Nicholas Kent is an 18-year-old ice hockey player for the Vernon Vipers in British Columbia, Canada, playing at a semi-professional level for the past four years. During one life-changing playoff game, he was hit into the boards. 

Rough body contact is nothing out of the ordinary in such a violent game, but he knew this hit was different. Regardless, he had no intention of stopping.

“I mean, I can’t stop,” Kent said. “It’s a playoff game, and [after] coming this far I had a job to do. Coach has a high expectation for every one of us, so I didn’t want to be the one to let him down.” 

And so, despite the pain, he continued the game, not realizing the consequences that would follow. 

Days after the game, his lingering pain began to intensify. He began to feel weak and nauseous, finding himself unable to skate or even stand. He continued to ignore the pain until he was finally forced to visit the emergency room. During his wait, his body finally gave in to his injury, and he passed out on the floor. 

Kent ruptured his spleen, resulting in a 25% loss of blood in his circulatory system. 

He was hospitalized for three weeks, during which he received three blood transfusions and multiple surgeries. His immune system was severely weakened, and even years later, Kent must still take extra precautions to protect his body.

Kent’s story is far from uncommon. Sports’ “walk-it-off” culture pushes athletes to keep playing despite sustaining significant injuries while playing.

According to a study conducted by Stanford Children’s Hospital, about 30 million children and teenagers participate in sports, and sustain over 3.5 million injuries annually. The majority of these include non life-threatening injuries including sprains, strains and broken bones. However, among fatal injuries, traumatic brain injuries (TBIs) are the primary cause of sports-related deaths. Sports activities account for approximately 21% of all TBIs among American children. 

One highly prevalent injury associated with full-contact sports is a concussion: a traumatic brain injury that affects memory, speech and overall cognition. Over recent years, there has been an estimated 1.6 to 3.8 million concussions in the U.S., affecting young athletes and producing lifelong consequences. 

To diagnose concussions, a physician performs several exams that test the patient’s overall cognitive abilities. Physicians will commonly use the ImPACT test, which includes verbal and visual memory, brain processing speed and reaction time. They may also order imaging tests including MRI or CT scans to ensure that there is no bruising or bleeding in the brain. 

However, concussions are not always diagnosed at the time of injury. 

A retrospective study conducted by Dr. William P. Meehan III, director of the Micheli Center for Sports Injury Prevention in Massachusetts, found that nearly a third of patients included in the analysis reported having concussions that were undiagnosed at the time of the injury. 

When concussions are not reported or are not diagnosed at the time of injury, athletes lack the proper directives needed to prevent further neural deficits. Some areas of the brain controlling mood, cognition and motor skills may be affected, inducing long-term damages if not treated properly. 

“Concussions lead to attention problems, which we can see using sophisticated techniques such as the EEG. This may also lead to motor problems in young athletes. This thinning [of the cerebral cortex is] correlated with memory decline and attention decline,” said Maryse Lassonde, a neuropsychologist and senior Canada research chair in Developmental Neuropsychology. 

When athletes are diagnosed with a concussion, sports physicians recommend reasonable physical and cognitive exercises and are advised not to participate in any physical activity that would shake the head. After injury, athletes are encouraged to engage in cognitive stimulation exercises such as reading or problem-solving to regenerate neural pathways.

In the normal aging process, cognitive abilities including processing speed, memory and language skills begin to decline. However, concussive head trauma has been shown to accelerate this process following significant traumatic brain injuries. 

“Concussions should not be taken lightly. We should really also follow former players in clinical settings to make sure they are not ageing prematurely in terms of cognition,” Lassonde said.

Howard L. Nixon, Professor Emeritus of Sociology at Towson University in Maryland, studied how individuals in sports networks, or “sportsnets,” influenced the culture of risk and pain in sports. In multiple studies focusing on both individual athletes and coaches respectively, Nixon said that players are expected to play as long as possible even in the face of pain or injury. 

“This culture of risk [taking] can foster guilt, shame, uncertainty, job insecurity, and frustration among those who complain about pain and injuries,” Nixon said. 

Athletes like 18-year-old Nicholas Kent who continue to play after sustaining significant injuries are affected by this “walk it off” culture, taking unadvised medical risks and sustaining life-changing injuries, like concussions, to stay in the game. 

It’s tough, you know. It sucks that even now I still got to watch out for a lot of things. I wish I’d been able to catch it sooner,” Kent said.

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