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Massachusetts Medical Society's Physician Focus

February 2016



  • Concussions are called ‘invisible’ injuries, as they have no recognizable signs of harm such as bleeding or pain.
  • The diagnosis can be difficult to make: symptoms are varied and vague, and there’s no definitive diagnostic test available.
  • Most concussions are resolved in about 10 days with no persistent problems.
  • With thousands of young people in sports, concussion is an important public health issue that needs to be addressed.

The injury has raised alarms in the most successful sports organization in the world. It has become the subject of a major motion picture. And it has raised fears among parents about their children’s participation in sports.

The injury is concussion – essentially an injury to the brain. Public and parental awareness of the risks of this injury has soared in recent years with the publicity surrounding professional football players, and the potential of its long-term health risks is now being recognized at all levels of sports.

Dr. Ann McKee, Chief of Neuropathology at the VA Boston Healthcare System, is one of the nation’s foremost experts on concussion and head trauma and appears as a guest on the February edition of Physician Focus to discuss the dangers and risks of concussions to athletes. Hosting this edition is Dale Magee, M.D., a past president of the Massachusetts Medical Society.

Dr. McKee explains that a concussion results from “an impact to the head that causes structural changes in the brain.”

The difficulty with concussions, says Dr. McKee, who is also a Professor of Neurology and Pathology and Director of the Chronic Traumatic Encephalopathy Center at the Boston University School of Medicine, is that it is an invisible injury, with vague symptoms and no obvious signs of injury like bleeding or pain.

“Concussions may include a variety of neurologic symptoms,” says Dr. McKee, “such as headache, trouble with vision or balance, nausea, memory or sleep disturbances. It does not have to mean loss of consciousness.”

Diagnosing a concussion is also tricky, she says. No absolute diagnostic test for concussions exists at this time, and the symptoms can be delayed. “Right now, it’s a series of tests,” Dr. McKee says, “with some balance testing, cognitive testing, a visual test, and physical exam.”

If a player is suspected of having a concussion, Dr. McKee is clear about what action should be taken: take the athlete out of play at once and don’t allow him or her to return until an examination by a medical professional has been completed. “If in doubt,” she says, “pull them out.”

“When a concussion is diagnosed,” she says, “the first remedy is cognitive and physical rest with no stimulation, and a gradual return to activities.” She notes that it is important to recognize the cognitive consequences of a concussion – that it is an injury to the brain – and that young athletes may have difficulty with school work.

Most concussions are resolved in about 10 days with nothing to worry about, she says, yet there are reasons for concern.

“A second concussion can be worrisome,” she says, “depending on the interval. The shorter the interval, the more dangerous.” She also notes that a small number of concussions may persist and that some may go on to develop long-term problems. The long-term issues, she says, are directly linked to years of exposure: “The longer you play, the higher the risk.”

With thousands of athletes – particularly younger children and adolescents – participating in sports, Dr. McKee recognizes that concussion is an important public health issue that needs to be addressed immediately.

And she issues a caution to parents of young children, whose brains are still developing. “Younger kids are more susceptible [to concussion],” she says, “and they take longer to recover. For sports with lots of contact, it’s best to wait until the body is physically mature.”.

Yet she also knows the benefits of sports. “Team sports are terrific for kids,” she says, “and we don’t want to take them out of sports. We know there are enormous benefits from physical exercise, physically, emotionally, and psychologically. We don’t want to stop sports, but we want them to play safe, to play smart, so that head impacts are not putting their long-term health at risk.”

Watch the above video for more conversation, including discussion about “sub-concussive” impacts, which sports account for the most head injuries, gender differences in susceptibility to concussions, and adopting “skill sets” that help to reduce the risk of concussions in sports

MMS/Richard Gulla

Boston University Chronic Traumatic Encephalopathy Center

Concussion Legacy Foundation

Brain Injury Research Institute

Mass. Department of Public Health

Centers for Disease Control Heads Up

Massachusetts Medical Society

From left, Dale Magee, M.D., Ann McKee, M.D.
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