Concussion occurs when an impact to the head or body sends a strong force to the brain, resulting in significant, acute brain injury with symptoms including headache, mental fogginess, changes in memory, balance, coordination, behaviour, irritability, and slowed reaction time. Over 90% of concussions are not associated with a temporary loss of consciousness and more than 80% of concussions are diagnosed the next day or several days later.
Sub-concussion impacts occur when the force of the impact damages brain cell function, but a player does not experience any symptoms and the impact is unnoticed. Repetitive, sub-concussive impacts cause injury to the tiny blood vessels in the brain. This results in damage to the ‘blood brain’ barrier, a structure designed to protect the brain. When this structure is damaged by repetitive trauma, an abnormal ‘immune” mediated inflammatory response is triggered with the production of neurochemicals. The neurochemicals and inflammatory response should be protective. However, the problem arises when the brain is subjected to repetitive impacts before the protective neurochemicals and inflammatory changes from the initial head injury have had time to return to normal.
The subsequent, repetitive head injuries can then result in an abnormally exaggerated further production of neurochemicals and an exaggerated inflammatory response which is harmful to the brain, rather than protective. This response damages the brain tissue and eventually leads to the irreversible death of brain cells. Over time, this abnormal inflammatory pathway, triggered by repeated head injuries in contact sports, eventually leads to changes in a brain protein called tau.
The tau protein which is found within cognitive brain cells normally stabilises brain cells to ensure they work efficiently and communicate effectively with other cognitive brain cells, so an individual can think and behave normally. When the tau protein becomes damaged, it can no longer stabilise the brain cells and they lose their ability to function efficiently and effectively. As the tau protein spreads around the brain, more and more brain cells, needed for thought and control of emotions and behaviour, are killed.
Brain injury is not specific to elite or professional football, it is very much part of amateur football. It can impact men, women and children, whatever age and fitness level. From the cages to the Camp Nou, the parks to the Parc des Princes.