UNIVERSITY PARK, Pa. —  In recent years, concussions have become a more prominent topic in the media, inspiring Hollywood movies and decreasing parental support for participation in youth football. Against this backdrop, researchers and clinicians around the world have increased efforts to prevent, diagnose and treat concussions. But even though awareness and understanding of concussions have improved, diagnoses of concussions in high school athletes have increased over the past decade. 

To help improve how athletes and doctors respond to concussions, Semyon "Sam" Slobounov, professor of kinesiology at Penn State, and Wayne Sebastianelli, Kalenak Professor of Orthopaedics at Penn State College of Medicine and director of Penn State Athletic Medicine, have edited a second edition of their book, “Concussion in Athletics: From Brain to Behavior.” In each chapter, a different expert from around the world describes the latest developments in the evaluation or treatment of concussions.  

“Clinicians, researchers, administrators, policy makers: anyone who treats, studies or makes decisions about concussions will be able to use this as a resource,” Slobounov said.  

Sebastianelli said that much has changed in the field of concussion research over the seven years since the first edition was published.  

“We have a better understanding of what a concussion is,” Sebastianelli said. “We have better tests, both in terms of brain scans and blood and saliva tests.  

“Additionally, we have a better understanding of when athletes should restart exercise,” Sebastianelli continued. “There was a time that we thought that we had to completely rest concussed athletes. Now we treat a concussion more like other injuries; the brain needs a little challenge to try and remodel itself. We try to get people to elevate their heart rate a little, and then we assess for symptoms. We also challenge them academically; someone with a concussion will be encouraged to read if it does not cause headaches. The same way that doctors carefully monitor the impact of light physical activity on a recovering limb, they should carefully monitor the impact of light exercise and mental work on a concussed person.”  

Understanding concussions 

The researchers describe concussions as “the most puzzling sports-related injury.” Concussions are puzzling because of their broad range of physical and cognitive symptoms, variable timelines for recovery, and potential long-term consequences like Alzheimer’s disease. The variability from person to person poses significant challenges for doctors and athletic trainers who are trying to understand when it is safe to allow concussed athletes to return to competition.  

People misunderstand concussions because they are not visible, according to the researchers. Following a concussion, a person may or may not look, act and feel fine. If, however, you ask that person to complete a task like reading or playing a sport, their performance may be compromised. Even if the person performs normally, there can be issues that should be monitored until they are healthy enough to participate in all aspects of their life again.  

Not a short-term problem 

Concussion is a long-term injury. When someone tears the meniscus in their knee, they might recover complete function, but that meniscus remains damaged for the rest of their life. The same is true with damage from a concussion.  

“Humans are very lucky that we have a lot of reserve in our mental abilities,” Sebastianelli said. “But, if someone keeps eroding that reserve through repeated injury, they will eventually demonstrate decreased cognitive abilities, physical abilities, or emotional regulation. We want to make sure that people avoid observable loss of function and experience full functional recovery.” 

The value of sports 

While people should take athletic concussions seriously, the researchers say that the benefits of athletics far outweigh the risks of injury. Research has shown that participation in sports promotes resilience, adaptability, physical conditioning, confidence, and other aspects of health and well-being. The most important thing for athletes is to take concussive injury as seriously as a physical injury. 

“A concussion needs to be tracked and monitored,” Sebastianelli said. “Parents should not let children slough off a head injury or play through it as a badge of honor. People who participate in sports at any level need to treat head injury as serious and potentially long-lasting, just as they would a knee injury. If we treat concussions appropriately, most people can quickly recover full function and safely return to sports.”    

Collaboration that makes a difference 

Since the first edition of the book was published in 2014, Slobounov and Sebastianelli have hosted an international conference on concussions, published multiple scholarly papers on the topic, and collaborated on a multi-year concussion research project involving the University’s football team. Slobounov, a research scientist, attributes the success of his long-term collaboration with Sebastianelli, a clinician, to the culture at Penn State.  

“This book is not the culmination of my work with Wayne,” said Slobounov. “It is only a single outcome of the culture of interdisciplinary collaboration that is fostered at Penn State. It is remarkable for a research scientist and a clinical practitioner to collaborate with the support of the athletic director, the football coach and the football team. It shows how dedicated Penn State is to breaking down barriers and encouraging collaborations that make a difference in the real world. We are all on the same team.” 

Alexa Walter, postdoctoral fellow at University of Pennsylvania, served as assistant editor for the book, which is published by Springer.