Concussions are a tricky subject in sports. On the one hand, there are risks in just about anything one does: a car accident is possible when making a short trip to the grocery store, being hit by the mailman is possible when getting the mail, getting a concussion is possible when playing a contact sport. On the other hand, concussions are a pretty serious form of injury that maybe is not taken seriously enough. This week in my Neurochemistry class, we read a paper about what happens in the brain with a concussion. This led me to take the opinion that the public and even sports players and coaches do not know enough about concussions and their long term effects and should thus be more educated before pushing themselves or their players.
With any concussion, traumatic brain injury may occur, but a concussion is marked by no gross pathology such as internal bleeding of the brain or brain structure defects. Mild concussions do not cause a loss of consciousness while severe concussions cause a loss of consciousness (i.e. knockouts in boxing). Repeated concussions over time can lead to a chronic condition called chronic traumatic encephalopathy, or CTE. CTE is extremely similar to Alzheimer’s disease in how it affects the brain and in its symptoms.
So what exactly occurs in the brain during a concussion? As the head is impacted hard whether by the ground, fist, or person, the head accelerates then decelerates quickly. This causes the brain to do the same and the accelerating and decelerating forces stretch the neurons in the brain. The stretch of the neurons causes ions like potassium and calcium to enter into the cells at a higher than normal rate.
One effect of these ions is to cause excitation of the neurons which eventually leads to an increase in excitatory neurotransmitter release (namely glutamate). Increased release of glutamate is characteristic in many neurodegenerative diseases (i.e. ALS). Glutamate can excite other neurons causing numerous effects like hyper -metabolism, over activation of cellular pathways, and can eventually lead to cell death.
Another damaging effect of the initial calcium coming into the neurons is that microtubules in the neuron can become damaged. The microtubules act as a transportation system (kind of like a railway) for the neuron. As the microtubules get damaged, the neuron axon swells up and the proteins that should be transported accumulate in the neuron axon. Some of these proteins are the infamous tau and amyloid beta proteins that cause a problem in Alzheimer’s disease. As these problematic proteins build up, they can turn into the neurofibrillary tangles and amyloid beta plaques that stop signaling in the brain.
All this from a few concussions?!? Yes, that was my response! So, get a few concussions while playing football, suck it up, continue playing, and have a possibility of getting CTE, which is basically like giving yourself early-onset Alzheimer’s. This knowledge may not prevent most athletes from playing contact sports or even getting back in the game after a blow to a head, but it is important to know as a parent of an athlete, coach of a sport in which concussions are common, or an athlete of such a sport.
Because concussions are not a visible injury and we must only rely on responses from the athletes, concussions don’t often get taken as seriously as other visible injuries. However, we should take concussions seriously because they have serious effects (especially long-term), and we should educate ourselves on what is actually happening in our brains due to the mysterious injury called a concussion.
Article Referenced:
http://www.sciencedirect.com/science/article/pii/S0896627312010367
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To Play or Not To Play?
