We had to wait ten years to understand. What happened to Raphaël Varane during the France – Germany match in the quarter-final of the 2014 Football World Cup? Usually so reliable, the French player misses a ball with his head. The crafty German Mats Hummels took advantage of this, diverted the trajectory and shook the nets. 1 – 0. At the end of the match, the “blues” are eliminated.
Ten years later, the player has just solved the mystery. The match before, four days earlier, he had received a blow to the head. A ball, full speed, full temple. He was still groggy at the fateful moment. The recovery protocol he followed had not fully recovered him. He revealed the existence of this concussion this Tuesday to the newspaper The Team. “I was not in my normal state,” he says today.
The player’s revelations focused on the rules of football. Should they be upgraded to avoid too dented heads? Rugby did this well, by prohibiting certain gestures deemed too dangerous. But a blow, in sport, as elsewhere, happened so quickly. How, when the damage is done, can we, like Raphaël Varane, prevent the suffering from lasting too long and reduce the after-effects?
In recent years, more and more scientists have focused on this question. Its interest goes far beyond sports arenas, as no one is safe, in their daily life, from an accident leading to a concussion. “For a very long time, sports medicine and medicine in general were only interested in head trauma, relatively severe shocks,” testifies Professor Philippe Decq, neurosurgeon at Beaujon Hospital (AP-HP), and advisor of World Rugby (the equivalent body to FiFA in football) on these questions.
Because, every time, it’s the same story. On the MRI, we see nothing. By definition, concussion is a mild shock, which leaves no trace on medical imaging. What’s more, victims only lose consciousness in about 15% of cases. In sport, very often, players return to the flow of the match. This was the case of Raphaël Varane, now retired from the France team, like many others.
Putting the brain to rest
But there are many consequences to these heads that are hit, or that collide. Around thirty symptoms are associated with these events, from memory loss to vision problems, including fatigue, balance problems and nausea. In some people, especially those like athletes who endure this regularly, these effects can last.
Since the 2000s, scientists and sports federations have been meeting to discuss, among other things, care. From these “international consensus conferences on concussions”, which review the science on the issue, a set of good practices emerged, which are now spreading outside of sport. Among them, the need in particular to reassure patients.
Because the challenge with concussions is finding how to put the brain to rest. “They temporarily disrupt the functioning of neurons. However, the brain needs energy to repair them. If we use it, we slow down recovery. A bit like a runner who continues with a broken ankle,” explains neurosurgeon Philippe Decq . To get better, you have to, in a way, stop thinking.
According to a study published in 2014 in the review Pediatrics, conducted on children and young adults, patients who engage in cognitive activities, such as reading, doing homework or playing video games, in an intense and prolonged manner, double the time to remission. And, even if we don’t do much, some patients think and think about the shock and the risk of after-effects. A blow to the head is not trivial, psychologically.
With his team, Philippe Decq set up a pilot experiment. He systematically calls his patients back, 10 days later, and gives them a questionnaire by telephone. Then, if they are still unwell after a month, they benefit from rehabilitation. Gentle physical activity sessions, preferable to total rest, in all cases. And psychiatric support, physiotherapy… “Before, we sent people home and told them to wait. But just by setting up follow-up, it reassures and reduces the remission time”, observes the neurosurgeon.
Biomarkers and treatments
Other scientists are trying to develop “biomarkers”, clues that can be seen or taken from the body, which would indicate whether the patient has a risk of after-effects or long-term illness. This is the case of Patrice Péran, Inserm research director. Under his direction, in the laboratory Toulouse NeuroImaging center, doctoral students attempted to carry out in-depth MRI examinations on athletes, five days after a first shock. But the experiment, which has not yet been published, produced nothing. “Here again, we do not see any lesion. We observe a slightly different functioning of the brain, but this cannot be exploited.”
Although several research teams have demonstrated that it is possible to differentiate, using MRI, healthy people from people suffering from concussion, for the moment, these results cannot be used outside of research. But according to the exchanges during the consensus conferences, which are the subject of scientific publications, the avenue is promising. Just like that of proteins. Some would be in abnormal quantities after this type of incident. Here again, it will take time before we can expect results.
More original, scientists hope that AI and video will one day be able to determine whether shocks are problematic, as explained in a publication by Clinical journal of sports medicine from May 2022. “Tomorrow, most athletes, amateurs and professionals alike, will wear equipment with chips that will measure shocks,” estimates Patrice Péran. And to cite the helmets and mouthguards of professional rugby, already augmented with such devices.
And for ordinary mortals? Apart from advances in treatment, some experts wonder if it would not be possible to find a drug that would help recovery. Researchers showed in 2021 that some proteins from platelets could be useful. Again, this is work still in progress. “At the time of the trauma, it seems good to have a small intake of sugar. And during the first week, omega 3. But these are not therapies, it is above all to avoid a deficiency and an aggravation”, specifies Philippe Decq. Which also helps to calm down.
.