The Centers for Disease Control and Prevention(CDC) estimates that Americans suffer approximately 3.8 million sports and recreation-related concussions annually. Football, hockey, cycling, and soccer are some of the sports known to put players of all ages and experience levels at risk of head injuries. Too many baseball, softball, basketball, skateboarding, scootering, water sports, winter sports, off-road sports, and other players have suffered from many head injuries both on the field and in the gym. Helmets function like a brake or shockabsorber, reducing the severity of impact. However, wearing a helmet reduces the risk of traumaticbrain injuries (TBIs) by only 20 percent compared with wearing no helmet, according to a study presented at the American Academy of Neurology’s 2014 annual meeting.

Although sports-related traumatic brain injuries(TBIs) receive all the spotlight, they only account for a small minority of all head injuries. 47% of all TBIs are the result of everyday falls that happen to all of us as we slip on stairs, trip over rugs, tumble from ladders, or stumble when we don’t look where we’re going. Some may hit their head on car doors and not realize that they’ve had a head injury or a concussion.Some brain injuries happen even without a concussion. Head injuries can result from a single blow to the head or repetitive hits over time.

According to the CDC, these incidents are especially prevalent among the elderly. A new CDC study finds that 1 in 45 people age 75 and older face a fall and a TBI. Currently, 5.3 million Americans are on life long disability following such an unexpected head injury. Clearly, head injuries have become a silent epidemic.

TBIs fall on a spectrum of severity, from subconcussive or concussive (which accounts for 70 to 90 percent of all cases), to fractured skulls or worse. Contrary to common perception, you don’t actually have to hit your head to get a concussion: It can result from whiplash, or from the shock waves of an explosion, such as those that troops experience in combat. This can cause or exacerbate post traumatic stress disorder (PTSD), according to a recent study. The far-reaching and seemingly disparate health effects of TBIs can include cognitive problems, coordination dysfunction, hormonal disruption, digestive issues, and mood disorders.

What happens to your brain in a concussion?

 A traumatic brain injuries (TBIs) can harm the brain in numerous ways:

• The brain is jarred in a concussion. It accelerates forward, crashing into the skull (known as a coup injury), then it often bounces back and hits the rear of the skull (contrecoup).
• Sometimes, it twists a top the brainstem, resulting in vestibular or endocrine issues.
• It may cause bleeding (an intracranial hemorrhage) or create a blood pool or clot (a hematoma); the brain tissue itself may be bruised or torn. These injuries can then put pressure on the brain, resulting in harmful inflammation.
• Can cause oxygen deprivation, leading to the death of brain cells
• Can damage the axon fibers that carry messages between different parts of the brain.
• Repeated brain trauma causes molecular changes to brain tissue that can have consequences decades thereafter.
• Measurable white matter changes were found inthe brains of 25 players age 8 to 13 over a single football season, based on pre - and postseason advanced MRI testing. The children in this study (Radiology, 2016) sustained hundreds of subconcussive hits over the approximately three-month season, without suffering actual concussions.
• Heading a soccer ball just once caused instant changes to the brain of amateur soccer players in the study published inEBioMedicine, 2016. In this study, researchers discovered alterations in brain corticomotor inhibition and cognitive function, and 67% reduction in memory-test performance in 19 players age 19 to 25 before and after routinely heading balls. The brain function of these study subjects normalized within 24 hours. However, we do not know whether repeated biochemical disruptions over weeks of heading-practice drills may cause long-term consequences on brain health.
• Damage to the blood-brain barrier may lead to autoimmune reactivity.  
• In some instances of trauma, inflammatory microglial cells in the brain turn on to clean up debris or areas of damage. It is possible to activate these inflammatory cells with repeated or severe injury or simultaneous inflammatory conditions in the body to the point that microglia remain activated and start creating enough damage to lead to loss of cell volume or collateral damage away from anarea of injury. This is believed to be the mechanism that relates to the onset or development of chronic traumatic encephalopathy (CTE).
• Pre-existing or resultant gastrointestinal pathology, ranging from infection to intestinal overgrowth of the gut microbiome, facilitates translocation of undigested food molecules through the gut lining and immune system activation. This systemic inflammation can penetrate through the blood-brain barrier and activate microglial cells, causing global inflammation within the brain.
• Concussions can cause higher resting heart rate and uncertain spatial awareness that result in an overactive startle response and hyperanxiety.

One of the most amazing aspects of the nervous system is its ability to recover from injuries, known as brain plasticity. You can make changes to the nervous system with repetition, intensity, and frequency. You just have to give it the right stimulation to help build plasticity. For this reason, it is best to initiate treatment soon after an injury, because the brain remains plastic and responsive for days or weeks. The longer one waits, the more likely the brain gets set in the new dysfunctional pattern. However, if an injury is months or even years old, it is still possible to benefit from functional-neurology testing and treatment.