Concussion in Music

Insomnia, fatigue, headaches, irritability, poor concentration, substance abuse, clumsiness - sound familiar? Welcome to post concussion syndrome, a career and life derailer.

Over the course of a decade in Olympic and professional sports, I saw a LOT of concussions. In fact, I helped launch a concussion baseline testing program with the NeuroAthlete Clinic in Monument, Colorado. Concussions in sport makes sense though, doesn’t it? Kids and adults run full tilt at each other over a ball. Some sports purposefully try to scramble your brain for a KO. 

Concussions in music was not something I was expecting, though. What we’re finding in our artists and crews is actually Post Concussion Syndrome (PCS) - concussions that occurred in the past, but were never properly treated. Considering most concussions (some cite upwards of 80%) go undiagnosed, and around 30% of concussions that are diagnosed become long term problems, we’re bound to come across them. 

Why even give attention to this?

Music is a physical career. I argue that music is sometimes even MORE taxing on the body than sports, because of the lack of physical recovery in music. Sports teams have entire departments keeping their athletes in top shape. The music industry as a whole hasn’t built out those resources.  The few studies out there find anywhere from 50-85% of musicians are playing through injury and pain. That would not fly on a sports field. The entire medical and sports training staff would be fired. 

Music has combined the worst of negative outcomes - statistically poor medical care anyway with statistically undiagnosed brain injuries. Post concussion syndrome can cause a myriad of negative effects in life, typically in 4 categories:1) Physical: headaches, dizziness, light sensitivity, noise sensitivity, tinnitus, vision disturbances, balance problems, excessive fatigue, vision stress, 

2) Sleep: insomnia, sleep apnea, and changes in sleeping patterns are frequent. 

3) Psychological/emotional: depression, irritability, mood swings, hyperactivity, loss of libido. 

4) Cognitive: memory problems, poor concentration, easily distracted, easily fatigued by mental tasks, and more. 

Long term, mild and severe concussions are statistically relevant in Alzheimer’s disease, Parkinson’s, epilepsy, stroke, CTE, and other psychiatric illnesses. 

Acute concussions (those that have happened recently) and Post Concussion Syndrome (those that happened in the past and went undiagnosed and untreated) can utterly derail a budding or successful music career.  Even if the injury itself took only a millisecond to happen, the inflammation in the brain and the symptoms can last for years, decades even. 

How do you get a concussion?

Concussions occur when the brain gets injured.  Some concussions occur through direct contact. Fell out of a tree as a 6 year old.  Played football or soccer in high school. Rolled an ATV or truck in your teens. Bar fight in your 20s or 30s. Ran into a kitchen cupboard. Fell off a ladder.  Sometimes, concussions also occur from just motion, like whiplash during a car accident. 

What makes things really tricky, and what we hypothesize we’re seeing most in music are “subconcussions.” These aren’t full concussions, they’re little, baby ones that aren’t likely to pop up on any screenings or give any pause in the immediate moment to think something happened. But, over time, all of these tiny concussions, these subconcussions, actually add up to the same effects as a full blown concussion. In music, if you haven’t had a full blown concussion, but now you’re feeling similar effects, our hypothesis is stage antics - like head banging! Some genres are going to be more susceptible to this than others just based on the culture. Heavy metal will see more head banging on stage than gospel, so we’re likely to see more subconcussion amongst that genre. Country music, with its increase in artists crossing over from sports to music, seems to be more undiagnosed concussions from sports. All genres have their fair share of shenanigans and other stories that can create subconcussions, which led to what we’ve coined “subconcussion accumulation.”

What tips us off to post concussion or subconcussion accumulation?

Gait is the easiest indicator usually. People who have suffered from concussions or subconcussion accumulation have gaits that tend to be wide, with arms that don’t swing in sync, legs that don’t swing with the same speed, and a dysfunction between left and right side.  It can be really obvious, but in many cases, these are minute details that the common person isn’t going to pick up on easily.  We liken it to how musicians can hear the differences in mics or amps, while the average music consumer couldn’t tell one brand from the other. 

Breathing is another big indicator that is often overlooked.  Concussions and subconcussion accumulations alter breathing patterns, and what’s really interesting is how many vocalists are able to compensate for this to a degree. When we start getting into it, we find dysfunctional diaphragms, breathing patterns that aren’t in sync, decreased rib expansion, breath holds which create stress, or vocalists who can’t even activate their diaphragm. 

Vision and vestibular are the most easily tested. Vestib-what? Your eyes do more than just look at things, they help your brain understand where you are in space. Inside your ears are a set of canals which also tell your brain where you are in space - whether your head is tilted, spinning, stationary, etc. They act just like construction levels. Concussions can scramble the information sent by these two systems in the brain, which results in dizziness, balance problems, headaches, vision impairment, and more, because your eyes may be telling the brain one thing (I’m upright), but your inner ears may be saying something else (no, we’re tilted a few degrees.) I’ve met artists who concert goers claim were drunk on stage, and while they could have been, some were actually suffering from PCS-induced clumsiness, made worse by the harsh lights and blaring sounds of a concert stage. 

We can ask a few questions about sleep health, moods, accidents in the past, do a few vision and balance tests, and within a few minutes we can generally tell who is either at risk, or very likely has undiagnosed post concussion syndrome. 

How are concussions diagnosed?

Not by CT scan. I hear so many people who say they got hurt, went to the ER, got a CT, it was clear, they’re sent home and never follow up.  CT scans are poor in diagnosing most concussions that don’t include significant brain tissue damage and definitely can’t diagnose subconcussions. Some imaging can be helpful in showing if parts of the brain aren’t as active as they should be, but that is only a single factor, and you have to have the resources for that high level imaging. Also note that during some of those scans, areas of the brain wouldn’t naturally be activated anyway. It’s akin to an electrician walking into your house and saying you need to replace your wiring because your bedroom light isn’t working, and you turn to them and say, “because I haven’t turned it on…”

While more accurate blood tests are being researched - through measuring certain protein markers in the blood - they aren’t great on their own, either. And, they require lab work. 

The most comprehensive and easily deployable concussion diagnostic tools are in-person tests, such as the SCAT 3, which measures balance, memory and concentration, and includes a symptom questionnaire.  Neurocognitive tools such as ImPACT measure verbal memory, visual motor speed, reaction time, and visual memory.  This is done with an iPad or other easily accessible electronic device. The King-Devick test measures eye movements, called saccades, and is great because this test can pick up on unreported mild concussions and also only needs an electronic device. The Dynamic Visual Acuity Test (DVAT) is another in-person test focusing on how vision and balance are affected by concussions. Other technologies are popping up, including vision testing and training in virtual reality-type goggles. 

How do we treat a concussion or subconcussion accumulation?

Each client is completely individualized. That’s one of the hardest things about testing concussions is that each concussion affects each person differently, so creating standardized protocols is often inadequate. There is no one size fits all, and there are no single practitioners to handle everything. A red flag is a protocol that is used on everyone. Concussion rehab isn’t the audience in an Oprah taping, “you get this protocol, and you get this protocol. Everyone gets this protocol!” No.

It takes a village, all with various tools. Some data-backed concussion rehabilitation methods include

• vision and vestibular training, 

• cognitive rehab, 

• breathing rehab, 

• cognitive behavioral therapy, 

• hyperbaric oxygen, 

• Pharmacological protocols,

• exercise, 

• rTMS (repetitive transcranial magnetic stimulation), and more emerging sciences.

Typically, we treat what we find on the SCAT3 and ImPACT scores. We find vision and vestibular dysfunction, we treat it. We find memorization dysfunction, we treat that, etc. 

What can be difficult for consumers is deciphering which concussion rehab protocols are real and which are snake oil sales, though.  Supplements marketed for “brain health” are unlikely to be anything more than a typical multivitamin. (Side note, having worked in the supplement manufacturing process, that $120 bottle of “brain health specially derived formula” is likely to only cost the supplier 1/10 or less of your price, and they generally source the cheapest ingredients possible for margin gains, AND the formula is probably nearly identical to their competitors.)  The same protocols given out to everyone. Brain scans showing “inactive” areas have the potential to be very misleading (see the electrician example above.)  Having a practitioner with Dr. on their nameplate isn’t always a trustworthy indicator, either. 

Here at RESTAGE, we go back to what are concussions most likely to disrupt in the brain, and work at retraining those skills.

• Vision

• Vestibular/balance

• Gait

• Memory

• Motor Control/ movement patterns

• Breathing patterns

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