canvas and is unable to rise to his feet before the count of 10. In most KOs it is easily apparent that the boxer has also suffered a concussion-he is rendered unconscious (sometimes only for a very short time) and when examined in the ring is frequently confused and disoriented (may not recall that he was knocked out, does not recall which round it is or the name of the arena). In these circumstances a concussion is easy to identify. There are though instances where the boxer may be struck by a ferocious blow such as a hook but he does not fall to the canvas nor does he suffer a loss of consciousness. In these circumstances the concussion is far harder to identify and many a times may be missed by the referee, the boxer’s own corner and even the ringside physician unless the fight is stopped temporarily and the boxer is assessed. Some people refer to these as sub-concussive injuries/blows.

Current scientific data indicates that multiple concussions are not good for the brain and there is concern (some degree of evidence but not definite proof) that it leads to a progressive degenerative disease of the brain called chronic traumatic encephalopathy (CTE) for which currently there is no cure. As prevention is always better than cure, hence the thrust that concussions especially on the sports field be identified in a timely and accurate fashion and athletes be rested (removed from play) till they are asymptomatic.

Nitin K Sethi, MD