Concussion

You can say it all kinds of ways.  You can say you got your bell rung.  You can say you got clocked.  You can say you got knocked cold, silly, or senseless.  No matter how you put it, if you are a bull rider it has probably happened to you.  And if you are a fan of bull riding, you've seen it over and over again. 

One of the chief problems with the way we think about concussion is that somehow, over time, it came to sound like a minor injury.  A bump on the head, maybe leading to dizziness, easily shaken off.  We heard the word so often and in so many different contexts that it didn't seem that bad.  Nobody made a big deal over it.  There were so many ways to refer to it and most of them were semi-amusing.  We saw stars, the lights went out, we got our chickens scattered. The other problem with concussion is that it is an invisible injury.  There's no limp, nothing broken, bruised, or scratched.  A mild concussion is an injury you can hide, ignore, and play through.  Of course the reality is that a concussion is an injury to the brain.  When we say it that way, we think about it differently.

The truth is, if you are a fan of bull riding, you may see concussions in a different way than fans of other sports.  Football players butt heads, bang heads, hit with their heads over and over, week after week.  But there are a lot of them on that field and as a fan you don't pay attention to every hit.  Bull riding, on the other hand, is a "one guy at a time" sport.  Fans see every hit individually, and in slow motion, and in close-up.  Fans of bull riding have a different perspective on concussion.  And if you are a bull rider, you have a unique perspective on it, too.  Because for you, it's an occupational hazard.  It might not be a given, but it's definitely a probability.

Recent high profile concussion-related incidents in the NFL and the National Soccer League have brought the injury and its consequences to the nation's attention in a new way.  After this long season of bull riding and its many, many concussions, this week I will be talking about the injury:  what it is, what causes it, frequency, symptoms, assessment, and treatment. 

Concussion: Definition and Symptoms

A concussion is a velocity injury.  It happens when the brain hits the inside of the skull.  The brain, which is soft,  is surrounded by spinal fluid that cushions it from your skull, but when your head collides with something else, or when it is shaken severely, the brain impacts the skull and neurological changes occur.  A bull rider's head hits the bull's head.  A baby is shaken violently.  A driver is involved in a whiplash accident.  A soldier is close enough to an exploding mortar shell that the  force of the blast impacts his head, shaking it violently.  Any rapid acceleration/deceleration of the head can cause a concussion. 

There are a few different grading systems for concussion with anything from three to five grades.  In most of them grades one and two do not involve loss of consciousness.  I am not a doctor, and the following breakdown is not an official grading system, but it should give you a feeling for the kinds of criteria used in the various grading systems.

• No loss of consciousness.  Feeling confused, stunned, or dazed.  Symptoms lasting less than 15 minutes.

• No loss of consciousness.  Symptoms lasting longer than 15 minutes.

• Loss of consiousness (under five minutes).  All previous symptoms.  May include amnesia - no memory of just prior to the incident and/or just after the incident.

• Loss of consciousness over five minutes.  All of the previous symptoms.

Concussion symptoms may also include irritability, headache, dizziness, seizure, fatigue, anxiety.  Part of the continuing study of concussions seeks to understand how long symptoms may last.

Concussion: Assessment

Over the years a protocol for assessing concussion has been developed, and bull riding and rodeo physicians and medical teams are proficient in its use.  Dr. Tandy Freeman, the PBR's medical team director, estimates that he evaluates riders for concussion at the rate of one or two per event, assessing for the following symptoms:

• Dazed / stunned / dinged
• Confused / in a fog
• Balance problem / unsteadiness
• Visual disturbance
• Ringing in ears / hearing problem
• Nausea / vomiting
• Drowsy / fatigued / slowed down
• Difficulty concentrating
• Amnesia / difficulty remembering
• Headache
• Irritable
• Not right
• Emotional lability
• Loss of consciousness or unresponsiveness
• Seizure or convulsive activity
• Exam showing changes in memory and speech, eye motion and pupils, coordination, and gait

The study of concussion is evolving continually and current attention to the injury is accelerating medical understanding and assisting in development of treatment protocols.  

Concussion: Hats Versus Helmets

The question I get asked more often than any other is, "Why don't they all wear helmets?" By an informal count, about half of the riders in the Built Ford Tough Series wear them, half don't. When I first started watching bull riding, I figured that helmets prevented two things: the crushing of heads and faces, and concussions. Helmets keep the head and face in one piece, yes.  Every time a bull bucks in the chute and throws a rider's face against the railings, or a rider's face collides with the bull's head or horn, often the use of the helmet is the one thing that stands between the rider and reconstructive surgery.  But concussions are a velocity injury and a helmet can't counter the speed at which head collides with ground, horn, bull, or chute. 

Many riders have worn helmets since they started riding steers as children.  Some riders start wearing them after a major facial or cranial injury.  Some just start wearing helmets because over time they are convinced that it is a good idea.  But many still choose to wear hats.  Some feel that their balance and visibility are negatively affected by helmets.  But the main reason for hats is tradition.  The thinking - and it is reinforced by centuries - is that cowboys wear cowboy hats.  If I were a bull rider, I'd struggle with that idea myself.  Even the riders who wear helmets take them off the second the ride is over, and the hat goes back on the minute the rider gets out of the ring.  That helmet is only on that head for maybe a minute total, but it's an important minute. 

The other question I am frequently asked is why the PBR doesn't require helmets.  The protective vest is required equipment, but the helmet is not.  In the beginning, the helmets worn by bull riders were adapted from other sports, most frequently hockey.  Because a helmet had not been made specifically for bull riders and for the specific dangers of bull riding, the PBR could not officially require one.  This would be the equivalent of, say, the NFL requiring use of a helmet that was not developed for use by football players.  The legal consequences alone would be a nightmare.  Bull riding helmets are in development, however, and I am told that it is likely that the PBR will eventually require their use. 

As far as preventing concussions in bull riding, the only way to do it is probably to stop riding bulls. Some studies suggest that the type and depth of playing surface may make a difference in the frequency of injury in some sports.  Some say that strengthening the neck might help prevent concussions or possibly decrease their severity in some cases.  (This makes sense when you take a second to notice that it's the thing that's holding our head up.  It's also commonly neglected in strengthening routines.)  New research will help us understand concussions and their effects.  New ways of treating them will be developed.  There are studies underway to determine whether wearing a helmet may decrease the severity of concussions or shorten the duration of symptoms.  But in bull riding, "occupational hazard" is the best way to put it.  The only way to avoid them entirely is to get out of the arena.