When New England Patriots tight end Rob Gronkowski took a helmet-to-helmet hit during the AFC championship game last Sunday, fans also felt a jolt.
Their fears were confirmed when the team said that he had sustained a concussion, just two weeks before the Feb. 4 Super Bowl.
With that, the health of Gronkowski?s brain after the hit by the Jaguars? Barry Church became the prevailing story line and biggest question mark heading into the big game. How badly is he hurt? Will he be able to play? Can he heal in time?
The team?s doctors aren?t saying. But two neurologists who were not involved in treating one of football?s signature players explained to the Globe ? in broad terms ? what a concussion does to the brain and how it recovers.
To get back in time for the game, as the team is dropping hints that he will, Gronkowski will have to recover from a fast-moving series of chemical disruptions triggered by the impact, which forced his brain into overdrive and depleted its energy resources.
When the head sustains such a hit, the sudden motion causes the jelly-like brain to move within the skull, stretching the cells.
The worst concussions occur when the impact comes at an angle, forcing the brain to rotate within the skull, said Dr. Alexandra M. Stillman, director of concussion, traumatic brain injury, and neurorehabilitation at Beth Israel Deaconess Medical Center. It is unclear whether that happened in Gronkowski?s case.
This trauma unleashes a cascade of chemical changes, starting with the release of neurotransmitters that rev up brain activity. Working overtime, brain cells quickly consume glucose, the source of energy. At the same time, the shock of the hit also reduces blood flow, further cutting back on energy supplies.
The result, said Stillman, is ?an energy crisis.?
For patients with concussions, that means temporary mental impairment, said Dr. William J. Mullally, director of sports neurology and concussion at Brigham and Women?s Hospital.
Patients may be momentarily dazed ? ?star-struck,? as Mullally put it ? and have trouble with balance. Sometimes they experience brief memory loss, perhaps forgetting how they got from the playing field to the locker room. But fewer than 10 percent lose consciousness.
Over the next few days, the patient may feel dizzy and mentally foggy, and suffer headaches, nausea, and other symptoms.
The solution is straightforward: Rest for one to three days (Stillman and Mullally differ on how long), and then gradually increase activity.
Resting doesn?t mean hiding immobilized in a dark room, just avoiding exertion ? ?not doing anything that puts a stress on your body or your brain,? Stillman said.
?The brain needs the rest time to rebuild its supply of energy building blocks, so it can reset itself,? she said.
Rest should be both physical and mental, Mullally said. For five to seven days, he said, people with concussions should cut back on using their brains: Students should study less and workers should take time off even if their job is not physically demanding.
For athletes, it?s critical not to resume full-contact play before the concussion has healed. With reflexes and balance impaired, players are at greater risk of a second concussion. Getting a concussion when the previous one hasn?t healed compounds the problem and leads to slow recovery. ?The two together are worse than each separately,? Stillman said.
Also, repeated hits have been implicated in the degenerative brain disease known as chronic traumatic encephalopathy.
On the other hand, the doctors said, resting too long will slow the recovery. ?Sometimes people rest too many days,? Stillman said. ?Getting back to physical activity is important.? Moving around restores normal blood flow to the brain.
Patients should resume exercise bit by bit, assessing their symptoms with each attempt at activity, Mullally said. Athletes are usually administered a 20-minute assessment of cognitive function that helps determine if they have recovered.
Under the National Football League?s concussion protocol, players diagnosed with concussions progress through carefully monitored steps from total rest through gradual increases in activity, with no set time period for the process. If the team physician believes the player can safely return to the game, an independent neurological consultant examines him. If the consultant concurs, full football activity can resume.
How long recovery takes depends on the severity of the injury and individual characteristics. Children younger than 15 are more susceptible. So are women, apparently because their usually more slender necks allow the head to swing more during a hit. Genes can also play a role.
But Mullally said that the science is not clear on the ideal rest period before an athlete is cleared to play. It?s possible that the metabolic and blood-flow problems persist after symptoms subside, he said.
So what are the prospects for Gronk? Neither Stillman nor Mullally know any specifics about his condition and can?t comment.
But Stillman said that athletes tend to recover faster than others because the blood flow to the brain ?is already finely tuned; they can get it back more easily than someone who hasn?t exercised in two years.? Most can go back to the game after two weeks, she said.
Mullally said that for athletes, if all the signs and symptoms are looking good, ?It would be reasonable that they may be able to go back in 14 days.?
That means, for Gronkowski, we could be talking about Super Bowl Sunday
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:scared:sadwave::scared