Wrestling fans are excited about the recent return of Daniel Bryan to the ring. Bryan, a star performer, was forced to retire two years ago due to multiple concussions. His return after multiple, comprehensive neurological evaluations has raised many questions regarding the criteria for medical retirement from sports after concussion.
Concussion is best defined as a group of neurologic symptoms that arise after a force is applied to the brain. Recovery from these symptoms can vary but the general accepted time frame is 10 days. This is often longer in children. The persistence of these symptoms is associated with post-concussion syndrome.
Repeated blows to the brain can result in permanent impairment with persistent headaches, cognitive difficulties, sleep abnormalities, emotional disturbances and other neurologic symptoms.
The often-asked question is: "How many blows can the brain tolerate before resulting in permanent damage?"
The human brain is a highly individualized organ. It consists of a mass of nerve cells that each has a threshold for injury. The challenge for physicians is to determine that threshold based on the symptoms suffered and the length of the recovery period.
There are some basic rules that indicate the need to retire from participation in high-velocity collision or combat sports. These include:
1. Persistent abnormalities on cognitive and psychological testing that can be linked to concussion
2. Structural abnormalities found in the brain that may be related to trauma or predispose the athlete to permanent injury
3. A demonstrated decreased threshold for injury over multiple, successive concussions
Another recent change in the presentation of sports-related concussion has been the desire to voluntarily withdraw from high-risk sports. Athletes, even at the highest levels of sport, are choosing that the risks outweigh the benefits.
In the case of Bryan or any other athlete, it is worth the time investment to seek out a highly qualified physician who works with athletes.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
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