Of all the injuries that can take you down in sports, head injuries are the hardest to evaluate and predict. They are the total wild card. As one mom explained about her daughter’s experience: “You only know how serious a head injury is when you look back on it.”
Ultimately, the only way to judge the severity of head injury is to see how long it takes to fully recover from it. Adding to the mystery is a recovery process that is rarely linear, but rather marked by phases of steady improvement and sudden regression. This feeling of toggling between the verge of full recovery and square one makes dealing with head injuries extremely frustrating for not only the athlete but also for all involved.
Awareness of head injuries has improved greatly in recent years, thanks mostly to the cautionary tales from the NFL.
Now, acronyms such as TBI (traumatic brain injury) and CTE (chronic traumatic encephalopathy) are widely tossed about in the sports community and have inspired higher safety standards in most organized sports, including skiing. These include:
- Helmets as standard equipment, for ski racers and also for most of the skiing population.
- A general improvement in acknowledging and indentifying head injuries as they happen — and in treating them.
- Better awareness of both the risk of reinjury through second-impact syndrome (sustaining another impact before the brain has fully healed) and the long-term effects of traumatic brain injury.
- At the institutional level, USSA (like other sports governing bodies) has a concussion policy, part of which is excerpted below.
- On the ground, parents and coaches are more apt to notice and assess signs of head injuries after crashes.
- From the recreational level all the way through to the elite level, better awareness of and compliance with thorough and responsible return to sport protocol.
From what I’ve seen as an athlete, coach and parent, this last part, about compliance represents the most profound change in concussion awareness.
That said, there is still much room for improvement, particularly in regard to mild concussions. Eric Ellingson and David Barlow run BE Fit Physical Therapy in Hanover, N.H., and work with many young athletes and skiers. They find that there is not always good awareness and follow through on return to sport. “I run into kids all the time who had a ‘mild’ concussion and then just basically went back to practice without any guidance more specific than ‘do what you can,’” says Ellingson who notes that more severe concussions tend to get better managed, while light to moderate ones often get minimal if any follow up with return to sport. “That may be part of why we see so many multiple-concussion kids down the road,” says Ellingson.
Recovering from even a mild concussion requires total physical and mental rest. We’re talking no TV, loud noises, bright lights, reading, texting or screen usage of any kind until all symptoms are gone. Then, return to play is a gradual, graduated and well-monitored progression, starting with light aerobic activity and then progressing to no contact sport-specific activity, drills, training and, finally, competition. Any return of symptoms takes you back to the beginning.
This approach is a far cry from the old-style, “walk it off and get back in the game” approach. To those of us raised (by wolves, it seems at times) in a different era it can seem like overkill in some cases, but erring on the side of caution is a good thing, considering that research continues to reveal that brain trauma is cumulative. Even sub-concussive impacts, when layered on each other, can lead to serious long-term consequences.
Steamboat Springs: This resort’s U10 program director, Deb Armstrong, restructured her professional life after years of strange symptoms. U.S. Ski Team photo
One ski racer who applauds all efforts of increased concussion awareness is 1984 gold medalist Deb Armstrong. The current U10 program director at Steamboat Springs Winter Sports Club significantly restructured her professional life after years of frustrating and mysterious symptoms. At the suggestion of neurologist Pamela Kinder, she finally underwent SPECT — single photon emission computed tomography (you’re welcome) — imaging.
In lay terms, an MRI looks at the hardware and structure — what the brain looks like. The SPECT looks at the software and the flow of information — how the brain works. Armstrong’s scan revealed areas of inadequate and excessive blood flow, which helped explain her symptoms and validate the changes she had made to accommodate them. “It was liberating to finally ‘get it,’” says Armstrong, who now writes “everything” down and warns new parents she may not remember their names the next day.
Armstrong writes everything down after learning how head injuries had impacted the blood flow to her brain.
Kinder sees Armstrong as a classic example of an athlete who underreported head injuries sustained during her career. As she grew older, it took less of an impact to bring on severe symptoms.
“As we age, our brains become less adaptable,” explains Kinder. So while it’s important to protect kids’ noggins against risk, young brains do have potential for healing. This decreases after age 28 or so, leading Kinder to worry less about kids in their sports than about older athletes with a history of high-impact sports. “Injuries when they are older, because of those earlier traumas, can be more dangerous and affect them long term,” she says.
The takeaway for kids and those in charge of them? Take every aspect of head injuries—from prevention to recovery—seriously. The takeway for oldies? Wear your helmets! And carry a notebook.
Pinpointing the Mind-Body Connection
Even when you’re fully healed physically, your mind often won’t set your body free because ultimately, the brain is the boss. This is especially true for athletes who have come back from major or multiple injuries. No matter how ready you feel rationally, you won’t find that highest gear until your mind gives the green light. For some, the solution is to take more time and continue building strength until the mind is ready. Some choose to “get back on that horse,” and boss their bodies into readiness. Others get proactive by exploring psychotherapy.
One non-traditional technique for getting back on your game is called brainspotting. It was born out of EMDR (eye movement desensitization and reprocessing; yes there will be a vocab quiz), an accepted therapy for treating PTSD patients. Paige Roberts of Ski Town Psychotherapy in Steamboat Springs uses brainspotting with many snow sports athletes to help them process trauma (like injuries) and move past it.
As defined by the treatment’s founder, David Grand, “a ‘brainspot’ is the eye position which is related to the energetic/emotional activation of a traumatic/emotionally charged issue within the brain… When a brainspot is stimulated, the deep brain reflexively signals the therapist that an area of significance has been located.”
In brainspotting, athletes talk through injuries or failures while a therapist tracks their eye movement, noting where their gaze orients. When Roberts watches a TV interview with an athlete, she studies their eye movements, watching for potential “brainspots,” which indicate unprocessed memories. She explains that the more upset or activated the athlete is, the more eye movement you see. “Sometimes they will only maintain the gaze for a second because they are unconsciously accessing ALL of their past unprocessed sports traumas.”
Roberts explains that right after an emotional or physical trauma, the body fights to create homeostasis. By adapting so quickly, the body’s survival mode becomes its new (depressed) set point of neurological and physiological functioning. This creates maladaptive neuropathways. Over time, the theory goes, our unprocessed traumas unconsciously begin to take over the neurological system, making it impossible to control athletic performance. “Brainspotting clears the unprocessed trauma,” says Roberts, “so your brain can then reassociate the positive performance neuropathways.”
Brainspotting works under the concept of neuroplasticity — that the brain can adapt and change. For an athlete coming back from injury Roberts recommends, “the sooner someone can process and release the trauma, the easier it is to clear the maladaptive pathways and reassociate the positive performance neuropathways.”