Heads Up: Subconcussive Impacts Can Be More Dangerous than Concussions

By Amy Geiszler-Jones
Wednesday, August 29, 2018
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Concussion awareness has grown significantly in the past decade. Now there is an entire annual medical conference devoted to the topic, medical journal articles have increased from a couple a year to multiple new articles every week, and every U.S. state has a return-to-play law requiring a physician’s clearance for student-athletes who have suffered a concussion.

Bart Grelinger, MD

But more awareness needs to happen — especially for athletes who aren’t diagnosed with a concussion, says Bart Grelinger, MD, a Wichita, Kansas, board-certified neurologist who helped pass Kansas’ return-to-play law and has testified since then before the Kansas Legislature. He and several other physicians and healthcare professionals developed an online resource, Kansas Sports Concussion Partnership, that serves as a game plan for educating, recognizing and managing sports-related head injuries.

“We physicians have learned there is no such thing as a mild, moderate or severe concussion: They are all medically significant,” Dr. Grelinger told the Legislature in his 2016 testimony. “We now know a seemingly light blow to the head can cause a more significant brain injury than a tremendously hard hit, due to brain anatomy and the direction of rotational shearing forces. We also know that an athlete does not need to be knocked out to have a severe injury. It doesn’t even take a blow to the head to cause a concussion, just rapid head movement.”

What worries Dr. Grelinger are the athletes who sustain hits, take headers or have any contact significant enough to whip the head and don’t receive a concussion diagnosis. All of those hits still can cause irreversible damage to the 100 billion fragile, hair-like neurons in the brain and can result in the same outcomes as someone diagnosed with a concussion, including early-onset Alzheimer’s type symptoms, changes in behavior and ultimately chronic traumatic encephalopathy or CTE, he notes.

“As it turns out, the diagnosis of concussion may be the good news,” he says. “At least those athletes are recognized and largely removed from the risk of further injury, giving the brain a chance to heal as much as it can. Subconcussive impacts are more dangerous than concussions because we do not even know they have occurred and, once initiated, the damaging process can continue.”

One need look no further than the case of NFL player Junior Seau, who never was diagnosed with a concussion yet his brain pathology after his suicide revealed one of the worst cases of CTE, Dr. Grelinger says.

He also uses this analogy: It’s likely no one would use a laptop to deflect hits from a soccer ball because it’s a very sensitive piece of technology, so why aren’t people willing to apply that same caution to the brain, our body’s most sensitive and vital organ?

Physicians who see patients who engage in competitive sports where significant contact can occur should keep an eye out for subconcussive symptoms. Parents need to be made aware to contact their child’s physician if the child exhibits changes in behavior such as getting easily angered, mood swings, trouble concentrating, a drop in grades, and other such cognitive and temperament changes.

“These kids are getting duller under our noses and our awareness needs to be higher,” says Dr. Grelinger, who regularly makes presentations about concussions and their effects.


Dr. Grelinger is part of Neurology Consultants of Kansas, which specializes in evaluating and treating acute and chronic neurological problems in adult patients including neuropathy, multiple sclerosis, Parkinson’s disease, seizures, headaches, tremors, dementia and stroke. To refer patients, call 316-261-3220 or visit neurologyconsultantsofkansas.com.