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Brooke de Lench
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"Back in the Game": A Concussion Book That Stands Out In a Crowded Field

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The book begins, appropriately, with a chapter debunking common sports concussion myths and fears, mostly perpetuated by the media. Kutcher correctly identifies the tradition of contact sports and the peer-enforced ethic to be tough as reasons why so many athletes, even knowing the dangers from continuing to play with concussion symptoms, don't tell anyone about their symptoms. He bemoans a culture in which "leaving the game or admitting they were hurt was not an option" and in which an athlete's teammates, winning, or their own ego are prioritized above their health (a culture which, I should point out, our new 5-step SmartTeamsTM concussion education program is designed to change).

A helpful explanation of what a concussion is and isn't is followed by a section in which Kutcher clears up the confusion in the minds of many between concussion (a term which, he says, should only be used to describe the injury or the immediate effect of the injury resulting from concussion forces transmitted to the head), post-concussion syndrome (symptoms patients experience for several months at a time when they are likely no longer concussed), and the problems former athletes, especially in contact sports, experience with their thinking, mood, and memory later in life, when they are no longer concussed, and the serious neurological condition they have as a result of playing sports is not itself a concussion and likely more the result of how often they were hit than their concussion history.

Kutcher and Gerstner then introduce what I view as the book's most valuable contribution to the concussion book genre: the medically inaccurate memes parents, coaches, and athletes are receiving from the media which have created a "tangible mounting fear of concussion" and a "state of near panic" about concussions, causing parents to avoid contact sports for their children based on "irrational fears of injury" which fail to weigh in the balance all the positive aspects of sports participation.

While the media's emphasis on the heartfelt and tragic stories of athletes dealing with mental illness and those who commit suicide may sell newspapers, improve ratings, or get a website more clicks, the concern, Kutcher and Gerstner argue, is that it is driving the conversation to emotional places from which it's an easy leap to conclude that contact sports, such as American football, must be a dangerous endeavor, only leading to pain and despair.

As a journalist and consumer of social media, I have been a frequent critic of the way media reports on concussions and head injuries. As someone who has tried every day for the last sixteen years to ground my advice on sports safety issues on science, I couldn't agree more with Kutcher and Gerstner when they argue that such memes "seem like fact, only because anybody with a little knowledge - and sometimes a lot of agenda or desire to gin up a false debate - can get on television or radio, or go on a Twitter rant to vent their thoughts to a large audience without challenge or fact-checking."

While the public has become more receptive to discussing concussions as an issue in sports, it is also heartening to know that the authors share my belief that the facts of the discussion have become "garbled" as a result of the media's morbid fascination with the heartbreaking stories of athletes, including Dave Duerson, Junior Seau, Kosta Karageorge, who were assumed to have had concussions and then committed suicide because of depression. Players who die, sometimes through suicide, are declared "with great fanfare" to have gotten CTE from concussions, when the reality, the authors say, is that concussions and long-term effects like CTE "are two completely different processes that may not even be related."The big problem, medically, says Kutcher, is that "we are not even close to understanding the connections that might exist between sports, concussions, depression, suicide, and CTE," so that linking concussions with suicides, is, in his view, "tenuous, and in a greater sense, also quite irresponsible." Again, while he's preaching to the already converted (I have been saying much the same thing for years), it is a message that all sports stakeholders need to hear.