Are concussions in sports preventable? Neurologists weigh in.

Concussions are a common injury, particularly in contact sports like football or ice hockey. While many people completely recover from a concussion, others who experience multiple concussions might suffer long-term consequences to their brain health.

In many contact sports, concussions are still largely considered the price of playing. Even with improvements to the helmets players wear, it’s not yet possible to prevent concussions. But will new research change this? First, we need to understand what causes a concussion.

What is a concussion?

“A concussion is a biomechanical injury to brain networks due to a force large enough to disrupt traffic on those networks,” said Erik Beltran, MD, a neurologist with Endeavor Health. “If you use the analogy of a highway, a concussion shakes the highway, causing accidents and slowing the speed of traffic.”

When a concussion happens, it disrupts the function of the brain’s nerve cells. Symptoms of concussion include headaches, sensitivity to lights and sounds, nausea, dizziness, trouble thinking, emotional changes, lower energy, sleep disruption, difficulty looking at screens, and unsteady walking.

“While concussions occur when a force of impact occurs directly to the head, they can also happen when impact happens to the body and gets transmitted up to the head,” explained Nicole Reams, MD, a sports neurologist with Endeavor Health. “Think of a rear-end motor vehicle accident that causes whiplash.”

What are the long-term impacts of concussions?

Most people recover completely from a concussion, usually within a few days or weeks. However, multiple concussions may have long-term effects on brain health.

“The long-term consequences of concussions are the source of active research,” said Dr. Reams. “We believe that there may be some damage at the level of the nerve, which may be reversible or irreversible.”

While it’s unlikely that a single concussion can have long-term impacts on brain health, researchers are trying to understand if multiple concussions can cause progressive inflammation and deterioration in the brain.

“There are potential long-term health impacts of numerous concussions or repetitive sub-concussive impacts (hits that aren’t necessarily a concussion), including cognitive difficulties, disruption of sleep, headaches, and mood or behavioral changes,” said Dr. Beltran.

Are concussions in sports preventable?

Numerous products — from helmet technologies to mouthguards — are being researched to prevent concussions in contact sports. However, there is no one single technology that can currently prevent concussions.

“There is ongoing interest in whether Guardian Caps (foam caps applied to the outside of football helmets) can reduce concussions during practice,” said Dr. Reams. “It appears this is true in the NFL, but not true at lower levels of play.”

But gear is not the best way to prevent concussion — it’s the rule changes. “Concussion prevention starts with promoting a culture of safety both on and off the field of play,” said Dr. Beltran.

For example, youth hockey in America has banned checking for players under the age of 13, reducing concussions by two-thirds. Similarly, U.S. Soccer banned headers for players under the age of 11 and also saw significant reductions in concussions.

The NFL has also implemented several rule changes, including a penalty for targeted head hits, banning the 10 lowest-performing helmets, and modifying kickoff rules.

What is the future of concussion prevention?

“I am hopeful we will get to a point where multiple technologies can come together to reduce the risk of concussion,” said Dr. Beltran. “In addition to concussion technology, there will likely also be blood and imaging modalities we will be able to use to inform us of the risk of concussion to brain health in the future.”

In the marketplace, some companies are inventing new devices that are attempting to reduce the risk of concussion in new and innovative ways.

“A new device called Q-Collar is trying to reduce the internal motion of the brain, rather than rely on external padding,” said Dr. Reams. “More research needs to be done to conclude if it can reduce concussions and if it is ultimately safe.”

What are the biggest concussion takeaways?

“There are two things everyone should know about concussion,” said Dr. Reams.

1. Early recognition is everything. Players who remain in sport following initial symptoms have more prolonged recoveries with potentially higher risk of impacts to brain health.
2. Find expert care. People who experience concussion should be cared for by a provider experienced in the care and treatment of concussion.

“The field of concussion is rapidly changing, and the way we treated concussions 10 years ago is no longer the way we treat them now — in fact, we have found it actually makes people worse,” said Dr. Reams. “Outcomes are much improved with newer techniques and multidisciplinary care, so seeing an experienced doctor from the beginning can help you get back to playing your sport soon and safely.”