How a concussion can affect the brain, and what Dolphins quarterback Tua may face next

Miami Dolphins quarterback Tua Tagovailoa is out of the game for now as he recovers from another concussion.

It’s the third concussion he’s had during his professional football career and reportedly the fourth in his life. The injury has raised concerns among sports fans awaiting an update on his condition.

Concussions are a mild traumatic brain injury common in sports, though they can also be caused by falls and accidents. About 1.5 to 3.8 million sports-related concussions occur annually in the U.S., according to the American Academy of Neurology. Concussions affect millions of kids and teens a year.

While concussions aren’t usually life-threatening, the brain injury can affect a person’s brain function for days, weeks or longer. And too many concussions can lead to severe brain damage or death.

For sports team doctors like Geden Franck, head team physician for professional rugby team the Miami Sharks, the main concussion concern is making sure players don’t experience “second impact syndrome,” or another concussion while recovering from a brain injury.

That can put players at increased risk for chronic traumatic encephalopathy or CTE, a brain disorder caused by trauma to the head that can cause memory and behavioral issues, said Franck, who also serves as head team physician for all athletics at Florida Memorial University and the University of Fort Lauderdale. He’s a sport medicine physician at Memorial Healthcare System, a public hospital system in Broward County.

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So, what are the symptoms, risks and treatment for this type of injury?

Here’s what to know:

What’s a concussion?

A concussion is a mild traumatic brain injury usually “caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth,” according to the U.S. Centers for Disease Control and Prevention. “This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

Concussions are common in contact sports like football and soccer, although people can also get injured in car crashes and falls. A concussion can lead to symptoms such as dizziness, headaches and memory problems.

But concussions are treatable. The usual treatment is rest — for the body and the brain. In some cases, physical therapy may be necessary.

What is the NFL’s concussion protocol?

Concussions are extremely common in football, including in youth, college and professional football. The NFL reported 149 concussions during its 2022 regular season, an 18% increase from 2021, ESPN reported.

The league even has a concussion protocol for teams.

The protocols for the diagnosis and management of concussion may include, and are not limited to, the following actions:

▪ Preseason education and assessment. These may include a physical examination by the team’s physician to review and answer questions about a player’s previous concussions and relevant neurological comorbidities. Players must be given a baseline neurological evaluation as part of a preseason physical examination, which should include comprehensive neurological and baseline neurocognitive examinations.

▪ Practice and game management protocols may include a pregame medical team meeting to go over medical and emergency procedures an hour before kickoff. If a player exhibits or reports signs or symptoms of concussion, he must be removed immediately from the field and taken to the locker room.

▪ Return to play requirements are evaluated by a head club physician who is designated for concussion evaluation and treatment who will work alongside an independent neurological consultant. “Return to performance” protocol may include a host of activities that may include light activity, aerobic exercise, football related exercise and non-contact training drills. A player may move on to regular training and be back on the field after clearance from the medical team.

What are the signs of a concussion?

Possible concussion symptoms include:

▪ Headache - sharp or throbbing or both

▪ Dizziness

▪ Nausea

▪ Balance problems

▪ Difficulty in communicating or concentrating on tasks

▪ Irritability

▪ Sleeping more or less than usual

▪ Blurred vision

How severe are concussions?

Doctors will determine how severe a concussion is based on the symptoms a person is experiencing and will conduct tests to assess a person’s condition, according to Franck. Are they sensitive to light or sound? Nausea and vomiting? Do they have a painful headache?

These are just some of the symptoms doctors will monitor for.

“One of the most important tools we can use to diagnose concussions is actually their balance ... because your balance is completely off when you have a concussion because of the trauma to the brain,” he said.

Doctors will also check a person’s long and short term memory, asking them questions such as whether they remember their name, what day it is, the time, and if they can spell certain words or count backward.

What’s the risk of multiple concussions?

“We do think that the number of concussions over a lifespan does change your outcome,” Franck said.

Chronic traumatic encephalopathy (CTE) is a brain disorder likely caused by repeated head injuries and kills nerve cells in the brain. CTE worsens over time, according to the Mayo Clinic.

“The exact time frame of your outcomes and your symptoms that you have when you’re older, the exact time period we don’t know because CTE can only be diagnosed after you’ve passed away and they evaluate your brain,” Franck said, concurring with the Mayo Clinic.

“But based on the professional athletes that we’ve heard about before, there are definite symptoms forgetfulness, headaches, sensitivity to light and other concussion symptoms that they’ve had.”

Multiple concussions can lead to mood changes, Franck said.

“Their family saying they’ve become a different person. Instability as far as emotion. Forgetfulness. Almost some of the symptoms that we associate with early Alzheimer’s disease is connected to frequent concussions,” he said.

How common are concussions in sports? What about in other activities?

About 7 out of 10 ER visits for sports-and-recreation-related traumatic brain injuries and concussions are among kids 17 and younger, according to the CDC.

The three youth sports with the highest rates of concussions are boys tackle football, girls soccer and boys lacrosse, the CDC says. Tackling is responsible for 63% of concussions in high school football, according to the public health agency.

How to treat concussions?

Physical and mental rest are the usual treatments for a concussion, experts say.

“The majority of patients who get concussions, the biggest thing that we worry about are the symptoms,” Franck said. “So we will treat sometimes with ibuprofen or Tylenol for the symptoms to help them be able to sleep. But the vast majority of patients and athletes, it’s mainly rest and monitoring.”