Any of you who have ever donned the tools of ignorance have probably had your bell rung at one time or another, from a foul tip or an errant backswing. Catchers aren't the only players at risk, however - collisions can happen anywhere on the field. Also, runners, fielders and even base coaches (or spectators) can be hit in the head by a batted or thrown ball. The net result is that head trauma, while not as prevalent as in collision sports like football or hockey, is still a fairly common occurence in baseball. With that in mind, in this blog I will discuss concussions - what happens during a concussion, what the symptoms are, what the risks are and a little about care of the concussed athlete. Then, I will go into prevention and provide a summary of the current thought regarding helmets - both for batting and for catching.
The brain is about the consistency of jello. It floats blissfully inside your noggin in a sea of liquid called cerebrospinal fluid. This fluid helps to cushion the brain from trauma. When a person suffers a concussion, typically a direct blow to the head shakes the brain violently, and the brain is injured. The symptoms of a concussion can vary. Sometimes you can be knocked out, but not always. In fact, in the majority of concussion, there is no loss of consciousness. More common initial symptoms of concussion include headache, memory loss (usually of the causative event but sometimes for hours or even days), confusion, dizzyness, "seeing stars" - or I suppose chirping birdies, ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, fatigue ... etc. Later (hours to days) after the event, a concussed person might note difficulty with concentration or memory, irritability or anxiety, difficulty sleeping, sensitivity to light or noise, taste or smell changes, or depression. There is a special condition, called "post concussion syndrome", that can occur some days after the injury - usually 7-10 days after the concussion, with symptoms similar to those decribed above that can last for weeks to months.
In every concussion, there is some degree of injury to the brain. The brain needs time and rest to recover. There are chemical, and in some cases, structural changes that take place in brain after injury that take time to heal and stabilize. Most concussed patients fully recover. Treatment is fairly straightforward . Rest is very important. It is advisable for the concussed athlete to avoid activities that elevate heart rate until the symptoms resolve. This also includes non-strenuous activites (computers, reading, watching television) that increase symptoms. Sometimes patients are advised to take time off work if work activity worsens symptoms. Analgesics (like acetominophen) can be helpful, but anti-inflammatories like Aleve (naproxen), aspirin or Advil (ibuprofen) are discouraged because they can thin the blood slightly which can increase bleeding from the injury, creating a potentially very serious problem. For severe symptoms such as increasing headache, marked behavioral changes, loss of coordination, confusion or disorientation, speech changes, seizures, visual or pupil shape changes, or if the injury results in loss of consciousness for greater than 30 seconds, the concussed player needs to be evaluated in the emergency room. Really, if there is any question, it is better to be checked out by a doctor sooner rather than later.
Regarding return to play, there are some clear guidelines. If you sustain a concussion, you are done for the day. No concussed athlete should return to play the same day as the injury. In fact, return to sports needs to wait until the player is completely free of symptoms from the concussion. If there is any doubt, I would advise seeing a neurologist or doctor trained in care of the concussed athlete prior to returning to sports. Also, there is an abundance of literature that documents player performance is significantly worse after returning from concussion, so there is no rush. More importantly, what we're trying to avoid is a permanent brain injury. The risk of seizures is doubled for 5 years after a concussion. Worse, there is a condition called "second inpact syndrome" wherein a second injury before the first has fully healed can result in rapid, often fatal, brain swelling. There is an abundance of literature from the NFL regarding "chronic traumatic encephalopathy" which is severe, permanent brain injury usually from repetitive brain injuries.
So, how do we prevent concussions? First, never bat against Eric Cole. Just kidding! Eric, you know I have much love for you! Also, you must have known the game in which you beaned me 3 times would come back to haunt you some day! Seriously though, having the right helmet is key. From a batting standpoint, there are a few considerations. In general, it is recommended that the helmet fit you well. Also, wearing anything under your helmet such as a baseball cap ( more of an issue for catchers perhaps) can reduce the effectiveness of the helmet. The one possible exception to this might be Lee Smith's mullet, which may provide some additional protection. For those of you who have been know to throw your helmet when it obviously caused you to strike out with the bases loaded, cracked helmets are "no bueno" - if you think your helmet was out to get you before, wait until you take one in the earhole when there is a crack in it. Last, there is the 1 vs. 2 earflap debate. One earflap helmets are generally sexier than two flappers. Those of us who wear the two flapped helmets resemble Kazoo at times. But from a safety standpoint, the double flap helmet offers some advantages, such as a snugger fit with more padding, and additional protection when you are running the bases since you can't always turn the flap towards the incoming throw. Also, if you're a switch hitter, two flaps means one helmet. Rawlings has helmets made from carbon fiber that are supposedly 300% stiffer and 130 times stronger than plastic, and are rated to withstand certain velocities, such as the s100 which is designed to withstand velocities up to 100 MPH. A brief look on line found these to be pretty spendy. However, they also make an s90, s80 ... etc, which are more reasonable. If you have the good fortune to ever bat when I'm on the hill, you'll be happy to know you'll only need an s37, which costs five bucks and is made of duct tape, coffee grounds and the comics section from the Sunday newspaper.
Regarding catcher's helmets, the debate centers around whether to wear a hockey-style helmet, or the more traditional skull-cap style. In a nutshell, the hockey style helmets provide better protection for the ear, face and side of the head, with arguably better field of view because the mask is closer to the catcher's face. The downside of the hockey-style mask is that it is harder to remove for pop-ups. Some people also feel the traditional skull-cap style provides better protection against direct frontal trauma, such as foul tips, because the mask has more padding and because it's farther from the face, the mask disperses the energy from the ball better. This seems to be mostly opinion, though, and I couldn't find much hard data to support this. In general, most experts feel both hockey-style and traditional catcher's helmets offer similar protection to direct trauma from foul tips, while the hockey-style mask provides better protection to the face and side of the head.
So there you have it. The take home message is concussions are serious business. There is no value and potentially major, even fatal downside in trying to return from a concussion too early or in delaying evaluation or treatment following a significant brain injury. When in doubt, go see a doctor. Also, be kind to your helmet. It didn't mean to make you strike out.