Physical Training Feb 2002

Head Injuries: Do Something

by Peter Kim
Copyright © Peter Kim 2002. All rights reserved.

  The problem with head injuries is that too darned few folks want to do what's sensible. And I'm talking about before they get hit on the noggin'.

Nobody argues about what doctors call "open head trauma," where the skull contents have been opened to the sky, usually by sharp penetrating trauma. Blood, bone, and brain made visible will make most of  us pull-up short, and strongly reconsider the folly of whatever we were just doing (if and when we regain consciousness in the neurosurgical intensive care unit, that is).

But too much "closed head trauma" --- commonly referred to as a "concussion" ---  is dismissed as not a big deal, something you shake-off and train through. Or worst of all, something you, your friend, or your students hide from a doctor, since that physician may demand a halt in continued athletic participation.

This is dumbass thinking, and I for one am getting sick of seeing this kind of idiocy.

People who don't die and keep taking hits to the head --- usually adults --- get brain damage. Sometimes it just takes one big hit, to keep putting the sugar bowl in the refrigerator, or to lose your engineering job because you can't concentrate on anything more complex than a grocery list without getting a splitting migraine. I've seen this in my own post-concussion patients who talk haltingly, frown a lot, and look slightly, chronically confused; they are different people than they were before the head trauma. And it's as bad, if not harder, on their families.

People who die from this often didn't have to --- and they're usually the young. Sudden death from repeat head trauma leaves a big hole in an entire community, and has everyone wondering "How could such a thing have happened?" Most often, the answer is that first hit wouldn't have killed, but the second or third or fourth time out, the hits finally did the job. "Getting back out there" should have stopped at one.

In my experience, the lion's share of the problem isn't misinformation, it's stupidity. A small part of the problem is lack of knowledge, not recognizing what the red flag symptoms of brain injury look like. That information and what to do with it ---  stop right now --- is relatively straightforward, and I'll go into it in a coming article. But too often, warning signs that had already been identified before the fatal final blow occurred just didn't make it to the people who could have done something about them. And whether it was deliberate ("Don't tell the team doc, he'll just pull you outta practice!") or just due to uncertainty about getting involved, the final tragedy is compounded by knowledge that could have saved a person's life that never saw the light of day.

Medical personnel at martial arts competitions (or even personal family doctors) are no substitute for responsible action on the part of the individual, referee/coaching staff/teacher, and family/friends/training partners. The simple fact is, most signs of brain injury are absent by the time the athlete presents to the doctor, especially when they're being downplayed to get back into the tournament or into training ASAP. It is far more likely that they will be seen by others close to the concussed, who need to know not only the significance of what they're seeing, but also that they're probably the only ones who can do something that may prevent a tragedy. It does no good to hear, after a death or after someone you know suddenly stops coming to class (and stops working and a whole lot of other things), that, yeah, he was acting funny the week before, yeah, he did complain of a workout headache after he took that shot to the head, yeah, he was having problems concentrating in class. That kind of after-the-fact revelation drives sports medicine doctors batty: it sure would've saved a life or prevented irreversible brain damage if brought to medical attention before the poop hit the fan, why the hell didn't anyone do just that? Because the person in question might have gotten pissed off? Because he might not have been allowed to continue training for the big regional or national tournament? Because he might have to put off testing for advancement for, my God, months?

We're talking about the seat of the soul. The neural net that drives, or at least ties together, all of what we call a person's mind, heart, spirit, and body. And it is as resilient as a bowl of firm jello, we can't fix it worth a damn just yet, and it generally gets less respect (i.e. sensible rest) than a dislocated shoulder. If you or someone you know participates in a contact martial art --- judo, jiu-jitsu, wrestling, boxing, TKD, karate, capoeira, vale tudo, kickboxing --- especially with a tournament competition component, you must realize when to back off from a head injury. The brain is wondrous and delicate and damage to it is irreversible; once out of kilter, there's no going back.

For Further Reading: and

Peter Kim is a practicing family medicine and sports medicine (sport medicine to Canadians) physician in Costa Mesa, California, a member of the U.S. Judo Medical Subcommittee, fellowship-trained in sports medicine and a holder of the CAQ in Sports Medicine from the American Academy of Family Physicians. He practices aikido, iaido, and judo, and has past training experience in savate, jeet kune do, kali-silat, Muay Thai, and Brazilian jiu-jitsu.
Physical Training Feb 2002