Concussions in Lacrosse: Part 2 of 3

Concussions in Lacrosse

Last week, we covered the basics of what a concussion actually is, what symptoms can be experienced, and the common causes in the game of lacrosse. In this post, I’ll be discussing why we should care about concussions and what type of consequences can be associated with this type of injury.

A 2012 study reported that among high school sports, concussion rate was third highest in boys’ lacrosse behind football and ice hockey. Another 2013 study by the NY Institute of Technology surveyed high school girls’ lacrosse players at elite tournaments and found that 11% reported having at least one prior concussion.

I’m comfortable saying that as lacrosse players, most of us have either experienced the consequences of a concussion or had a friend sidelined (sometimes indefinitely) after suffering one too many. Although there are often magic numbers floated around the athletic community, there is absolutely no way to predict how many concussions a brain can bear before an athlete must stop playing or risk severe long-term difficulties. Why? Because every concussion and every athlete is different.

In some cases, just one concussion leaves a person struggling with post-concussion syndrome (PCS) for months or even years, as in the case of former Blue Devil and Cannons midfielder Brad Ross. PCS is essentially a state of prolonged concussion symptoms that frequently includes headaches, problems with thinking and memory, and/or behavioral changes.

Former Harvard football player, WWE star, and Head Games writer Chris Nowinski, on PCS:

In even scarier cases, the brain can rapidly swell due to a second concussion before it has recovered from the first injury, usually within two weeks of the first. This is known as second-impact syndrome (SIS), which typically leads to severe disability or death, especially in young athletes.

Although we’ll be addressing what to do about concussions in the third installment of this series, it’s worth saying now that the best thing for someone to do after a concussion is rest until all symptoms have completely subsided, including those that only present during physical activity.

In addition to PCS and SIS, there are also more downstream, long-term ramifications of head trauma (like concussions). With orthopedic sports injuries like torn ligaments or cartilage, long-term consequences can mean wearing a brace, walking with a limp, using crutches or a wheelchair, or needing a total joint replacement in your elder years. Concussions have their own long-term effects, only they come in the form of complications with brain function and are much more difficult to treat.

Over the last few years, the disease called chronic traumatic encephalopathy (CTE) has become a hot media topic, especially with the recent buzz around the NFL and its concussion battle. CTE is a degenerative brain disease that has been linked to repetitive head hits, seems to present itself some years down the line after an athlete’s career (or more generally a person’s exposure to head trauma), and includes a variety of cognitive, mood, and behavioral symptoms. The most common of those are short term memory loss, short fuse or impulsivity, aggression, personality changes, depression and anxiety. Like Alzheimer’s disease, CTE can lead to full-blown dementia if the person lives long enough.

At this point, diagnosis of CTE requires the analysis of brain tissue after the subject has passed away (Junior Seau is a prominent example), although researchers are pushing to find a way to diagnose CTE during life.

CTE has been described in athletes as young as 17 years old, and in the brains of deceased boxers, football, hockey, rugby and soccer players, martial artists, military veterans, a domestic abuse victim, and even a circus clown who was repeatedly shot out of a cannon during his career (no joke).

To this day, CTE has not been described in a former lacrosse player but then again, a brain of someone who primarily played lacrosse has not been examined for CTE. There are enough head hits in lacrosse that it would not be surprising to find this disease in a former player.

The figure below, courtesy of Boston University, shows brain tissue from three post-mortem brain analyses. At left is a healthy 65 year old brain; the middle was a 45 year old former NFL player; the right was a 73 year old boxer with dementia.

CTE Brain Slides Concussions
CTE Brain Slides

Most anyone can tell that there is something wrong with the middle and right brains – they look disfigured, brown in some areas, and the close up images of the cells look cluttered and tangled. Those two brains were diseased with CTE, which is given away by the brown-stained protein. If the circuitry of your brain is like a highway, those brown protein tangles are like traffic accidents along the road that can slow you down or even prevent you from reaching your destination – or in this case, stop messages from being properly relayed through your brain. That gives rise to the variety of cognitive, mood and behavioral symptoms that I described.

It’s important to distinguish CTE from concussions in that CTE is an irreversible brain disease, from which there is no coming back once it begins. Concussions are brain injuries and with rest, 99% of people will recover from them.

In the next post, I’ll be discussing what we can do about concussions to improve our chances of recovery and continue our careers in the greatest game on earth.