When talking about injuries associated with the practice of exercise, and specifically of blows to the head and the brain injuries that they trigger, misunderstandings often arise and it is interpreted that physical activity is being discouraged. Quite the opposite: the health benefits of abandoning a sedentary lifestyle always outweigh the risks. What it is about is choosing the most appropriate sports discipline based on the age and situation of each person and promoting the adoption of preventive measures.
No sport or exercise is completely exempt from occasional problems, although Contact concussions are generally considered to cause the most concussions. and head injuries. However, this generalization has many nuances because a multitude of modalities are included in this group. For example, within martial arts, blows to the head are more frequent -without actually posing a significant danger- in taekwondo than in judo; hence, in the first helmet is used and in the second, not.
“In team sports”, as indicated Joseph Medinahead of Functional Rehabilitation at the Guttmann Institute, “the contusions can be of different levels: direct hits with another athlete, on the ground, with the ball or ball, against the fences…”.
The beautiful sport… in blows to the head
the neurologist Jesus Porta-Etessamvice president of the Spanish Society of Neurology (SEN), is clear about the sport that would be at the top of a hypothetical ranking of those that cause the most brain injuries: “The first, and by far, is boxing”. The first cases of what was previously called dementia pugilistica were described in this discipline. “Even has been linked to the development of secondary parkinsonism to continuous trauma; a clear example is that of Mohamed Ali”, adds the expert.
The next sport in that ranking would be American football.which is characterized by direct contact between heads and produces microcontusions that, in the long term, increase the risk of cognitive impairment. It is the so-called chronic post-traumatic encephalopathy, captured very accurately in the film The truth hurts (original title: Concussion), starring Will Smith. The symptoms that some players of this sport end up presenting are very similar to those of Alzheimer’s, and are reflected in cognitive problems such as memory loss. What is decisive in this case is not the intensity of the blows, but the repetition of the traumatisms over time.
In rugby, blows to the head are much less frequent. because, although it has many similarities to American football, the dynamics of the game are different.
Another example of a sport in which there is a lot of head-to-head contact – helmet to helmet, actually – is hockey. In contrast, in European football (soccer for Americans) the risk of brain injuries is lower, largely due to the changes that have occurred in recent years. “The balls are less heavy, less is played on wet pitches and less is finished off with a header,” summarizes Porta-Etessam. Repetitive headers have also been associated with chronic post-traumatic encephalopathy. For this reason, in England they don’t let children under 14 do them when they train, says the neurologist.
Porta-Etessam urges paying special attention to the risk of head injuries in minors, choosing sports with less risk and taking the necessary preventive measures in each case. Thus, in the case of football, a measure as simple as the one adopted in England can be very effective. Regarding sports such as American football or rugby, he warns: “The helmet does not work, what you have to do is avoid injuries.” There is only one sport whose practice is discouraged for children: “As a neurologist, I cannot recommend boxing”. In short, he considers that sport “in itself is very good and, except for some in which direct head injuries occur”, in the rest there is no reason why there should be any complications.
Types of trauma according to the alteration of consciousness
“When one hits the head in any physical activity, whether in a group or individually, three levels can be differentiated,” explains Medina.
Level one
There is a transient disturbance of attention and thinking, but normality is restored in less than 15 minutes. This would be the mildest type of concussion.
Level two
When confusion or altered consciousness, even if it is slight, it exceeds 15 minutes.
Level three
There is a loss of consciousness that lasts for 30 minutes, an hour or more weather.
Beware of second impact syndrome
Any blow to the head of a certain intensity requires immediate attention and, in the event of any of the three levels of altered consciousness described, even even if the state of confusion only lasted a few seconds, it is necessary to leave the field of play or cease the individual activity that is being carried out. “If it is not abandoned, what is called second impact syndrome may appear,” says Medina. “Although neither the affected person nor the coach notices it, there may be vascular micro-injuries”. If so, and a new impact occurs, that second hit can be much more dangerous and damaging.
“This second impact syndrome may not occur in the same game, but a week or two later.” Therefore, experts advise, first of all, wait a reasonable period of 24-48 hours before playing again or train hard. But not only will it be necessary to wait patiently for the danger to pass, but also to carry out a medical evaluation of the athlete, with the neurological and imaging tests that are required.
How to treat brain injuries
The brain injuries that can trigger blows to the head are very varied. In addition to the intensity of the blow and its possible repetitive nature, it influences where it is located. The most frequent falls are those that occur backwards, in which the area with the highest risk of injury is the occipital part of the brain. There are also falls and frontal blows, in which the affected part is the anterior one. However, as Medina warns, “a blow of this type can cause an injury to the frontal part and, by rebound, to the occipital part.” Side falls, which are more rare, can injure the temporal lobe part of the brain. “They are less common because the shoulders often act as a brake.”
The treatment of the lesions will be aimed at improving the altered brain functions in each case: motor (difficulties to regulate or direct the essential mechanisms of movement), cognitive (immediate memory, concentration, perception…), behavioral, language…
“Basically, you have to work the motor part and the cognitive part”, confirms Medina. “From the point of view of rehabilitation, we try to organize an exercise program focused on improving these functions and, above all, to work on functional patterns that improve independence in activities of daily living of the person”. Thus, sports, hygiene, clothing, personal mobility or activities in the urban environment are added to physiotherapy and occupational therapy.
The rehabilitation expert points out that different actions are carried out at each level of affectation. In the most severe cases, highly affected patients or those with minimal response, “an individualized treatment of sensory stimulation in a quiet environment, very controlled, so that they integrate small stimuli that the therapists work with them”.
