The science
Science clearly indicates that impacts, blows, and jolts to a head cause the brain to move and twist inside the skull, which may damage it. Decreasing the number, magnitude, frequency, and proximity of those forces – across the whole athlete pathway – is how we improve the health and wellbeing of athletes repeatedly exposed to them, in the short, medium, and long term.
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7 things every athlete should know
Blows and jolts to a torso can cause brain injury too. Concussions and sub-concussive events are caused by rapid head movement – acceleration and deceleration – as the brain moves, squeezes, twists, and scratches inside the skull.
There is 40 different mechanics for functional brain injury to occur. A good thumb rule is the higher the number of events and magnitudes involved, the higher the risk the damage may occur.
If nothing feels immediately wrong after a potentially injurious event, athletes may routinely keep training or playing. All available information on the events occurring is needed to support assessment and decision-making.
Unlike a twisted ankle or a broken wrist, a brain injury sends no immediate signal of pain. Athletes may simply not know when something is wrong.
Age, gender, concussion history, and other factors affect risk. What looks like a tolerable event for one athlete may be more concerning for another. Generic rules may not be enough.
Sub-concussive events are smaller impacts and events that do not cause concussive symptoms. Their accumulation over time and career can contribute to CTE, early onset dementia and Parkinson’s, and other neurodegenerative brain diseases.
There is no medication and no cure for sport-related concussion, or the neurodegenerative diseases these events may contribute to. Reducing the number, magnitude, frequency, and proximity of impacts on a head is the only defensible, practical approach.
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Head injuries in sport are relatively common, but recognising and examining them is significantly more challenging than, for example, orthopaedic injuries. Based on my own professional experience, a head trauma like concussion can also go unnoticed if other, more obvious injuries are present and focused on.
Common misconceptions
“A helmet keeps me fully protected from brain injuries.”
Reality. Helmets are excellent at protecting against skull fractures, cuts, bruising, and other soft-tissue damage, and some can reduce the magnitude of certain impact forces. But brain injury like concussion is caused by movement of the brain inside the skull, which a helmet cannot fully prevent. Always wear a helmet – just don’t expect it to protect you against concussions or sub-concussive events.
“A mouthguard protects against brain injuries.”
Reality. Mouthguards protect teeth, gums, and the jaw. They are not designed to absorb or dissipate the forces associated with rapid head or brain movement. Wear one to protect your mouth – but it won’t protect your brain.
“I didn’t hit my head, so there’s no risk.”
Reality. A sudden forceful jolt to the head or torso can cause a traumatic brain injury without any direct impact at all. The key risk factor is the rapid movement of the head – not whether something physically struck it.
“Repetitive heading or impact training makes the brain more resilient.”
Reality. Current scientific evidence does not support this as a protective strategy. While individual low-magnitude events may not pose a significant acute risk, cumulative exposure over time is concerning. The goal should be quality – fewer, better – not quantity.
“I played for years and I’m fine – this is overblown.”
Reality. Not all athletes sustain permanent damage, but too many do. Equipment and science have improved – but so has the game’s intensity, speed, and force, and the time spent training and playing. Any one athlete injured unnecessarily is one too many. Scientific evidence cannot and should not be dismissed based on individual experience.
Currently, 3.5 years after my last concussion diagnosis, I still suffer from brain injury symptoms. I want to speak openly so that more people could understand what sport concussions can cause.
Reducing the number, magnitude, frequency, and proximity of impacts is the only defensible approach – and you cannot reduce what you cannot see.
