The Unfathomable Inner Reality of Sports-Related Concussions

James M. Loy, Miami University's College of Education, Health, and Society

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Before she witnessed the aftermath herself, Megan Loftin, like many people, was unaware of what sustaining a serious concussion really meant, and just how traumatic the injury can be.

“I had friend who sustained a concussion while skiing, and it ended up being incredibly serious,” she says. “He got pulled out of school and I saw all this bad stuff happen. Even now he struggles with voice issues. I knew him before this happened, seeing how he was this happy-go-lucky-guy, and then he had his injury and I saw his personality change. There was something about this injury that I felt we didn’t quite understand.”

This experience fueled a passion to learn more, and it lead Loftin to an original line of research focused on the ongoing psychological effects often triggered by such an injury.Megan Loftin

Now she is on a mission.

"I want to change the way we are treating athletes"

As a Sport Leadership graduate student in Miami University’s College of Education, Health and Society (EHS), Loftin is exploring the academic and social lives of former athletes who were forced to quit high school and college sports after experiencing a serious concussion.

Her research involves conducting in-depth interviews to gain a better understanding of what the injury is really like and what the experience has meant to each participant. It’s a qualitative approach that could eventually lead to better concussion assessments and treatments, and it’s already won her a finalist position in Miami’s recent Three Minute Thesis graduate student competition.

“I want to change the way we are treating athletes because I think we are missing that psychological aspect,” she says. “If they are dealing with irritability and depression and anxiety, if they are having those symptoms, are we treating that as well? Are we helping these individuals with that other side of the concussion that occurs?”

Suffering a concussion has always been a potential risk of sports. This is not a new phenomenon. But what is new is the amount of attention increasingly surrounding their occurrence.

Until fairly recently, concussions were often seen as a “bump” or a “ding.” For decades, especially in light of the dominate cultural ideologies and masculinity-based stereotyping that still pervades some sports today, many athletes often felt social pressure to simply “walk it off” or to “tough it out.”

Medical science, however, is beginning to differ, and public opinion is swaying as well.

The new science behind brain injuries

Concussions have recently been re-classified as mild traumatic brain injuries (MTBI). And thanks to the pioneering work of neuropathologist Bennet Omalu, who first noticed that repeated MTBIs led to a degenerative brain disease he named “chronic traumatic encephalopathy,” many professionals, players, and fans now recognize the inherent danger.

“The symptoms of chronic traumatic encephalopathy have a distinct pattern,” says Sam Morris, Miami University Sport Leadership and Management clinical professor. “People are beset, often fairly suddenly, by memory problems and an inability to control their emotions. So they have these wild outbursts and erratic, unpredictable behaviors.”

Morris teaches several ethics-related sports leadership courses at Miami, and he often focuses on the risks associated with athletics and coaching.

“It has been an imperative of mine to do a better job of helping our students fully understand and appreciate the knowns, the known unknowns, and the unknown unknowns,” he says, “to broaden the knowledge base of our students about what MTBIs in sports are, what the likely outcomes are, and what you are truly risking.”

At Miami, students will get this message in Morris’ classes. And it’s also an issue that EHS has consistently addressed through various interdisciplinary efforts including a number of events organized by Miami faculty. For the past several years, for example, a variety of notable guests have shared their personal experiences and professional expertise surrounding sport-related head injuries.

Dr. Omalu and Dr. MorrisLast year, the Miami University Lecture Series invited Dr. Omalu, currently a professor at the University of California, Davis, to speak about his discovery of chronic traumatic encephalopathy. And during this year’s Alan G. Ingham Memorial Lecture, University of Colorado Denver associate professor Sarah K. Fields spoke about the movie industry’s unrealistic and blasé portrayal of concussions.

Previously, the Departments of History, Psychology, and Kinesiology & Health also collaborated on a lecture featuring former rising NFL star Chris Borland, who made national headlines, and who was called the “most dangerous man in football” by ESPN, when he suddenly and voluntary quit after sustaining a head injury. Borland called his abrupt retirement a preemptive move to avoid brain damage and a lot of people noticed.

So overall awareness is growing, but even so, many people still have a false sense of knowledge. Conceptually, the dangers of sport-related head injuries have entered the zeitgeist of mainstream culture. The message is “out” there so to speak. And in general, the public at least claims to acknowledge the risks, even if many do not yet grasp the full significance.

“When I talk about this, many students will say things like, ‘Well, we know what we signed up for.’” Morris says. “And I want to say, ‘Really? Because there is team of medical researchers at Boston University who have been studying this for more than a decade and they don’t know. And you are telling me that you do?’”

Throughout her research, Megan Loftin found similar trends among the former high school and college athletes that she’s interviewed. Until, that is, they learned the hard way.

Using personal experience to help others

“A lot of these athletes were somewhat unaware of the dangers of concussions until they sustained them, which then opened their eyes to how serious they were,” she says. “A lot of them mentioned educating themselves afterwards, to really understand why a concussion is serious, and the long-term consequences of this injury if they continued to participate in sport.”

These same athletes also expressed an interest in using their experiences to help others in similar situations. And for Loftin, on both a professional and a personal level, this notion also resonates deeply.

Long after her friend had experience his brain injury on the slopes, and even after her concussion research at Miami had begun, she too experienced a serious sport-related head injury, which brought this harsh reality clearly into focus.

“I got this concussion last semester, and it clicked for me,” she says. “So when I am talking with people, I feel like I have that insight that I didn’t have before, of what it is really like. To feel all those physical and emotional and cogitative symptoms and how much they relate to each other, and how much it impacts your life.”

Her work now aims to bring this level of subjective understanding to everyone, especially to those on the other side, those of us who have luckily not gained this knowledge first-hand. And, surprisingly, research from this perspective is starkly lacking.

Currently, most sport-related concussion research is almost exclusively quantitative, which is helpful when measuring various return-to-play metrics or objectively assessing structural damage. However, it is far less able to target the psychological links between a history of concussions and depression, for example, or how physical symptoms can exacerbate a host of emotional symptoms that can last for years afterwards.

But through her qualitative approach, Loftin is striving to overcome the disconnect between those who have experienced a concussion and an inadequate support system that still fails to perceive, and therefore treat, all sides of this injury.

“If you haven’t had a concussion you don’t really know or understand what it is,” she explains. “So that is a barrier. How can you really help someone if you don’t quite know or understand what it is? That’s part of what a concussion is. It is unfathomable to so many people.”