How many concussions are too many? It's a question that concerns many players and parents of players alike. Head impacts are always a health concern in any environment, and unfortunately, in contact and collision sports, head injuries like concussions happen all too often.
In a nutshell, there's no simple answer to the question. In rare cases, just a single concussion can cause brain damage. On the other hand, with effective treatment and sufficient recovery time, most players are able to recover completely from multiple sport-related concussions eventually. Whether a concussion has done significant damage depends on the severity of the head contact, the amount of time between successive concussions, and how long it takes to recover from any post-concussion symptoms.
One of the best ways to ensure that the effects of a concussion are minimized is to increase awareness at all levels of sport - from youth to elite professional levels. Indeed, thanks to growing awareness, contact sports like soccer now have a level of preparedness to deal with concussion and other head injuries that has improved significantly in recent years.
What Is a Concussion?
Let's take a look at what concussion is, what causes it, and how it affects your health.
Basic Definition and Causes
A concussion is also known as mild traumatic brain injury (mTBI). It is a common traumatic brain injury characterized by a head impact that causes unconsciousness or a change in consciousness, such as incomplete memory of the impact, confusion, or disorientation.
A concussion is associated with sports, especially contact sports like American football and basketball, and collision sports like boxing or rodeo. However, concussions aren't just sports-related. Falling and banging your head, automobile accidents, and even whiplash can also cause concussion. In fact, anytime there's a bang to the head or violent movement of the brain, there's a risk of concussion.
Furthermore, you don't have to lose consciousness to be diagnosed with concussion, as is widely believed. A player clearly showing signs of reduced brain function after a knock to the head will likely be diagnosed with a suspected concussion during sideline concussion assessments and not allowed to continue playing. However, even if the player appears fine immediately after the impact and can continue playing more or less normally, some symptoms may only appear days later.
Common Symptoms
Because concussion is essentially a brain injury, the symptoms can be physical, mental, and emotional.
- Physical symptoms include headaches, dizziness, sensitivity to noise or light, and issues with balance.
- Mental symptoms include feeling sluggish, problems concentrating, and memory issues, especially working memory.
- Emotional symptoms include increased irritability, mood swings, depression, and anxiety.
As you can imagine, these symptoms can be seriously debilitating and last for days, or weeks, or evolve into longer-term issues.
Understanding Repeated Concussions
One concussion is dangerous enough, but cumulative concussions can be even more serious.
The Risk Increases with Each Concussion
Like bones or muscles, the brain needs time to fully recover from an injury. When its healing mechanisms are overwhelmed by successive concussions, the risk of permanent brain damage increases. Because the brain hasn't healed properly from the first injury, repeat concussions often require less force to cause further damage, and take longer to heal.
The result of repeat concussions is known as cumulative brain stress. Research shows that cumulative brain stress can cause long-term changes in the brain, for example by changing the structure and function of brain regions like the prefrontal cortex, which are used for higher-order thinking.
No Universal “Safe Limit”
That brings us back to the question of how many repeat concussions are too many.
Sports medicine experts like the NYU Langone Concussion Center and UPMC Sports Medicine Concussion Program don't offer a strict number, for example, "three concussions is too many." They suggest that other factors are more important than the number of concussions when it comes to the risk of brain injury.
As noted earlier, the severity of the damage caused is a crucial aspect. More serious damage will typically require longer to heal properly. The time between head injuries is also an important consideration - naturally, the longer the better. The quality of the recovery also plays a big role. You don't want to be exposing yourself to new concussions before you've properly recovered from the last.
If sufficient time and appropriate treatment aren't provided, the long-term consequences of concussion can be dire. Depending on the nature of the damage and the individual, early retirement from the activity that causes the concussion is sometimes recommended.
When Is It Too Many? Key Factors to Consider
So, how do you know when it's one concussion too many?
Red Flags That Warrant Medical Concern
If you experience any of the following, it's definitely time for a thorough neurological examination to determine whether it's safe to continue playing sports at all:
- Persistent symptoms that last beyond one month
- Worsening cognitive and brain function, such as impaired memory, reduced processing speed, and difficulties with language
- Multiple concussions with a short interval between them
- A history of mental confusion after concussion, as opposed to a loss of consciousness
Signs You Should Stop Contact Sports
If the medical recommendation after neurological evaluation is that you should stop all contact sports, it would be foolhardy not to heed the warning. However, even without a medical recommendation to stop, if you're experiencing lingering cognitive and/or emotional effects, it's probably time to stop anyway. Another bright red flag that it's time to hang up your boots is if it's taking longer to recover after each successive concussion.
Long-Term Effects of Multiple Concussions
As mentioned earlier, the long-term consequences of multiple concussions can be devastating if sufficient time isn't given for the brain to heal properly between them.
Physical and Cognitive Risks
The short-term symptoms of concussion – balance issues, memory loss, dizziness, and headaches – can become permanent. Each consecutive concussion also raises the risk of developing chronic traumatic encephalopathy (CTE). This neurodegenerative disease causes behavioral problems, mood problems, and problems with thinking in general. It worsens over time and often results in dementia.
Another common effect of multiple concussions is dysregulation in the visual, vestibular, and hormonal systems, which are all intricately connected. This can lead to migraines, vestibular migraines, visual disturbances, vertigo, and other permanently debilitating conditions.
Emotional and Behavioral Impact
The long-term emotional and behavioral effects of repeated concussions, including depression, anxiety, mood swings, and personality changes can destroy your quality of life. Relationships can become strained and work life is negatively affected as a result. In some severe cases, perhaps inevitably, suicidal thoughts emerge.
How to Minimize Risk Moving Forward
Alarming as the risks may be, there are several steps that players, coaches, and officials can take to limit the risk of concussions, and the potential damage they may cause.
Smart Training & Play Practices
Both during and after games, it's important to follow the return-to-play protocols for that particular sport. These protocols, such as sideline concussion assessments, have been designed by sports medicine experts to rapidly identify possible concussions and take the appropriate actions.
It's also important for referees and other adjudicating officials to enforce proper tackling and heading actions during the game, and punish infringements appropriately. The cleaner the game, the less the chance of nasty, concussion-causing collisions.
Many experts also recommend mandatory rest periods after all brain impact events, just to be safe. As noted before, it can sometimes take days before symptoms become an issue.
Protective Gear That Can Help
There's also a selection of protective gear you can use to reduce the risk of concussion and other brain injuries, especially for youth players.
- Concussion headbands for soccer and basketball players are padded headbands that won't prevent head impact, but will absorb some of the force, softening the impact on the brain.
- Storelli ExoShield Head Guard is a high-quality full-head protector that protects the face and head and has been rigorously tested to provide maximum impact absorption.
- Mouthguards are primarily designed to protect the teeth rather than the brain, but they also increase jaw stability during contact, which helps to limit the impact on the brain.
Storelli.com carries a range of certified protective gear specially curated for high-risk athletes to reduce the risk of concussions. Additionally, you'll find other protective equipment, such as soccer gear for men, women and kids, such as shin guard sleeves and soccer goalie equipment, including youth goalie gear like goalkeeper gloves. Protecting other parts of your body means you can better protect yourself from concussions.
Recovery: Healing From One or Many Concussions
The best way to ensure that a concussion doesn't become one too many is to recover properly from it. And that is best accomplished in stages.
Best Practices for Recovery
The first and most important of the recovery stages is rest. Initially, experts recommend full physical and cognitive rest until no symptoms are present. Then, as recovery progresses, activity can be gradually reintroduced under medical supervision. With time and patience, you should be able to make a full recovery. However, if any symptoms linger, the next step is supervised neurocognitive rehabilitation.
When to Seek Advanced Help
If symptoms persist beyond three weeks, it's definitely time to seek specialist help. But even before that, if standard treatments like rest, physical therapy, light therapy, and medication aren’t effectively reducing symptoms, that's a sign that there might be more serious damage. Fortunately, in most large cities there are specialized clinics that offer brain imaging and functional therapy that can help relieve the symptoms that more standard treatments can't.
FAQs
What happens if you have 7 concussions?
That depends on how severe each concussion was, the interval between them, and the quality of the recovery from each. At best, you'll have no significant damage and be able to continue playing normally. At worst, you may have serious brain injuries and have to stop playing entirely as a result.
Is 4 concussions in a year bad?
It's best to avoid even a single concussion in a year, so four certainly isn't great. However, how bad four concussions in one year are depends on the severity, intervals between them, and quality of recovery from each.
What is the 3 concussion rule in the NFL?
The NFL has strict, if sometimes controversial rules for players returning from concussion. Although there is no set limit to the number of times a player can get concussed before not being allowed to play in the NFL further, they must complete the five-step plan before they can return.
How many concussions does it take to get CTE?
Research suggests that individuals with CTE report an average of 17 concussions. However, although CTE is associated with multiple concussions, even a single severe concussion can cause it. It depends on the individual case.
