Concussions, And What You’re Wrong About

Safety -

By

Concussions and what you're wrong about

If you didn’t lose consciousness, you probably don’t have a concussion.

Wrong again. Concussions can occur with or without conking out (2). You might feel nothing more than an adrenaline hangover and a bit of a headache once you dust yourself off. But if your brain is concussed, symptoms are likely to start popping up over the course of hours, days or even weeks.

(Note: the presence of brain injury of any kind is greatly increased if loss of consciousness does occur, and the longer you’re out, the higher the risk and severity of injury).

As long as you feel ok, you probably are ok.

Hmm…define ‘ok’. Symptoms of concussion can be physical, cognitive, emotional, or sleep-related, and you can pretty much throw a dart at any of those categories and hit a symptom attributable to brain injury. Symptoms can also be any shade of subtle. You may feel fine physically, but be irritable as hell. Or depressed, can’t sleep or can’t concentrate.

A couple weeks after my concussion, I found myself staring at the directions on the back of a box of instant mashed potatoes and being stumped after “in a large bowl…”. My headaches and dizziness were improving, but clearly, I wasn’t “ok”. Someone who can’t follow two-step directions to make instant mashed potatoes should not be examining sick people and prescribing medications.

Or riding motorcycles. It was nine weeks before I felt “ok” enough to return to work, and I stayed off my bike for twelve. When it comes to brain injuries, 1+1=5. Re-injuring an already injured brain can have devastating consequences, and it doesn’t take much. This is called second-impact syndrome, and it can kill you (3). Or worse.

The length of time it takes to heal from a concussion is complicated and controversial, so the discussion about when it’s ok to get back on your bike is one you should be having with your neurologist or neurosurgeon, not with me or with other riders on some forum somewhere. I will tell you that when people like me who know what I know get a concussion, they take healing very, very seriously.

A good helmet will prevent a concussion.

Maybe, maybe not. If you do sustain a concussion while wearing a helmet, consider yourself lucky; you can be damn sure it prevented something worse.

When you think about it, everything in life is about mitigating risk, isn’t it? You mitigate risk of failure by preparing for whatever it is you want to do successfully. You want a career? You mitigate the risk of sucking at it by educating yourself. You want to have a family? You mitigate the risk of losing it by supporting it. You want to ride a motorcycle? You mitigate the risk of damaging the one thing you need to do anything you want in life…and you wear a helmet.

Sources:

(1) Although there are subtle changes that may be observed in specific sequences of a diffusion-weighted MRI scan, there currently exists no known biologic markers for concussion. [Neurology, published online November 20, 2013.  HYPERLINK "http://www.neurology.org/content/early/2013/11/20/01.wnl.0000437302.36064.b1.short?rss=1" Abstract].

(2) Consensus Statement on Concussion in Sport–the 4th International Conference on Concussion in Sport Held in Zurich, November 2012. The Clinical Journal of Sport Medicine, 2013; 23:89-11

(3) Second Impact Syndrome. Western Journal of Emergency Medicine. 10(1); Feb 2009.

  • John

    Fantastic, quality information. Thanks!

  • Mattin11225

    Great write up, Heather! Thanks for some good information and advice.

  • Jack McLovin

    Does it make difference if you’re a man or a woman? And I’m not talking about the walk it off mentality I mean physically to be specific.

    • Strafer

      wouldn’t think it so
      it is about your brain getting jostled and knocked against your skull, hormones, muscle structure etc. don’t really come into play

      • Heather McCoy

        see my response above.

    • Heather McCoy

      Actually, there is a difference. Women are at increased risk with regard to incidence and outcomes with traumatic brain injury, suffering 1.57x the mortality rate of men. This is still poorly understood, but there is some evidence to suggest that biomedical and hormonal differences to play a role in recovery, as do social norms that indicate women tend to be more forthright with self-reporting of symptoms. (Hey, don’t blame the messenger…).

      • mms

        I’m female; despite a number of bicycle, motorcycle, and skating crashes, my only concussion was from falling backwards off a couch. One of my exes departed his bike at 100mph and landed square on the Shoei but wasn’t even disorientated afterwards. I prefer to think of that as “fool’s luck”. Makes me slightly feel less idiotic. The internet says that, despite appearances, brow ridges, and anecdotal evidence to the contrary, women do have thicker skulls than men. So less fluid padding perhaps?

        • Heather McCoy

          Your pal’s luck is directly attributable to his fine helmet; that couch of yours though…I dunno…

          • mms

            I shouldn’t have tried to do a flip off the back. Not the couch’s fault. It was a pretty nice couch ;)

          • Piglet2010

            Might a “square blow” be less harmful than a glancing blow that causes rotational acceleration? And are any moto helmets designed to reduce rotational brain injury (my current pedal bike lid is a POC Trabec MIPS that claims to do so)?

            • RyYYZ

              I don’t think there are any approved motorcycle helmets on the market yet that are designed to absorb rotational forces, but I know I’ve seen a article or two (might have seen one of them here) about new ones that are in the works. From what I understand (which is limited, to be sure), rotational acceleration can be particularly damaging to the brain.

              • Heather McCoy

                yes, the worst of all injuries. These are the injuries most of us would rather not survive. Interestingly, they’re the one non-helmet wearers don’t even seem to think about, perferring a “life or death/helmet or no-helmet” dichotomy. Sorry to say, they’re much more likely to survive, albeit horribly injured.

                • BMW_rider

                  Doesn’t the HANS device in race cars mitigate injurious rotational forces? I know, it’s not a motorcycle helmet system, but I’m still curious.

                • Jon

                  The HANS device prevents a very specific type of injury, a basal skull fracture, where the spine actually causes damage to the brain stem. It’s still very possible to suffer a concussion while wearing one.

              • susannaschick

                check out http://www.6dhelmets.com/ they kinda do.

            • Heather McCoy

              Right again, Piglet. The worst of all brain injuries, a diffuse axonal injury, is typically the result of said rotational injuries. It’s like scrambling an egg. Don’t know of any helmets designed specifically for this mechanism, as it involves the entire body rotating in space.

        • HammSammich

          Moral of the story: Next time don a Shoei before you attempt sofa gymnastics. ;)

  • karlInSanDiego

    the link to 2nd page has a bogus filename that breaks the link. Removing all after /2/ fixes it.

    Thanks for the great article. The documentary the Crash Reel explores this subject, in that case a very severe TBI, from the perspective of Pro Snowboarder Kevin Pearce. I recommend it.

  • octodad

    cannot get past the number of riders that do not wear full face head protection. can you elaborate on mandibular and cranial injuries. some of these issues never resolve. I am the luckiest SOB in that competent neurosurgical and plastic reconstruction guys were around for my helmetless insult. as a young man and not aware (or did not care) about consequences, I took unnecessary chances. perhaps a credible voice could wake some of these people up to reality. enjoy gearing up so I can scoot in comfort. safe travels to all…

    • Heather McCoy

      GREAT idea! I’ll discuss with the editor and start talking to my maxillofacial and plastic sgy colleagues.

      • Piglet2010

        How good are modular lids? I like wearing my Bell Revolver EVO around town (always with the chin-bar closed) for convenience, but should I stick with a fixed lid for highway use?

        • eddi

          If you have the chin bar down on a DOT approved model, that’s how it was tested and passed. And Bell has a good rep anyway. Just remember, the faster you go the harder you hit. Your mileage etc.

        • HammSammich

          I’ve been wondering this exactly, and even sent RideApart an email a couple of months back requesting they do a story about it. 10 years ago when I bought my first Street helmet, the guy at the dealership told me that modular lids were really just open faced helmets that had a visor to make them look like a full face. I’m sure that is not entirely true anymore (if it was even true then), but I’m guessing that some are better than others. I’d really like some guidance on this issue RideApart!

        • Heather McCoy

          This is an interesting question; I’ll do a bit of research, but my initial suspicion is, much like a hinged door vs a solid wall, they are “safe enough”, but not AS safe. Or should I just tell you that I’ve never worn one and I never will?

          • BMW_rider

            I agree with Piglet2010! This is a personally relevant topic for me too. I’m in the market for a new lid and I’m drawn to the techie doodads of Schuberth’s modulars, but I can’t help but wonder if I should just stick with the full-face protection of Arai’s line up. Here’s a question; is motorcycle gear subjected to similarly grueling crash tests that cars have to go through? (Above and beyond DOT/Snell/ECE 22.05/CE) If so, can you weigh in on the difference between gear that simply meets the minimum standard versus gear that exceeds those standards?

            • eddi

              The CE approved armor inserts are the only other piece of worn gear that is tested by an independent agency. Jacket, pants etc materials may be tested by the R&D folk at a company, but they set their own standards and there is no real effort at uniformity. Racing organizations seem to all say “leather suit or no ride”. (citation requested) Since the racers stress-test their outfits regularly, that probably as close to a set standard as you will find.

      • Nemosufu Namecheck

        This article was so awesome it gave me MTBI… gonna go lie down. Thanks Rev!

      • Paolo

        I was wearing a 3/4 open face helmet when I had a huge wreck last February [2013]…Needless to say, the results were not pretty…14 days for the swelling to subside, and the facial reconstructive surgery for my Lefort II lesion. I now wear 34 titanium screws and several plates (?) in the affected areas (my face is like a mini-hardware store now!) . It was not a pretty process. At least my Icon Motorhead jacket prevented broken ribs and such. Luckily (if there’s such a thing as luck) there appears to be no brain damage from the accident.

        Lesson learned.

        • octodad

          oh dude…get well brother. I am cringing right now…

          • Paolo

            Yeah, it does look like pain doesn’t it? I’m doing much better now, thanks. Surgery was on March 5th…I got back to riding on July. Oh boy, I thought I was a goner for sure!

            • octodad

              you know every one has a story. mine happened 11 July 1975. still chokes me up when I see what you are going through. only thing I remember is feeling really drunk (was perfectly sober on way home from work). woke up 10 days later, couldn’t talk because of trach tube. kept writing “what happened”?

  • Dan

    Great article. Thanks!

  • ookla_the_mok

    good article – thanks for sharing your combined medical/motorcyclist perspective.
    I’ve had a few concussions since my teenage years, and have always wondered if these head injuries could have contributed to my acute sensitivity to motion. I get dizzy in cars all the time, sometimes even if I’m driving

    • Heather McCoy

      Very possible, ookla. I would ask your PCP for a referral to an ENT specialist though; could be an inner-ear problem for which vestibular therapy could really help. Or MAYBE it’s the universe telling you to always ride your motorcycle, I dunno…

      • Piglet2010

        I never have problems when controlling the motorcycle, but I almost fell of the back of Jason Pridmore’s bike after two laps around Blackhawk Farms Raceway due to motion sickness.

        • Heather McCoy

          Oh, I feel you pain, Piglet…I once took a few laps on the back with Larry Pegram at LVMS…made the mistake of looking at the spedometer coming into a turn (137mph)…didn’t know if I was going to barf or just crap my pants!

          • Piglet2010

            I was not worried at all about JP43 crashing (I peeked too – 140 mph indicated at the end of the main straight, so 120-something actual), but more about falling off, since the pillion foot-pegs are so high on a “Gixxer Thou” the only thing keeping me on the bike was my grip on the (specially added) tank handles.

            • eddi

              Under those circumstances, they’d have to unbolt the handles to get me off the bike. I make a horribly nervous passenger, bike or car.

  • William Connor

    More articles like this, less about movie premiers. Very good information. I have suffered multiple concussions over the years. A couple were fairly severe and a couple were mild by comparison. This is only talking about symptoms that were noticeable, underlying damage may have been worse in the ones that “felt” less traumatic. In my crashes that I have had on a motorcycle I was wearing a full face helmet and both time came away with no head injury.

  • Alex DeSantiago

    Thank you for that great article. I’ve had a concussion, and since i did not recognize it, it wound up being way worse than it should’ve been. I practice MMA, while training at the end of a sparring round (10 seconds left) I dropped my guard, the lad i was sparring with was frustrated bc he could not take me down, he took me down with a double leg take down, instead of landing on my back, i landed on my shoulders and head, i knew my bell was rung, but shrugged it off. The next day while training Muay Thai i caught a innocent looking cross on my chin, and that spun my whole world. knowing something was wrong i went to get checked out, and the doc was very specific, it could be weeks of months or more to get better, the big factor was two hits less than 24 hours apart, was a worse case scenario. I’ve just recently returned to Martial arts, it’s been 2 1/2 years. i feel great now, but i’m still very careful about covering up my head and chin upon sparring. if you feel anything out of the ordinary, don’t wait, get checked out, better safe than sidelined for 2 plus years… cheers

  • Christopher

    Good article, although I do however take strong issue with the “mild form of traumatic brain injury”.. there is no such thing as mild brain injury, really. That’s been the point of all the recent focus as well as to correctly imply that concussions are actually straight up “traumatic brain injury” of a particular type instead of a particular severity. Nobody says “mild gunshot wound”.

    I spent 6 months trying not to fall over immediately when I standing up after my own concussion. Totally empathize with the descriptions of your own experience.

    • Heather McCoy

      Good point, Christopher; there is a distinct tendency for those of us in medicine to put concussion in some sort of comparative context, probably out of some ill-gotten concern for not wanting to scare or overwhelm patients and family members. In reality, it’s a complete disservice to sugar-coat a very serious diagnosis. You are of course, absolutely right. If I had a dollar for every time I talked to a patient about their broken neck, only for them to interrupt me and say something like, “Broken neck?! I thought it was just CRACKED??”
      The word ‘mild’ is henceforth stricken from my TBI language base. Thank you for your comments.
      Heather

      • Christopher

        That’s another good point too. I got educated quickly that “fractured” = broken and there wasn’t a difference between cracked/broken/fractured at all. I’d have owed a dollar :)
        Oh, should also add – thanks for being on the frontline for us who’ve needed it.

        • Heather McCoy

          That is really nice of you, Christopher, and you’re welcome. You just made my day! :)

  • markbvt

    Out of curiosity, is it possible to have a brain injury such as a hemorrhage (due to impact) without having a concussion? I ask because when I got hit by an SUV two and a half years ago, my head hit the pavement hard enough to cause a minor bleed (thankfully not worse due to my ECE 22.05 helmet). I never heard the word “concussion” afterwards though, and didn’t have any significant mental aftereffects aside from very hazy memory of the next few weeks — but that could just as easily have been due to the drugs being pumped into me because my femur was broken in the crash. I was back at work four weeks after the accident.

    To this day I’m convinced that I would have been injured worse with a Snell-rated helmet. I still occasionally look at the helmet and the area in which the inner liner was compressed, and I’m grateful that the technology has improved so much in the past couple of decades.

    • Heather McCoy

      It is possible, markbvt. It could be that the impact you sustained was focal enough to cause a focused, small area of hemorrhage without the global disruption of function seen in concussive syndrome. When I see an injury on imaging, I tell patients about it and always tell them to presume they have a concussion as well (and review those symptoms, too). Most people don’t understand when I say “small area of traumatic subarachnoid hemorrhage” but they do understand the word “concussion”. Plus, symptoms of concussion may present after they’re discharged.
      And when I say “tell”, I mean I write it down for them, too. Most people retain <20% of what they're told in such a setting.

      BTW—I'm confused by your last statement…"injured WORSE with a Snell-rated helmet"? You mean "without", right?

      • markbvt

        No, I meant with. Snell-rated helmets have significantly firmer liners than ECE 22.05-rated ones in order to pass the particular tests the Snell Institute designed, and therefore they transmit more g-forces to the brain. Ask Wes about it — he’s written about his preference for ECE 22.05 helmets here in the past. I suspect strongly that I would have had a more significant head injury if I’d been wearing a Snell-rated helmet.

        • Piglet2010

          The issue has no clear answer, but I would suggest retiring any Snell 2005M lid for either a Snell 2010M or ECE 22.05 lid.

          • RyYYZ

            Yes, I probably should replace my Snell 2005 Arai Profile. It’s probably about due, anyway, although it hasn’t been heavily used and is still in good shape. Unfortunately buying a new Arai is expensive, but the Arai Long Oval shape is the only one I’ve ever tried that really fits me well. Would love to find a somewhat less expensive helmet that fits as well. I guess $500 or $600 every 5 years or so for a good quality new helmet really isn’t that much, though.

            • Heather McCoy

              See my response above. I made it sound even cheaper!

          • Heather McCoy

            You’re right, Piglet; helmet integrity degrades over time, regardless of use. Helmets should be replaced every 5 years OR any time it’s hit the ground. I bumped RYYZ’s estimate up to $700 (since we’re talking Arai), which pro-rates to $140/year, or $2.70 per week TO PROTECT YOUR BRAIN. Maybe that helps the medicine go down, huh?

        • Heather McCoy

          Oh, yes, of course…a Snell-only rating is not ever on my recommendation radar. Ever. Shockingly sub-par.

          • Piglet2010

            In the US, is not a DOT rating required regardless of any other ratings unless it is being sold as “novelty head-gear” and not a protective helmet? Every Snell rated helmet I have seen for sale in the US is also DOT rated, and the same is true for ECE 22.05 certified lids. But I understand that Snell 2010M (and 2005M) and ECE 22.05 certification cannot be combined.

  • Heather McCoy

    Thank you all for the supportive comments. I’m more than happy to address other medical issues as they relate to riding or injury prevention for future articles. Feel free to email me your suggestions: heather@RevGirl.com, and I’ll run them by the editor here.

    • Dennis Hightower

      Yes, great article… but you made me think about the choices I make… damn you! ; )

      • Heather McCoy

        Lol…MISSION ACCOMPLISHED!

  • KeithB

    It would be hard to think of anyone more qualified to give accurate facts.
    Thanks for stepping up and giving us the straight goods.

    • Heather McCoy

      You’re welcome, and thank you, Keith!

  • KC

    Thanks, Heather. Way back, when I went down bad, I was ridiculously “level headed” about the whole thing. I knew I hit my head, I knew I had broken bones, I even knew I had wee bits of motorcycle and gravel stuck in me. The problem was “I” was not “me” at that moment. I ended up in the ER several hours later.

    It may be a myth, but if you’ve done any sort of head damage, and you think you’re fine, have someone stay with you, or at least check in on you, for at least 48 hours. I’m lucky I did. My vision went “off” and I had an intense headache.

    A concussion is not just about hitting your head on the outside. It’s also about your brain hitting the walls of the skull from the inside. A helmet only protects the outside.

    • Heather McCoy

      Not a myth, KC. When I discharge patients, my schpeel is “must have 24-hr supervision by a responsible adult” for X-number of days (depending on their injury). One of the most serious brain injuries there is (an epidural hematoma) can occur quite suddenly but with a delayed onset. It is a true neurosurgical emergency.

      • KC

        I, apparently, missed the “responsible adult” part. I certainly wasn’t at that moment. My doctor was not happy when I checked in with her. I was a mess in so many ways.

        Heather, thanks again.

  • Sentinel

    Excellent article; thanks! :)

  • http://www.mises.org/ Core

    Interesting article. Especially that bit at the end about mitagating risk. Nice.

  • AHA

    Great piece – really informative. Thanks.

  • AHA

    Wes – any more news about those 6D helmets that have that double lining technology? I guess they’d help a lot with concussion type trauma? Has anyone else corroborated the low speed impact reducing efficacy? Any news on road as opposed to MX helmets?

    • worker88

      Wes who?

    • Piglet2010

      Wes Siler is no longer associated with RideApart.

      • Paolo

        Hmm…Yay?

      • dead_elvis

        Where’d he go? Or has he not landed anyplace yet?

    • Heather McCoy

      will look into the low-speed impact thing. Some of the worst brain injuries I’ve ever seen happened in 1st or 2nd gear. Or from a complete standstill.

      • Piglet2010

        Or falling in the bathtub/shower or out of bed.

  • Nemosufu Namecheck

    Heather – I just read a post on Ride Apart about 2015 GM SUVs and I think I haz concussion. Should I see my podiatrist?

    • Heather McCoy

      LOL…I’m going to have to read this thing. What I know about GM SUVs is A) uninspiring ride (hey, it’s an SUV), B) you will need to replace the engine entirely at about 80,000 miles or roughly 1-year after the transmission, whichever comes first, and C) buy a black one. Anything new for 2015?

      • Piglet2010

        Black GMC SUV – are you a Russian mobster? ;)

        • labradog

          Or a congressional Republican?

  • Toly

    Would you do a write up about Diffuse Axonal Injury, and its occurence in motorcycle accidents?

    • Heather McCoy

      Well, I did discuss this with the editors…it’s a serious downer; DAI is the worst of all TBIs, and they happen ALL THE TIME in motorcycling. You sure?

      • Toly

        It may make some people more cautious. Or at least change their living will :)

  • Benjamin Lindemuth-Mcrobie

    +1 On great articles like this, -10 to the SUV post next door, drawing huge negative feedback.

  • RyYYZ

    Only had a concussion once in my life that I know of for sure. That was a car accident where I was a passenger and rattled my head off the b-pillar pretty good. I was out for a couple minutes and definitely not thinking right when I did come to – I couldn’t say what day of the week it was at first. I’ve probably had a couple of more minor concussions in my life which didn’t involve consciousness.

    Ever since the concussion I’ve been more prone to getting bad headaches which I never used to get. No other long-term effects that I’m aware of, but then I wouldn’t necessarily be aware, would I?

  • John

    “Concussions and why you are mistaken”. Or you could just go with “Concussions, why we suck at grammar”.

    • Heather McCoy

      …and punctuation. Hello, semicolon.
      BTW…not responsible for the title, but sometimes questionable grammar be more noticed.

  • Slacker

    I have a quick question if I may… A good friend of mine attributes severe sleep apnea to a motorcycle crash and concussion he sustained some years ago. The apnea is so bad he can’t even just use a C-PAP or B-PAP but has to use a Pure Oxygen machine…. his brain stops his breathing several times a minute when he’s asleep. I’m not sure if the injury could have been prevented by wearing a quality helmet (he says that he was wearing a cheaper helmet, thinks that maybe a higher quality helmet could have prevented his condition). Is there any evidence that you’ve seen that would support the idea of a higher quality helmet being better for preventing injuries of that kind?

    • Heather McCoy

      Hmm…sleep apnea is typically managed by a pulmonologist who specializes in sleep medicine, but I’ll do my best here. What I know about sleep apnea is that it’s often due to exogenous causes: obesity, chronic obstructive airway disease (COPD), some sort of hyperplasia or overgrowth of tissue in the upper airway, etc. I’m not aware of a link between concussion and sleep apnea, but then again, when it comes to the brain, well, there’s a lot of gray (get it? Gray? Ha-ha). What I do know quite well is that the area of the brain that controls respiration is very deep; just above the spinal cord, actually. Injuries to this part of the brain are usually not the kind any of us want to “survive”. I’m not aware of any product development specifically to reduce the incidence of injuries to the brain stem, but of course, the highest quality helmet one can afford is the helmet one should be wearing. Always.

      • Piglet2010

        Both my inexpensive Bell Vortex and quite dear Bell Star are Snell 2010M rated – other than weighing a bit less, does the Star offer any protection advantage?

  • HankBWYT

    Thanks! You rule. The second impact thing is something I’ll keep in mind.

  • Eyvind Mondragon

    Heather, thank you for the great article. No non-sense quality medical information so we can grasp it. Right to the point or riding safely.
    Also, not an article about “10 ways how my jacket feels different now than when I bought it”. Just because of that, it’s cool, but the article itself is well written and important. Thank you!

  • susannaschick

    Princess Concussia approves! Having had 7 Grade 3 concussions since 1985, I gotta say, the ones where I was wearing a helmet would’ve been a lot milder if I’d been wearing a helmet for the first two. ;-) I was shocked at how well the bicycle helmet worked when I had to use it. It worked better than the $700 AGV replica pictured at left. But part of that was probably because that one got used only 8 months after the bicycle helmet got used. I know you’re supposed to avoid having concussions “back to back” but define that, please. I suspect it’s just a gradual change- the longer it’s been the less it will impact you?

    https://www.facebook.com/princessconcussia

    Also, all the more reason I can’t WAIT till 6D comes out with a street helmet… http://www.6dhelmets.com/

  • Joshua Rodriguez

    This is by far one of the best articles I’ve read on this topic. You should look up the M.A.C.E. exam for testing someone who has a “concussion” or mTBI. I’m a military medic and we use it quite often just to get a field expedient result on the severity.

  • diablito

    Don’t forget the seizures that come with a good concussion. I had quite a few of those during my6 hr stay in the ER in Broward county back in 2010. I can clearly remember them, I also remember the CT asshole telling me I need to hold still during a scan, and gritting my teeth as I shook violently and muttering “I’m trying!” I believe I had about 8 seizures during the course of 6 hrs. I never rode again without a helmet.