What follows is an excerpt for a recent piece by Matt Gammons, MD, Second Vice President of the American Medical Society for Sports Medicine. Gammons identifies the following three myths:
Every athlete who sustains a hard hit must have a concussion.
Although our knowledge about the forces involved in concussion is improving we still have not found a level of force that definitely causes a concussion. At times high forces do not cause an injury and relatively lower ones may. This means that we should not overact to every head impact but also need to listen to athletes who complain of concussive like symptoms after any head contact. Because there is no known force level for concussion in-helmet devices that are marketed to consumers as “concussion alarms”, they are not recommended as they will likely lead to both over and under diagnosis of concussive injuries.
Better helmets and mouth guards will prevent concussions.
Unfortunately there is no good scientific evidence that helmets of any type (hard shells, soft-padded or head bands) or mouth guards can prevent or reduce the risk of concussions. Hard helmets can reduce the risk of more serious head injuries (bleeding, skull fractures etc.) and should be worn in high risk sports. Mouth guards can prevent dental injuries and should be worn for sports with a high risk of these injuries. Helmet-add ons additionally are not effective in concussion prevention and using these will generally void any warranties associated with the helmet. Risk reduction may be possible in some settings with rule changes (e.g. no hitting from behind in hockey) and behavior changes (e.g. tackling technique in football).
Once you have a concussion you will always be more susceptible to having another one.
While there appears to be an increased risk of recurrence in the first few weeks after a concussive injury it is unclear what factors may influence the risk of another injury in the future. Despite being a commonly held belief there is no evidence to suggest that athletes develop a decreasing force threshold after each injury. A few small studies have found the opposite. The largest risk to any athlete for a recurrent concussion is exposure (playing a sport) and since most athletes who have a concussion plan on continued participation this likely is the leading cause. Other risk factors discussed before may play a role but this is not yet defined. Management of concussion will continue to evolve as more research develops. Removal from competition and early intervention with a healthcare professional knowledgeable about concussions will help protect our athletes and allow the fastest and safest return to play.