Higher Altitude Protects Teens from Concussions

The human brain is a vulnerable thing, perched in its peanut shell on top of our walking, stumbling bodies. Humans who enjoy collision-heavy pastimes—say, tackle sports—put their brains in particular danger. And when it comes to concussions, young people are at even more risk than adults. Yet kids who play at at higher altitudes seem to be safer than their peers. The reason, hidden somewhere in the brain's squishy dynamics, might help protect kids and adults who are smashing into each other everywhere.

You don't have to travel to Denver's Mile High stadium for your body to start responding to altitude. "Relatively small changes in altitude can have significant changes upon the physiology of the body," say Gregory Myer and David Smith, both in the sports medicine department at Cincinnati Children's Hospital Medical Center. (The coauthors responded to my email jointly.)

At just 600 feet above sea level, the authors point out, oxygen in the atmosphere has already dropped from 21 percent to 20 percent. Your body notices this slight change and adjusts. One measure it takes, upon noticing there's less oxygen available than usual, is to send a little more blood to your brain. "This leads to a slight filling up of the brain space," Myer and Smith say. Your brain ends up squeezed just a tad more tightly into your head.

Wherever you are, if you get suddenly knocked on the head, your brain will ricochet around inside your skull's fluids. In actual scientific terms, it "sloshes." The delicate brain squishes and twists, and hosts of neurons fire all at once. You may black out. Afterward, you might have memory loss, confusion, nausea, dizziness, and other symptoms that can last for days or months. The looser, stretchier blood vessels in the brains of people under age 20 may explain why they're at even greater risk.

Concussions might be prevented if the skull could keep the brain from sloshing by holding onto it a little tighter—as it does at higher altitudes. To find out whether this works, Myer, Smith and their colleagues used data from the National High School Sports-Related Injury Surveillance System. Run by the University of Colorado, Denver, this study collects data on injuries from high schools across the country.

The authors looked at nearly 6,000 concussions from about 500 schools. The concussed kids were athletes in all kinds of sports, at schools ranging from sea level to 6,900 feet. When the researchers divided student athletes into those living above and below the median altitude—which was 600 feet—they saw a significant difference in concussions. Across all sports, kids at higher altitudes had a 31 percent lower risk of concussion. Among football players only, the results were essentially the same: a 30 percent lower risk at higher altitude.

It's an intriguing difference. As sports organizations and the public learn more about chronic traumatic encephalopathy (CTE) and the long-term risks for athletes with head injuries, the quest to prevent concussions is growing more urgent. High schoolers, though, don't travel to play like professional athletes do. Could some of their lower risk have to do with changes in their bodies that happen over a lifetime of living at a certain altitude? "Visiting altitude will begin creating a tighter fit the minute you arrive," Myer and Smith say. However, adjustment happens over the long term too. "Everyone is likely different in how quickly they respond [to altitude] and how protection occurs for them," the authors say. "This is why we are working to evaluate technologies that can give this same protection whether you are in Denver or Miami." They'll be looking next at adults and professional athletes to try to find answers.

One hint comes from an earlier study David Smith performed on rats. While wearing a collar that slightly squeezed their jugular veins, the rats were hit hard on the head. The collar seemed to make rats less vulnerable to concussion, apparently because more blood was in their heads, squeezing their brains more tightly and preventing sloshing. This all sounds pretty unpleasant for the rats, but Myer and Smith insist that "the technologies we are studying are no more risky than yawning or even the act of lying down."

Animals like woodpeckers and head-ramming sheep manage to protect their brains from damage, the researchers point out. So why can't we? Of course, in our case the head ramming is in the name of fun. But there might be ways to safeguard our brains, like these animals do, from the inside out.


Image: Rocky Mountain High School in Colorado, by Paul L. Dineen (via Wikimedia Commons)

David W. Smith, Gregory D. Myer, Dustin W. Currie, R. Dawn Comstock, Joseph F. Clark, & Julian E. Bailes (2013). Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes. Orthopaedic Journal of Sports Medicine DOI: 10.1177/2325967113511588