How do we Reduce the Risk of Concussions?

In our final instalment of this series, we will look what we can do to reduce our risk of suffering a concussion. Though we cannot prevent all concussions, there are things athletes and parents can consider to help reduce the incidence and severity. Potentially the most beneficial is a shift in attitude regarding contact and collisions in sport on the part of athletes, parents, coaches, officials and administrators. Enforcement of rules while promoting clean and fair play can reduce the incidence of concussions (i.e., checking from behind, or a spear tackle). The behaviours of players are an important element in concussion prevention, therefore teaching players correct playing positions (especially those used in contact situations) and the rules of the game by qualified coaches is paramount. Similarly, proper education regarding detection and return to play procedures should be implemented at all levels of sport. Creating an environment that allows athletes to come forward about their concussions without downplaying the seriousness of these injuries is crucial. 

A common misconception is that protective equipment, like helmets and mouthguards, prevent concussions (Daneshvar, 2011; Harmon, 2013). While helmets can reduce a direct blow to the head by dissipating impact forces over a larger surface area, they do nothing against rotational forces and the brain can still move in the skull. However, they are crucial in reducing the likelihood of scalp lacerations, skull fractures, and brain bleeds, and possibly can reduce the severity of a concussion. For example, think of a hockey goalie getting a slap shot to the head. The helmet prevents cuts and a skull fracture, but the force still travels into the skull and can cause a concussion. They are especially useful when the head comes into contact with hard surfaces (e.g., hockey, cycling etc.). 

Similarly, mouth guards prevent dental and oral injuries by shielding the teeth, but there is little evidence they prevent concussions. Concussions are acceleration injuries, so logically a mouth guard wouldn’t do much to dampen these forces. This is by no means suggesting to not use helmets or mouth guards, as they do help prevent serious head and facial injuries while helping to reduce impact forces, but it should be understood that just because someone was wearing a helmet does not mean they are less likely to suffer a concussion. Proper management procedures should still be followed. An overlooked reality of protective equipment is that it can give players a false sense of security, resulting in more reckless playing styles, potentially leading to an increase in concussion risk.

Creatine supplementation has neuroprotective effects due to its ability to combat oxidative stress and other toxins in the brain (Beal, 2011; Bender, 2016). This is likely why research has found creatine supplementation can decrease the damage associated with Traumatic Brain Injuries and Spinal Cord Injuries. Brain concentrations of creatine decrease after a concussion, which could be why creatine supplementation has been shown to increase cognition and decrease symptoms in children who sustained moderate to severe concussions (Ashbaugh, 2016). The protective effects are thought to be because creatine can maintain the efficiency of the mitochondria (Kreider, 2017), thus combating some of the energy deficit problem post-concussion and limit the damage from concussions. Such information is particularly important for any athlete, but especially those in contact sports where the risk of concussion damage is very real. This doesn’t mean creatine can prevent a concussion but may help support the brain during the recovery process. Considering creatine monohydrate is cheap, incredibly safe, easy to use, and confers many performance enhancing effects, it is a relatively straightforward way to get some protection against concussions.

Note - For more information on Creatine Supplementation and how to take, please read our heavily researched article here or download the pdf.

Neck strengthening through direct and specific exercises theoretically helps to reduce the likelihood of concussions, as stronger neck muscles would stiffen the neck and decrease the acceleration forces experienced by the brain. This is thought to be one of the reasons why females tend to experience higher concussion rates compared to males. Research on rugby tackles showed that a stronger neck can lower the acceleration of the head (Dempsey, 2015), while clenching the jaw has been shown to decrease head accelerations in contact situations (Hasegawa, 2014). Another study has found that for every 1 pound of neck strength increase the odds of concussion reduced by 5% (Collins, 2014), though correlation does not equal causation. We don’t know if the time and resources spent on specific neck strengthening programs actually improve concussion outcomes compared to general training alone (more research is warranted). Though a stronger neck is likely useful, these benefits go away if the athlete has no opportunity to ‘prepare’ for impact (‘blind-sided’; muscles cannot pre-emptively contract to dampen accelerations), which is why safe play and enforcement of rules is still the biggest factor in reducing the likelihood of concussions. 

Being more fit, especially aerobically, may confer benefits in relation to concussion prevalence and recovery. A study on high school football athletes found that those with lower aerobic fitness had a higher rate of concussion (2 times greater risk) and took around 3-4 days longer to recover post-concussion, compared to their more fit counterparts (Kontos, 2006). There may be 2 reasons for why this is the case. Higher levels of fitness may have a protective effect on the brain, similar to how aerobic fitness limits cognitive decline in older individuals. This is due to improvements in cerebral blood flow (which decreases after a concussion) and improved vascular function, though more research is needed in this area to really understand the protective mechanisms. The second reason is that the more fit you are, the more resistant to fatigue you become. As an athlete fatigues, they are more likely to become distracted and have lower reaction times, thus putting themselves in more dangerous situations. Similarly, when muscles fatigue your strength and speed outputs drop, which can put you in sub-optimal positions to handle external forces.

Therefore, being more fit can help to reduce concussions in some instances while speeding up recovery. However, this does not mean becoming a distance runner prevents concussions. A properly designed training program that is consistently performed will ensure an athlete is fit and robust while being more prepared for the demands of his or her sport, including knocks to the head. This is especially important for youth athletes where there is a stigma (still!) around youth training. Putting an underprepared, weak and unfit child into an aggressive sport like football, hockey or rugby can be a recipe for disaster.

Even though there are precautions we can implement to reduce the risk or protect against concussions like regular fitness training, supplementation and rule changes, we cannot completely prevent concussions. What we can do though, is improve our understanding of concussion risk, detection, evaluation and management to ensure athletes are remaining safe and are recovering properly. As the majority of athletes under report concussions it is up to parents, coaches and administrators to step in and ensure rules and best practices are being followed.

Conclusion

Throughout this article series, we explored what a concussion is, how it occurs, what goes on in the brain, and what risk factors there are. We discussed how symptoms are caused by an energy deficit in the brain, and that a gradual return to play process that incorporates physical activity and reduced cognitive load yields better results than complete rest. We also answered the question of how we can reduce the risk, with overall fitness, concussion education and rule enforcement being the most potent. We hope this article was informative and gives you a new appreciation for concussions and provides you with the tools to advocate for yours or your child's well-being.

Thanks for reading!

~Coach Gies