Yale Hockey Player Writes- Don’t Be a Hero: Second Impact Syndrome and the Risks Athletes Take by Playing Through Their Brain Pain

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Paige Decker

{Editor’s note:  In November of 2013, Paige Decker, a forward on the Yale Women’s Ice Hockey Team, suffered what she believed to be a rather minor concussion. What followed was a battle with a concussion so severe in its symptoms that it would go on to change her life forever.  Recently, Paige began to speak out about her injury and the healing process, which is something we know all too well about: You can’t keep an athlete down for very long- even in the midst of miserable symptoms. Motivation and determination tends to seep into different outlets when we are removed from competition. You can view her blog at www.theinvisibleinjury.net . Paige- keep at it. You WILL get there–Jay}

 

By Paige Decker

If there was one message I want you to take away from my journey, it would be this:

Do NOT play through your concussion symptoms.

This is a hard lesson to learn considering it is the exact opposite of what so many athletes have done their entire careers.  Practice of any sport basically programs a player to push through any form of injury, whether physical or mental.  This is something that is committed to muscle memory; whether it’s an ankle sprain, stress fracture, tendonitis, or pulled groin, you leave the trainer’s room and get back to business.

I was no newcomer to playing through injury.

In high school I played field hockey with a broken jaw, two busted teeth and a split open lip.  I played lacrosse with a broken wrist for three weeks before realizing it was actually broke.  And I’ve played with many of the common injuries I listed above.

These stories aren’t special.  Any competitive athlete can tell his or her own versions.
Injuries are expected and sometimes you just have to suck it up and push through it.

I mistakenly applied this logic to my concussion.

The Fear

I told myself to be tough, to suck it up and do my job, to take one for the team, to be a leader.  I told myself I was unbreakable, convinced myself to be a hero.

Thinking about it now, I realize this strategy wasn’t heroic at all.

It was the most cowardly way of handling my concussion.

 

I was scared to not play.

Scared for so many reasons.

Scared to let my team down.

Scared of what they would think if I took myself out of the line-up, leaving them with only 8 forwards to compete against one of the best teams in the country.

Scared of how it would look if I were too cautious, if I ended up feeling better in a day or two and regretted not playing.

Scared of looking weak, of what it could mean for my spot in the lineup, of letting myself down.

I think about this mindset now that I’ve experienced the last 22 months.  All the tears, all the suffering, all the doctors.

I think about it all and I want to go back in time.

I think back to when I was sitting on the leather couches in the foyer outside of our locker room, my two linemates beside me as we geared up for our second match up against a team that had only recently lost their historic winning streak.

Unknown to me then, this would be the last time I sat with them strategizing about an upcoming game.  I was quiet that day.  I couldn’t focus on their words.  My brain seemed to be covered by an umbrella of clutter preventing me from comprehending whatever it was they were trying to say to me.

I wanted to put my head under a pillow.

I laced up my skates instead.

The Prevalence

It terrifies me knowing this happens more than it should.  The Center of Disease Control and Prevention (CDC) estimates that 1.6 to 3.8 million concussions occur annually from sports-related activities.

Even more concerning is these numbers are vastly underestimated because athletes often continue competing in their sport while they have a concussion, just as I did.  In fact, the CDC recently released a report stating the 69% of student athletes with possible concussions don’t report their symptoms.

The staggering nature of these numbers, I can attest, are in large part due to a lack of understanding about the devastating effects a brain injury can produce.

Brain injuries simply aren’t like other injuries.

If your ankle is sprained you get it taped, tie your skates a little tighter, wince through the pain and the worst thing that might happen is the sprain gets a bit worse.  Maybe you have to ice it a little longer after practice, do some more rehab or wear your walking boot more often.  But you’re eventually alright.

Maybe the stakes are a little higher with a tear in your groin.  You might need surgery down the line and you’ll be away from the game for a few months, maybe longer.   You’ll spend tireless hours doing rehab and maybe your comeback isn’t quite as picturesque as you envisioned, but in the long run you’ll be just fine.

With brain injuries it’s a whole different ball game.

The stakes are so astronomically high that it isn’t even fair to put them in the same category as those other injuries.

Causing more damage to your brain is not like causing more damage to your ankle.

More damage to your brain is catastrophic.

The Facts

Playing with a concussion increases an athlete’s risk for Second Impact Syndrome (SIS) or a more severe traumatic brain Injury.

Second Impact Syndrome occurs when an individual who has a concussion sustains a second head injury before symptoms related to the first have resolved.

The end result: rapid and often fatal swelling of the brain.

SIS is believed to involve a loss of autoregulation of the brain’s blood supply.  Autoregulation is how the body’s arteries dilate or constrict in order to keep blood flow constant and under normal conditions.  In the brain, these arteries are extremely sensitive autoregulators of arterial blood pressure.

A concussed brain can experience a dysfunctional autoregulation system for brief periods (hours, days and in some cases weeks), and it’s during this time that a brain is the most vulnerable since it’s unable to regulate blood pressure changes normally.  It’s important to know that this autoregulatory dysfunction occurs at a relatively high rate among concussed individuals:  20-30% in mild traumatic brain injuries and 80% among more severe cases.

If this occurs after concussion #1, it can cause an absence of space-occupying hematoma in the brain, meaning there isn’t enough room within the skull to effectively manage even more swelling from concussion #2.  According to Dr. Nicholas Wetjen, if a subsequent stress-inducing second impact occurs while the brain is in this vulnerable state, it can trigger a catecholamine release, blood pressure spike and the rapid malignant brain swelling of SIS.

This can produce devastating results:  Second Impact Syndrome has a mortality rate just under 50% and a morbidity rate approaching 100%.

Also concerning, it doesn’t take much to induce SIS.  In fact, the second blow to the head can be surprisingly minor according to Dr. Robert Cantu, who cites that even a blow to the chest that indirectly jerks the athlete’s head can produce accelerative forces in the brain and lead to SIS.  This can occur even after a grade 1 concussion, the mildest form of a brain injury.

Combine this information with the fact that after you get a concussion you are six times more likely to sustain another concussion in the future, and it begins to look like the odds really aren’t in your favor if you elect to play while you have an injury to your brain.

Even so, the prevalence of SIS appears to be relatively low.  However, Dr. Cantu suggests it is more common than initially thought.  Often times, reported head injuries with clinical findings consistent with SIS are not labeled as such, making it difficult to adequately document its prevalence.

While it’s still true that many athletes who play concussed may never suffer from trauma as devastating as Second Impact Syndrome, the reality is they’re still increasing their risk for a more severe concussion.  And there’s no doubt that playing while concussed will make existing symptoms worse and recovery longer regardless of whether or not a second blow to the head occurs, as it did for me.

It’s also not hard to postulate that by repeatedly choosing not to allow your brain to adequately heal from concussions could make you more prone to devastating long-term effects similar to those seen in football players with Chronic Traumatic Encephalopathy (CTE).  CTE is a progressive neurological deterioration that occurs from repetitive brain trauma (see the below trailer of Concussion for more information).

But this doesn’t mean you have to hang up your skates or cleats just yet.

It simply means it’s important to truly understand the risks that come with continuing to play while you have a concussion.

It means stepping back when you don’t feel right and giving your brain the time it needs to properly heal.

It means putting your health above all else and beginning to think about your concussion differently.

Just because it’s an injury you cannot see to the naked eye, because its symptoms aren’t linear or concrete, or because as an athlete you’ve been groomed to push through all forms of pain does not give you free reign to pretend like the trauma to your brain does not exist.

The Mistake

When I was sitting with my linemates trying to comprehend strategies for the game, I should have gotten up, walked down the hallway and into the trainer’s room, my feet grazing over the beautifully adorned floors where the words “Win, Passion, Respect, Discipline, Teamwork, Confidence” lay boldly inscribed.

I should have walked up to my trainer and told him I couldn’t do it.

That I didn’t feel right and it wasn’t safe for me to play.

Instead I gave my trainer a light smile as I walked past him towards the medicine cabinet, ever so casually searching for the extra-strength Tylenol so as not to arouse any unwanted suspicion about my deceitfulness.

Do not make the same mistakes I did.

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Sources:
1. Cantu RC.  Second Impact Syndrome.  Clinics in Sports Medicine 1998; 37-43.
2. Cantu RC,  Daneshvar DH,  Nowinski CJ, McKee AC. The Epidemiology of Sport Related Concussion.  Clinics in Sports Medicine 2011; 1-17.
3. Wetjen NM, Pichelmann MA, Atikinson JLD.  Second Impact Syndrome: Concussion and Second Injury Brain Complications.
4. Lam JMK, Hsiang JNK, Poon WS. Monitoring of autoregulationusing laser Doppler flowmetry in patients with head injury. J Neurosurg 1997; 86:438–445.
5. CDC Report: 69 Percent Of Student Athletes With Concussion Symptoms Don’t Report It. CBS New York. Web. 20 Sept. 2015.

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