Neuropsychologist Gary Solomon, Ph.D., recently weighed in on one of the hottest debates in sports medicine, asserting that research doesn’t support the popular theory that concussions put athletes at higher risk for psychiatric illness.
He made the remarks during Sports Concussion: The State of the Science, a seminar he and other experts with the Vanderbilt Sports Concussion Center hosted for health care professionals, athletic trainers and school officials.
The seminar covered a broad range of topics, including concussion treatment, long-term effects of the brain injury, efforts by the National Football League (NFL) to prevent head trauma and a former professional hockey player’s account of dealing with postconcussion syndrome (PCS).
Jeff Miller, senior vice president of health and safety for the NFL, and Stu Grimson, who played 13 years with the National Hockey League (NHL), were guest speakers.
Research into the effect of concussions on psychiatric illness is limited, Solomon said, and the evidence at this point does not support a direct link.
“I would maintain that despite anecdotal and case series reports, it is my opinion there is no compelling empirical evidence to indicate that sports-related concussions or subconcussions are the sole and direct cause of psychiatric illness and suicides,” Solomon said. “As sports medicine physicians, it is incumbent on us to focus on the relevant multivariate factors in the outcome of sports concussions and not reinforce the simplistic, linear belief that concussions cause everything.”
Solomon said that if sports-related concussions directly caused psychiatric illness and suicides, the prevalence among athletes would be higher than in the general population, which is not the case.
The Vanderbilt experts focused on the importance of quickly diagnosing athletes with concussions, getting them treated and identifying which ones were most at-risk for PCS, a condition where concussion symptoms linger for months or longer.
Allen Sills, M.D., professor of Neurological Surgery, talked about predictive factors for which high school and collegiate athletes were susceptible to PCS. Those factors included a previous concussion, a history of psychiatric illness or mood disorder and a family history of those conditions. There’s likely to be genetic vulnerability to PCS among some athletes, he said, similar to how some families are more predisposed to certain cancers.
Most concussions are mild and do not require transfer to a hospital, said Christopher Bonfield, M.D., assistant professor of Neurosurgery. Even with mild concussions, athletes should be given time to recover and monitored closely before returning to play.
However, providers must be aware of “red flag” symptoms, such as including severe headaches, seizures, altered mental state, repeated vomiting, slurred speech, increasing confusion or agitation, weakness or numbness in limbs, neck pain and clear drainage from ear or nose, that could signify a more severe injury. Athletes with these concerning symptoms should be taken to a hospital emergency department for further evaluation.
Grimson, an enforcer for NHL teams including the Nashville Predators who was called the “The Grim Reaper” because of his aggressive play, stayed in the rink after suffering concussions throughout his career and developed PCS. Concussion symptoms lingered longer as he got older. When those symptoms began to go on for days, he didn’t tell his coach or team physician about the problem until he talked with the team captain.
“I needed somebody to give me permission to say I was in trouble to get that kind of help,” Grimson said.
He retired from the NHL, but it took a year and a half for him to recover from PCS.
“I didn’t realize what a terrible condition I was in until I stepped back and just tried to rest and let my brain recover,” Grimson said. “You have to remove yourself and allow somebody to remove yourself from the action, from the mix, from the competitive environment, to truly heal.”
While athletes of many sports are at risk for concussions, football has received more scrutiny in media reports. Miller gave updates about ongoing changes in rules and medical coverage that the NFL is implementing to make the game safer. He also highlighted the role of education, especially in youth levels of the sport, and discussed ongoing work on helmet design and field surfaces.
Concussions are difficult to diagnose on playing fields because many athletes, wanting to stay in the game, aren’t forthright. Tennessee implemented a sports concussion law in 2014 that established protocols to protect young athletes. Those guidelines include a “return to play” policy for when concussed athletes can resume physical activity. Alex Diamond, D.O., MPH, assistant professor of Pediatrics and Orthopaedics and Rehabilitation, revealed that the state is working with experts from the Vanderbilt Sports Concussion Center to also develop a “return to learn” guide that would help schools better manage academic activities for concussed athletes.
