After the hit: What to know about concussions
September 23, 2025 | Episode 47
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Lindsey Gordon, Marcus Thorpe, Dr, Ben Bring, Dr. Obi Moneme
Marcus Thorpe 0:14
And we welcome you back to the wellness conversation and Ohio Health Podcast. I'm Marcus Thorpe
Lindsay Gordon 0:19
and I'm Lindsay Gordon. First, we have some great news to share. Our podcast is growing, and we want to thank you for that, more listeners than ever, more subscribers each month, more plays, more downloads. This is very exciting for our team, and you've helped us get here. So thank you so much. If you're new here, please like this episode, rate the podcast and subscribe to help others find us too. It is so important, and we can't thank you enough.
Marcus Thorpe 0:41
And today we are tackling a very important topic for athletes, the weekend warrior out there, everyday, folks, kids, we're talking about concussions, and we are pleased to be joined by Dr Ben Bring who's a sports medicine physician, as well as Dr Obi Moneme, who is a neurologist, both at OhioHealth. We'd like to welcome you both to the conversation. Thanks for being with us.
Dr Ben Bring and Obi Moneme 0:42
Thanks for having us, thanks for having us.
Marcus Thorpe 0:51
It's going to be a great conversation. Let's start from the very beginning, because look, concussions can be a very confusing topic. Not everybody knows. Do I have a concussion? Do I don't? What's going on when this happens? From a medical term sports headlines, we see it a lot. What is an actual concussion? Dr Monomoy, you want to kick us off?
Dr. Obi Moneme 1:20
Sure. Yeah, I can start there. So I think the guidelines and the definition has changed over time, but really the most accurate guideline or concussion definition is a traumatic brain injury that comes from a direct blow, either to the head, the neck or the body, that causes neurological symptoms, right? I think when you kind of frame it in that way that encompasses all the different ways that someone can suffer a concussion.
Lindsay Gordon 1:42
I think that's a great way to think about it, because I was just actually thinking about this while you were speaking last night, my kids were rough housing, and they bonked heads, and it was enough for a bump to form on both heads. And so we grabbed the frozen peas, we wrapped it in the paper towel. And I've always heard a bump is better than a dent, and this is going to happen with kids, but I went down the rabbit hole in my brain. I'm like, is this a concussion? Do I need to get them in? What do I do? Do I call the doctor? And so I just say that to say, concussions don't just happen on the field. They happen in everyday life. They happen crazy times. And so when we talk about a concussion, are we talking about a bruise on the brain? Are we talking about more than that? And Dr montemay, you kind of already alluded to that, but there's definitely something more than just a bump on the head there, right?
Dr Ben Bring 2:31
Yeah, I think the other thing we looked forward to are symptoms. So the biggest ones we'll see, especially in kids, are fatigue, sleep issues, sometimes even depression, anxiety can get worse, headache, head pressure, nausea, too. Those are some of the more common symptoms that we'll see on a molecular level. The way I like to explain it to patients is in our brain, we have a lot of neurons. The neurons help us transmit signals, helps our processing, helps us kind of think, form memories. What happens with these neurons is, with a brain injury, they twist and they shear and then they get damaged. And so what ends up happening is, you get, that's where kind of the brain fog comes from, is those, those neurons are just no longer functioning like they should, and then, so when you get that twisting, that shearing, that's kind of like where you feel, yeah, I don't really feel myself, or I kind of feel out of it. I'll share a story. During my third year of residency, I was playing basketball here at McConnell. Jay Cassie, a great trauma surgeon, Now, ironically, ran me into the wall. Had a concussion. It was six weeks before my boards, and I was fortunate. You know, it took me a couple weeks to heal, but Dr halema actually sent me home from rounds. She said I wasn't making a whole lot of sense, but I thought I was. But, yeah, it's kind of a funny story looking back, but so anyway. So you know, it can take time. Unfortunately, as we get older, as my fellow men over 40 years old, it takes a little bit longer than in kids. Usually with kids, they're a little more resilient. Usually within a week or so, they can get back to normal, but Right? But usually it's it can be very scary. Some of those symptoms
Marcus Thorpe 3:57
Our hardcore crew fans might recognize Dr Moneme name actually played for the Columbus Crew back you said, in 1996 for a season. I'm sure that you know all the headers that you had to take and you're going up for contested balls, and your whole entire career, you must have had some concussions along the way. Can you tell us about your journey with the concussion?
Dr. Obi Moneme 3:58
Yeah, I think it always happens. I think it's part of the game in some ways. I think the interesting thing is, even now in youth sports, they've kind of made heading is a foul for the younger kids, knowing that even sub concussive blows that aren't big hits that kind of make you lose consciousness, can result in concussion and concussion like symptoms. So every head ball, every challenge, you know, there's some risk, you learn ways to try to protect yourself, to minimize risk and minimize injury. But you know, I also think things have changed. Back when I played, you kind of got your bell rung and, you know, you might have been dizzy, but they threw you back in, right? And I think now that we recognize the physiology behind. Concussions, and the fact that not letting your brain rest and recover can cause bigger problems down the road, that we're much more aware and we're much more likely to try to protect our athletes
Marcus Thorpe 5:11
from a sports medicine perspective, too. Dr bring I mean, you watch some players who, you know, get their bell rung, and they'll immediately grab their leg because they know if I have a concussion, they're not going to let me play. From a sports medicine physician perspective, that's what you're there on the field to be keeping a close eye on to make sure if you see something, you immediately pull these kids off for some examination. That's a really important part that we've kind of graduated from. What Dr Moneme was saying of this, just rub some dirt on it. You'll be fine perspective.
Dr Ben Bring 5:41
Well, you know, we've seen the state legislature for this too, which has been great to back us up where we have the ultimate authority to pull a kid, you know, especially if we do suspect a head injury. And that's been very effective. I think that the best thing that's happened though, over the years is the education that comes with coaching. I know I coach some of my kids youth sports, and I'm we have to do concussion training, which is great. So all the coaches now are getting trained in recognizing signs and symptoms of concussions, but then also understanding when the medical staff or athletic trainers or team docs, when you step in and you say, hey, this kid's got a concussion, you know, we're able to pull them out. I know there's been some pretty traumatic head injuries in the NFL over the years. I know we've kind of seen some of the severe injuries, you know, where we'll even see some of like the fencing sign, which shows a deep neurologic brain injury in some of those athletes. And obviously, those are the things we want to avoid, especially in kids. You know, 99.9% of these kids are never going to play professional sports. And so, you know, I tell these kids this, like, Look, you have the brain. You have your brain for the rest of your life, you know what? Regardless of what you go into, you only get one. You got to take care of it. You got to protect it. What's really interesting, though, is, you know, I'm curious to hear Dr monomy thoughts on this too. Is the micro trauma of the headers over the years, you know, in us regular athletes, you know, not the non professional ones, you know, I always want we've done a lot of studies on chronic traumatic encephalopathy in professionals, but not as much in the day to day, like the kids that maybe played high school soccer, and then they go on, you know, and live regular adult lives. So that's another really interesting area of research, I think, is that CTE, they call it the chronic traumatic encephalopathy for some like long term risk of depression, anxiety, Alzheimer's, dementia, those types of things.
Lindsay Gordon 7:23
Yeah. Dr Moneme, what are we risking with that long term injury?
Dr. Obi Moneme 7:27
Yeah, I mean, I think there's lots of research in this space, and it's an interesting place to kind of think about how we treat our athletes, right? And I think once again, we get so concerned about the big hit, and we forget about the kind of this chronic sub concussive hits. You know the football player who trains and practices helmet to helmet every day. And the interesting thing from a physiology perspective is we even know that even these proteins called micro RNAs that get secreted in the brain after head trauma, so within a minute after a head trauma, your brain actually starts to change chemically and affect protein production. And you can actually and we've talked about in the past with concussions, with saliva testing that we've explored for diagnosis. So they've even done studies about athletes over the course of a season, and how the protein and how the metabolic profile can change with these sub concussive blows compared to the big hits. So there's certainly some physiology about how these things can, you know, remodel and change brain function over time. So.
Lindsay Gordon 8:24
What about mouth guards? I mean, I remember when I was playing hockey, there was a big push to keep that mouth guard in your mouth. It's not for your teeth necessarily. It's more for a concussion prevention method. You know, heads up, don't duck. Was the slogan when you're going into the boards, keep that head up. But mouth guards, I mean, is that, have we found that to be effective, or is it sort of a myth?
Dr. Obi Moneme 8:42
I think it's effective. It's interesting. I think in the last concussion conference in Amsterdam, they talked about the fact that mouth guards can reduce the risk of concussion by 30 to 40% simply just limiting head to head contact and practices has a really significant impact in reducing concussion. So I think there's value to these different tools. And I think really, with these young kids, anything you can do to limit their risk is a positive and a benefit.
Marcus Thorpe 9:09
I think equipment's a big part of that too. My son plays hockey in high school, and I try to get him to put his chin strap that's right up against it, and nice and tight. He always tells me, hey, the cool kids like to have a little hang on their thing because it looks better. And I'm like, Yeah, but if you get hit that's so loose, you're going to have some problems. Can we talk about equipment? I mean, we've seen some really good advancements, I think, in some of this equipment, but if the kids aren't using it right, they're not really getting the full benefit, are they?
Dr Ben Bring 9:40
As concussion prevention goes, I've still not seen anything, I think, on the market that completely prevents concussions. I think that's what we're still in the search for. When I was in medical school down at Virginia Tech, one of my mentors, Dr Gunnar brolinson, led this area of concussion research, especially with helmets. So they built these helmets with these accelerometers, and they. Been doing research for 25 years now on Virginia Tech football athletes, on when they get a head injury, how fast were they going? What were the angular forces, etc. And we also did force play testing on these athletes, where we would have them do, not only the impact testing for on the computer, but also force play testing, where before and after, we would kind of measure the x and y axis of how they shift their weight prior to getting prior to even starting hitting. So that's really, it's been really cool to see the technology improve over the years in those helmets, unfortunately, they still don't 100% prevent concussions. The other thing you'll see a lot in high school kids are these Guardian caps. Kind of looks like an inverted helmet that goes on top of the of the helmet. And again, you know, I think, you know, we've every year we go back and forth on this. It might mitigate some risk. I think that's the key statement here, is it may decrease your risk a little bit, but it will never completely prevent it. And then the third product, this one's kind of been kind of cool. Actually, knew the guy that developed this. It's called the Q collar. I don't know if you've seen the Q collar. It's kind of like a plastic collar that goes around the neck. In theory. Basically what happens is it occludes your jugular vein, thereby increasing your intracranial pressure just very slightly. So the guy that developed it was in the military, and he always said, Well, how come? You know, woodpeckers don't get headaches, or woodpeckers don't get concussions, and they look there's actually a muscle inside the woodpecker neck that occludes the jugular vein, so when it's pecking, it doesn't get that increased pressure doesn't cause the brain sloshing around that kids get so and again, I was looking up the studies on this this morning. It doesn't completely prevent it, but it can potentially reduce risk. I know Cincinnati Children's has done quite a bit of work in that space.
Marcus Thorpe 11:41
Good luck finding a smarter podcast than this.
Lindsay Gordon 11:44
I'm learning so much. This is amazing. I'm benefiting from this. My kids are, you know, behind yours in the sports world. You know what this will be my world someday. And I'm so glad I know this information. We actually got a couple great questions on social media about concussions. So, rapid fire. We'll, we'll throw these out there. The first one, if you suspect a concussion, where should you go? Do you go to urgent care? Do you go to the emergency department? Do you call your primary care? Where do you go?
Dr. Obi Moneme 12:10
That's a good question. You know, I think you know the lay person. We always say you shouldn't be a doctor, a neurologist and make a diagnosis, right? So I think if someone's having symptoms, it's always okay to call a medical professional for advice. I think that's number one, and I think we'd never want anyone sitting at home trying to make a diagnosis. That being said, as a neurologist, we look for focal neurological problems. So when patients have a concussion and we see things like weakness, we see bruising around the eyes or behind the ear, we see facial drooping. So there are very specific kind of neurological symptoms that get us concerned that there's something more serious than a concussion, and the biggest thing is bleeding in the brain, which can happen with severe enough trauma. So I think from a neurology perspective, if we're not hearing those focal deficits, and someone's having headaches, dizziness, balance problems, the other classic concussion symptoms we feel pretty comfortable with, you know, talk to your primary care doctor, have a plan for observation, and within 24 to 48 hours, you would like to hear that there's improvement of symptoms. And if there's not, then there's a real reason to kind of go in and get further evaluation. That's a general guideline, yep.
Marcus Thorpe 13:17
How does that impact? Like a return to play? Right? When? When should you start to say to yourself, Okay, you need to be out for this long. It's hard because it's such an individual situation.
Dr Ben Bring 13:29
Yeah, So we look at a tool called the scat five. So it's the sport concussion assessment tool. Basically, what the scat tool allows us to do is look at symptoms. So we have 22 different symptoms graded zero to six, six being the most severe. So at the time of concussion, our athletic training staff can be very effective with this. And so this is where I feel like it's great to have physicians on the sideline so we can do that detailed neurologic exam. You know, because if we do see changes in you know, if there's more nystagmus, where the eye kind of twitches back and forth, or there's pupil dilation or something that looks abnormal, we use what's called the GCS score that can kind of help us with this too, to see if a kid needs to go to the hospital urgently. If not, we stick to the scat five, where we can do those symptoms and then kind of track them. So going back to your question about return to play, you know, for me, for a high school kid, if you have a concussion tonight, tonight's week one, and you get a concussion tonight, it's a very low probability you're going to get back for that week too. Now, could it happen? Absolutely, the only way it could happen is if they're symptom free. Basically, tomorrow morning, we progress them through a normal week of practice, and they're symptom free throughout the whole week. That's really the biggest thing we look at here, is symptoms. And you know, what other things are they are occurring, and this is really hard, because we have to have our high school kids. My son's almost, he just turned 12, where they may not be as honest with you as as you would like. So they may lie and say, No, I feel fine. You know, it's week eight. I got we were in the hunt for the playoffs, but this is really where you got to talk to kids and parents and say, Hey, you have to be. Honest with us, so we know there is some interesting data coming out. So when I trained, we just did, you know, five days of rest with gradual progression back to activity. Now, what they're showing is early signs of, you know, walking or getting out and moving can actually help get those symptoms down a lot faster, doing some light activity.
Lindsay Gordon 15:17
Yeah, interesting. Because I've always heard like darkness, you know, stay in a dark room.
Dr. Obi Moneme 15:21
Definitely a change. That's definitely a change. And most recommendations now coming from the most recent concussion guidelines. 24 hours of rest, okay? 48 hours of no screen time. And after that, there should be a return to activity, light, walking. And in the past, we used to say any symptom you stop, there's a sense that mild symptoms are okay to work through, because that helps you with your progression of return to play. So I think there have been some changes, and recognizing that that kind of strict bed rest with no activity actually could be detrimental for recovery if it's too long and prolonged.
Lindsay Gordon 15:52
The other quick question we got from social media was, if you suspect you had a concussion even as far as, like a year ago, should you still go get medical advice?
Dr Ben Bring 16:03
I think so absolutely. I mean, the long term effects of concussions can be damaging, especially in adults. You know, when you look at the if you especially if you have underlying risk factors, depression, anxiety, ADHD, head injuries can actually be prolonged if you have some of those pre existing conditions. And so I, I'm a big believer in that, especially with mood disorders, because concussions can actually make mood disorders worse. So the longer that you wait and sit on those you know, that could be a detriment to your health down the road as well.
Marcus Thorpe 16:32
I know we're talking about the traditional places where you would see concussions, you know, football field, soccer field, those kind of things. I kind of want to transition to where else you could see it. I think one of the maybe under reported things that people don't think about is kind of like the dance teams or the cheerleading teams. Like, you know, these kids are doing flips and they're doing a lot of different things. Or, like, workplace injuries, yeah, and workplace spaces. We do see concussions outside of the traditional playing fields a lot, don't we?
Dr. Obi Moneme 16:54
Agree. See them everywhere. I think it's recognition and awareness. And I think, to your point, education, we focus on sports and contact sports, because we think the risk is higher. But I think there are all these different environments where people are at risk. And I think, you know, really educating people about the signs and symptoms of concussion, what are high risk activities? I think those are important. And then also, you know, being mindful of symptoms, you know, and if you are at work and it's not a physical environment, but you still have some type of trauma. No, there really should be some type of assessment.
Lindsay Gordon 17:25
Yeah, so interesting. I've learned so much. So far. It's been great. I mean, I thought that a concussion was like walking into this podcast today. I'm telling you, my impression of a concussion was you passed out right away, or you started puking and then you were shunned to a dark room, like, that's, that was my thought on it, and that was, or I remember playing hockey growing up, you know, there would be a collision and you'd have this one saying, I got it. I'm good, I'm good. I'm back in coach, and then they hit the ice and they fall down, you know, like, that's been my, my take on it, my only experience with it, and so it's so exciting to hear that the research keeps going and you've discovered more. And thought, hey, maybe this wasn't as effective before. Let's try this. I want to ask you both, what's your hope for the future? Where is the research still needed?
Dr Ben Bring 18:17
Gosh, that's a that's a loaded question. Yeah. I mean, I think for me, from a sports standpoint, the equipment is definitely the way to go. The rules, especially in soccer, have helped quite a bit too. I think, you know, mitigating that risk of head injury. You know, I played sweeper in high school, and we were always taught to head the ball directly out of the air off of goal kicks or, you know, or punts. And, you know, I wonder about that too. So I think the other research, which I'm personally excited to learn about is for the everyday athletes, people that you know may not have played professional sports or professional football, but, like, played a little bit of football or soccer, and then you get older, and how did those, those micro trauma, those hits, kind of add up as you get over time, and then, from an equipment standpoint, too. I think if there's anything out there that could, again, continue to help reduce risk, I don't foresee any product ever being able to completely guarantee no concussion risk. But, you know, finding ways to mitigate that risk is going to be the best thing.
Marcus Thorpe 19:14
I still tell my kids to put a helmet on. I mean, they're they're always 12 and 15, and I'm like, they walk out the door on their scooter. I'm like, do you have your helmet, right? I mean, I just You cannot risk
Dr. Obi Moneme 19:23
Your scooters, yeah, all over the place. No, I think diagnosis from a neurologist, right? We like to diagnose things. Having better tools to really differentiate between the people who are high risk and low risk would be great, right? And I still kind of go back to that whole concept of this saliva testing. Now, would it be nice for a sports medicine doc to have their exam on the field, but also have a biomarker of some sort to kind of say which are the people that are high risk, right? Because a lot of times it's borderline, right? And you've got a kid who, I mean, if you get hit, yeah, you may feel a little dizzy. Is that really a concussion, or is it not? And right now, we err on caution, and everyone sits out. But could you get better at being able to differentiate? You know? Which are the people who really should be out, versus the people who who aren't, and also with a long season, who are the people who suffered more injuries in a long season and need more care?
Marcus Thorpe 20:09
That's what I was going to ask you, too, because we see often in the NFL, just because it's visible and we see it, but I'm sure it happens in other sports, even in the high school spaces that we don't see, I don't personally see, is you get one concussion? Are you more susceptible to get more concussions if you're rushing back or even in general, are people more susceptible to get a second concussion if they have a first one?
Dr Ben Bring 20:31
It was funny. I was reading incidents of new concussions. The chances of a high school athlete per 100,000 it's actually more likely that they'll get a first concussion compared to a repeat concussion. Now I also say if you, if you get back to return to play too soon, then that definitely can increase your risk of a second head injury. Most severe is what's called second impact syndrome. So this is where you get dangerous brain swelling and you can die. And this, this came up a couple of years ago. There's been a couple of isolated high school football cases. Again, you know, kid gets his they say, Oh, you just got your bell rung. Get back in there. Kid takes another hit, and then is running and all of a sudden just passes out and dies right there. Because you get dangerous brain swelling and bleeding. And once you get that cerebral edema, you know, our skull is, it's a it can't expand, and so that that can be a very, very dangerous thing. So that's the biggest reason. That's the thing I tell these kids, you know, it is life threatening if we don't pull you out right now.
Lindsay Gordon 21:26
I was just having the conversation this summer with friends of mine, and the husband's a football coach, college football coach. He's got two sons, and they're about, you know, almost Pop Warner or youth football ready, right? And so we were having that discussion. And I said, are they going to play youth football? He's like, You know what? I don't think so. And I was surprised to hear that, because football's in his blood. I mean, he has a cousin who plays in the NFL. It's just, it's there, it's what they do. And he's like, I think we're going to start with flag football, because I'm truly concerned about head injuries, especially younger. So is there benefit to starting kids a little bit later, we have seen a decline in youth football registrations across the country. We're seeing an increase in, you know, flag football as the alternative. What's your take on that?
Dr. Obi Moneme 22:14
Cumulative effect right, if we're talking about sub concussive blows and hits and how they affect your only brain that you have, would you want to start developing trauma or directing trauma to that brain at an early age? Right? So I think it's just protecting your brain. And I think whether it's football, soccer, softball, any sport, dancing, you know, you really want to just say, Let's protect your brain, right? And if you don't have to hit your head or directly, kind of put yourself at risk of trauma, it's better to avoid it.
Marcus Thorpe 22:41
As we kind of wrap up. Is there a message you want to leave folks with as we kind of go back out into our regular lives? I think this is going to be a really well received podcast, because it is one of those topics that everybody wants to know a little bit more about. I think as we kind of wrap up, what messaging would you want folks to take back with them, into their daily lives, into their kids lives, and those kind of things. Dr, Moneme, let's start with you.
Dr. Obi Moneme 23:05
Yeah, I probably have maybe two things. Number one, concussions don't show up on MRIs, right? And I think that's one thing as a neurologist that we get a lot of information and questions about. I need a brain scan to Dr Brings point, concussions are metabolic, they're neuro, chemical. They don't show up on scans. It's very rare for us to see anything related to a concussion on a scan, right? So I think really kind of getting out of that mindset that I need to get a scan and focusing more on symptoms is the most important thing for identifying concussions. And then number two, concussion rehab therapy works, and I think in our young athletes and adults who have suffered concussions, we have a great Ohio Health Program with comprehensive concussion rehab, balance, headaches, cognitive function. And really what I see in my clinic is sometimes people wait and they sit at home, to your point, in a dark room for a week, and they don't do anything for a couple of weeks, and they come to me and I say, I wish someone would have gotten you into concussion rehab therapy sooner, because we know that those types of interventions help people return to work and return to play much faster. So I would you know if you're still symptomatic within seven to 10 days after a concussion. I really think that you know, leveraging with your PCP or a specialist to get in for some rehab really provides a lot of benefit.
Marcus Thorpe 24:20
Dr Bring.
Dr Ben Bring 24:21
Yeah, just kind of build off of that too. I think education is really important. So if there's ways in which schools can provide education to families and coaches, you know, it makes the conversations a lot easier when parents, especially have had that education on concussions. When I first started as a resident doctor covering high school football games, I got yelled at by a coach for pulling a kid out for he was having double vision after a hit. That has not happened, that was more than a decade ago, that has not happened since. And I think a lot of that's because of education. So that would be my, my first thing. And then the second thing too is, you know, there's the myth of, well, I just have to, you know, or. The myth of like, I have to wake you up every hour hour for neurologic checks. That can actually be pretty dangerous, too. So once a kid has been cleared, you know, just let them, you know, teenage kids, I always say this is a time where it's okay, you know, to stay in that dark, you know, dark room, no screens, but then also that early activity. And just to clarify my point, earlier some sort for some teenagers, if I say light activity, they say, Well, that's a pickup game of basketball. Yeah, what we're saying is, you know, maybe a brisk walk outside with some sunglasses and not, not a pickup game of basketball with your friends. Yeah.
Lindsay Gordon 25:31
Interesting.
Marcus Thorpe 25:32
I wish we had like, two hours to spend. I mean, I think we're gonna have you back, because I do think that this is an always evolving conversation. And as you both know, you're finding out new things every single day in the research, and you bring it to our audience. And I think it's so valuable. So it's been great. Thank you so much.
Dr Ben Bring and Obi Moneme 25:49
Thanks for having us.
Lindsay Gordon 25:51
And thank you to our listeners. If you enjoyed today's episode, subscribe to the wellness conversation wherever you get your podcasts.
Marcus Thorpe 25:57
And before we wrap up, if there's any health and wellness topics that you want us to cover on the podcast, we certainly would love to hear from you. Can drop us a comment and like and subscribe. It also helps us get the word out to our new listeners.
Lindsay Gordon 26:09
This episode transcript will also be available on the podcast page, so if there's any information you'd like to go back and read about, you can find us at ohiohealth.com/the wellness conversation as always, thanks for joining us.