Star football player’s concussion a reminder that ‘these things are serious,’ sports medicine doctor says

October 05, 2022
A Tweet from the New York Times shows Tua Tagovailoa lying on football field surrounded by other men checking on him.
A Tweet from the New York Times shows the moments after Tua Tagovailoa hit his head on the turf.

Alec DeCastro, M.D., was more than 600 miles away when Miami Dolphins quarterback Tua Tagovailoa was sacked, hitting his head on the ground during a game against the Cincinnati Bengals. The star athlete was left lying on the turf with his hands in front of his face, some of his fingers bent at awkward angles.

DeCastro, a sports medicine specialist at MUSC Health in Charleston, South Carolina, didn’t need to be there in person to know what had happened. “I was like, ‘Wow, that’s a pretty big hit. He clearly has a head injury, and he’s out.’ I mean, I can diagnose that from the TV. He most likely was unconscious and had this hand response called a fencing injury. It’s caused by an injury to his brain stem, which is a sign of a concussion.”

It was a televised testament to the potential impact of an injury DeCastro sees a lot of. “Concussions are very common. I see them both on the sidelines and in athletes that are referred to me from our various teams. I’m the team physician for the Charleston RiverDogs, the Stingrays, Charleston Battery and various high schools that our athletic trainers are affiliated with. And so, throughout all those sports, I definitely see in different sports, whether it be hockey, baseball or soccer or football, I see concussions from all these different athletes.”

DeCastro said Tagovailoa’s injury, which may have been his second concussion in a week – the potential first concussion was diagnosed as a back injury – serves as a reminder of the importance of two things.

Head and shoulders shot of Dr. Alec DeCastro. He is clean shaven with dark hair, a coat and tie. 
Dr. Alec DeCastro

“First, organizations need to make sure that their concussion protocols are truly followed. Also, the athletes themselves, or even weekend warriors, understand that concussions can be serious. They need to get diagnosed, by a physician, athletic trainer or somebody to help them recognize their injury to ensure that they are safe and treated appropriately.”

The Centers for Disease Control and Prevention defines a concussion as a traumatic brain injury “caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

DeCastro, an associate professor in the Department of Family Medicine at the Medical University of South Carolina, said a concussion usually is a short-lived impairment caused by a head injury that typically resolves itself. The athlete is usually the one who first notices its effects.

“It’s not diagnosed by a CAT scan, X-rays or labs. You can have symptoms like a headache, dizziness, sensitivity to light and sound. You could also have cognitive impairment, like brain fog, and you feel like you can’t focus. The symptoms can be mild to severe.”

They can even include mood changes such as anxiety and depression. “If any player has any of these symptoms, they should not be returning to play at that time,” DeCastro said. “When in doubt, sit ‘em out. That’s what I tell athletes, parents and coaches.”

Repeated concussions can lead to long-term problems. “One complication we’re really concerned about is called CTE, or chronic traumatic encephalopathy. It can only be diagnosed postmortem, after athletes’ brains are donated to a brain injury center that can do an autopsy and see that they had these chronic changes, which we think are from repeated concussions, or repeated brain injuries.”

That’s not a concern for most athletes, who won’t play sports professionally and won’t suffer from repeated concussions. But it’s worth being aware of, DeCastro said.

He also described a rare condition called second impact syndrome. “If you have one impact and then you have a second impact after that and you’re still symptomatic, you can be subject to brain swelling, causing immediate death. And it’s very rare, but it is one of the reasons why you shouldn’t return to play right after or why you’re still symptomatic from a previous injury.”

While Tagovailoa recovers from his injuries, DeCastro hopes the public pays closer attention to the importance of taking concussions seriously. “We’re trying to really educate people, particularly young athletes. I tell them, ‘Most people don’t play in the NFL, and you want to save your brain later in life to have a job and a career. You don’t want to risk your brain.’ So you need to identify a concussion, sit out until you are better and, finally, be returned to your sport appropriately to avoid any short- or long-term complications.”

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