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With all of the coverage given to knee injuries and broken bones caused by wakeboarding, most avid wakeboarders understand that although the sport can be a lot of fun, it can also be dangerous. Just like everything in life, there are risks surrounding every action that you take. Anything can happen. Who knows? You may fall down a flight of stairs and snap your femur, the exact same injury that I sustained nine years ago from falling on a switch backside 360. Risks are always present and we need to assess these risks and make informed decisions regarding them. To help you do that, I want to tell you a little bit about concussions, which, due to a few very unfortunate situations, have received a lot of attention over the past several months.

Let's start with a little lesson about the brain. This most important of organs has numerous responsibilities. It controls things such as cognitive thought, memories, emotions, equilibrium, sight, smell, taste, touch, hearing and much more. It also controls homeostasis, which is the general equilibrium inside the body, including heart rate, body temperature, blood pressure, fluid balance and more.

Obviously, the health of the brain is vitally important to its owner leading a normal functioning life. In order to keep it safe, the skull, as well as the meninges, surround the brain. The meninges contain cerebrospinal fluid, which helps cushion the brain from bumping into the skull when the head is hit by something or the head runs into something. Unfortunately, the cerebrospinal fluid isn't always able to soften the blow enough. If impact to the head is greater than that which the cerebrospinal fluid can handle, the brain rattles against the skull and may cause a concussion.

What actually happens when somebody gets a concussion? Typically, a concussion is caused by a sudden acceleration or deceleration of the brain causing it to slam into the skull. This, in return, can cause rupturing of blood vessels leading to a

lack of blood flow to certain parts of the brain. It can also cause axonal tearing, which means that the nerves aren't able to communicate properly with each other. These injuries can result in the degradation or elimination of communication between the brain and the rest of the body.

A concussion can be defined as an injury to the brain that causes any abnormalities in normal neural functions. The following list is a compilation of some of the more common symptoms associated with concussions. Please note that even one of these symptoms may be an indication of a concussion and that the severity of the concussion determines the severity of the symptoms.

• Unequal pupil size
• Unreactive pupils
• Nystagmus - pupils flutter when looking at peripheral vision
• Blurry vision
• Glassy or glossy appearance of the eyes
• Incoherent behavior
• Speech difficulties
• Dizziness
• Nausea and/or vomiting
• Tinnitus - ringing in the ears
• Drowsiness
• Loss of consciousness
• Loss of coordination
• Amnesia
  • Retrograde - can't remember what happened before the injury
  • Anterograde - can't remember what happened after the injury
• Bleeding from the eyes, ears or nose
• Temporary paralysis

These symptoms may occur immediately after the blow to the head or they may develop over several days. It is extremely important that an individual with a concussion understand his/her current symptoms and can recognize if these symptoms get worse over time. For most concussion cases, the symptoms will improve. However,

if they deteriorate, the head injury may be more severe causing an increase in intracranial pressure, which may lead to brain damage. In the cases where the symptoms deteriorate, it is imperative that the individual goes to the hospital to get checked out.

After sustaining a concussion, the symptoms may last anywhere from a few minutes to several days or even longer. It is important to recognize when the symptoms completely fade away and know that until they are gone, you should avoid anything that may cause the brain to be rattled around even a little bit. If there is a second head injury prior to the resolution of the previous symptoms, the individual may undergo what is called second impact syndrome. This can lead to swelling of the brain, which significantly increases intracranial pressure and to herniation. When this occurs, the individual's condition deteriorates quickly, which may lead to a coma and even respiratory failure. This is a morbidly serious situation, which has a 50% survival rate.¹

Head injuries can get really serious really fast, so it is important to recognize them as well as manage them. First of all, if you feel like something is wrong with you or one of your friends, don't hesitate to get to the hospital to get checked out. It's a lot better to go to the hospital and find out that everything will be alright with some rest than to regret not going and having a tragedy on your hands.

With that said, more often than not the hospital will tell you to go home and relax. You should probably have somebody with you just to help out and watch over you. They will also tell you that you shouldn't sleep for over one and a half hours at a time at least for the first night. The reason for this is to recognize the progression of the symptoms and to make sure that they are not getting worse and that the individual is not slipping into a coma.

When is it safe to resume wakeboarding or other impact sports after sustaining a concussion? Unfortunately, there is no clear answer to this question. Athletic trainers all have different guidelines that they follow before they allow an athlete to come back and start playing. Some of them base their guidelines on a time frame, while others analyze the athlete's performance and abilities.

Basically, what really matters when returning to a sport is making sure you wait for all of your symptoms to disappear and that you are back at baseline. Unfortunately, the only person that can tell you when you are back to normal is you. Make sure that you are being honest with yourself and don't rush your recovery with these types of injuries because there can be some serious consequences. This is a great opportunity to err on the side of caution by taking the extra time off and giving your body plenty of recovery time.

Helmets

When the concussion topic is discussed, the issue of whether or not to wear a helmet inevitably follows. When participating in a sport where there is a danger of the head coming in contact with a solid object, including hitting sliders and other obstacles on a wakeboard or wakeskate, it's a no-brainer. Simply strap on a helmet and you will greatly decrease your chances of ending up with a head injury.

However, when you're dealing with straight wakeboarding or wakeskating without any obstacles involved, the issue isn't quite as clear. Although hitting water with your head can sometimes feel a lot like hitting a solid object, it differs in the fact that your head is not actually stopping when it hits the water; it is being slowed down as it continues through the water. Therefore, factors that increase or decrease the rate of deceleration must be taken into account. Will a helmet increase or decrease the chance of injury when the head is entering the water at high speeds? There are valid arguments on both sides of the issue.

A helmet is effective in reducing the extent of a head injury by functioning as a direct barrier between the head and the surface of impact, by dissipating the kinetic injury of the impact, and by functioning like the crumple-zones of an automobile.

Unfortunately, these mechanisms may not apply in the water medium of wakeboarding. It can be argued that by increasing the cross-sectional area of the head, resistance is increased in the water, and a helmet would increase the decelerating forces on impact on the water surface. The increased torque could conceivably place additional stress on the cervical spine.²

Other factors that may increase injury include the bucketing affect of the helmet. The bucketing affect can take place when the edge of the helmet catches the water upon entry and water is actually forced underneath the helmet. This can increase the deceleration of the head and/or pull the head and/or neck in an awkward direction.

On the other hand, the padding in the helmet is going to help the head decelerate at a slower rate than if the head didn't have the benefit of the extra padding. Not only that, but no matter what kind of wakeboarding or wakeskating you do, you can't get away from the fact that there is always going to be a hard object in the equation; the board. Especially with wakeskating, there is always the danger that the board will come in contact with the head. If that ever happens, you will definitely wish you had a helmet on.

The affect of these factors all depends on the degree to which each is present in a particular helmet and the manner in which the head is entering the water. Unfortunately, there is no one "right" answer to the question of whether or not one should wear a

helmet when participating in non-obstacle wakeboarding or wakeskating. With so many variables involved (helmet type, fit and quality, speed, ability level, water debris, entry angle, etc.), the rider has to figure out what's going to work best for their particular situation.

Whether you're a rider, driver or passenger out on the boat, knowing what a concussion is and what symptoms to look for can make a big difference when you or someone you know suffers a blow to the head. Make sure your crew is aware of the dangers and, if a rider does get hurt, he or she takes the time to get right before returning to the water. Everybody wants to get back on the water quickly, but don't let that get in the way of getting back on the water healthy.

1. Prentice, William. Arnheim's Principles of Athletic Training: A Competency-Based Approach. 11th ed. New York: McGraw-Hill, 2001

2. Chia JKK, Goh KYC, Chan C. An Unusual Case of Traumatic Intracranial Hemorrhage Caused by Wakeboarding. Pediatric Neurosurgy 2000;32:291-294 (DOI: 10.1159/000028957)

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