2 Kids, Sports, and Concussion George Foreman had been concussed. But why? What is it that happened to George Foreman’s brain at the time of that right cross that rendered him stunned, off-balance, incapable of contin- uing the fight? What was it about that right cross that resulted in Foreman’s brain malfunctioning? If the brain is located in the top of the head, above the eyes, why would a punch to the jaw injure the brain at all? This chapter will provide answers to these questions. A concussion is a type of traumatic brain injury. When athletes sustain concussions, their brains stop functioning properly as a result of trauma. Per- haps the simplest way to think of a sport-related concussion is: a temporary dysfunction of the brain caused by trauma. Despite popular belief, a concussion is not a bruise on the brain. There is no detectable bruising, bleeding, or swelling of the brain by conventional, modern-day imaging of the brain. It is not cut, scratched, or abraded. The brain, however, cannot function properly when it is concussed. Memory, con- centration, reaction time, the ability to learn new information, and the ability to solve problems are all temporarily disrupted when an athlete sustains a concussion. Since one of the main functions of the brain is to maintain consciousness, any athlete who loses consciousness after head trauma has sustained a concus- sion. Most concussions in sports, however, do not involve a loss of conscious- ness. In fact, less than 10% of all sport-related concussions involve a loss of consciousness. A blow dealt to the shoulder will bruise the shoulder. Most people are familiar with this type of injury. Therefore, many people believe that a concus- sion is a bruise on the brain sustained by a blow to the head. Medical science, however, has shown that this is not true. Remember, the brain is protected by the thick, hard bone of the skull. In order to bruise the brain, the skull would have to break or bend inward and strike the brain. While this can happen, the forces involved in sports are often too low to cause this type of skull deformity. Furthermore, in the sports that carry the greatest risk for sustaining concussions, the brain is often protected by a hard helmet in addition to the skull. In fact, many concussions are caused by a blow to the facemask, chin, or other part of the body, as opposed to the head. Readers who are familiar with boxing or mixed martial arts will be well aware of this. Concussions are fairly common in these sports. For a physician who studies concussive brain injury, a lot can be learned from observing these combat sports. At the time of writing the first edition of this book, I was having trouble sleeping. I used to get out of bed, go into the living room, and watch some television. One night, I came across a show featuring the ultimate fighting championship’s (UFCs) greatest knockouts. I started watching volume 3. I was on volume 6 by the time I returned to bed. There were approximately five or six knockouts per episode. So I was able to observe a good number of knock- outs in a relatively short period of time. I noticed that most of these knockouts resulted from a blow to the chin. Remember that the brain is in the top of the skull, mostly above the eyes. A blow to the chin results in no impact on the
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