Researchers have recently found a new sign of concussion that could help catch up to one-third of previously undiagnosed cases.
This discovery focuses on a quick head-shaking motion that often follows a blow to the head.
Though this movement has been shown in movies and cartoons for many years, it hadn’t been given serious attention by medical or sports professionals.
No official lists of concussion symptoms had included this action until now.
The lead author of this study, Chris Nowinski, Ph.D., co-founder and CEO of the Concussion Legacy Foundation, is pushing for this motion to be recognized as a clear sign of concussion.
Together with co-author Dan Daneshvar, MD, Ph.D., of Harvard Medical School and Spaulding Rehabilitation, they named it “Spontaneous Headshake After a Kinematic Event” (SHAAKE).
Their research, published in the journal Diagnostics, reveals that athletes who showed SHAAKE behavior reported having a concussion 72% of the time. Among football players, this percentage was even higher, at 92%.
So, what exactly is a SHAAKE? It’s a sudden shaking of the head side to side, typically happening right after a hit. This movement usually involves two to eight shakes per second and lasts under two seconds.
It’s not related to any other purpose, such as communicating or reacting to a minor inconvenience. The researchers believe that when athletes show this movement after an impact, it’s a reliable clue that a concussion might have occurred.
The importance of this discovery became clear after a controversial incident involving Miami Dolphins quarterback Tua Tagovailoa.
On September 25, 2022, during a game, Tagovailoa’s head hit the ground, and he was seen shaking his head quickly before losing his balance and collapsing.
Medical staff didn’t diagnose him with a concussion at the time, attributing his symptoms to a previous back injury. But if the SHAAKE movement had been recognized as a concussion sign, it might have raised red flags.
Four days later, Tagovailoa was back on the field and suffered another, more serious head injury that left him unconscious. If SHAAKE had been acknowledged earlier, it could have led to a more cautious approach and possibly prevented his second concussion.
Chris Nowinski emphasized that SHAAKE needs to be included in the lists of concussion signs used by sports organizations and medical staff. Coaches, medics, and officials should be trained to watch for it and remove athletes from play for further evaluation.
To understand how common SHAAKE is and its connection to concussions, the researchers surveyed 347 athletes between 18 and 29 years old. These athletes watched video clips of SHAAKE and then reported their own experiences.
The results showed that 69% of the athletes had experienced SHAAKE at some point, and of these, 93% linked it to at least one concussion. Athletes typically reported experiencing SHAAKE around five times in their lives.
Dr. Daneshvar, the senior author, explained that SHAAKE is a clear signal similar to other signs, like an athlete holding their head after a hit, getting up slowly, or losing balance.
He stressed that if an athlete shows SHAAKE, they should be removed from play to be checked for a possible concussion.
When the athletes were asked why they thought they shook their heads, many mentioned feeling disoriented, needing to “restart” their minds, or sensing changes in their awareness of space.
Other reported symptoms linked to SHAAKE included dizziness, headaches, difficulty thinking, and changes in vision or hearing. Some athletes reported shaking their heads due to non-concussion reasons like neck pain, cold chills, or emotional reactions to the event.
The researchers believe this finding could be a major step forward in improving concussion diagnoses.
Dr. Robert Cantu, CLF medical director and co-author of the study, highlighted that many concussions go unreported because athletes either don’t recognize their symptoms or fear being pulled from a game. He said it’s crucial to treat every possible concussion sign seriously to protect athletes’ health.
However, the study had its limitations. One challenge is that the data was based on athletes recalling their past experiences, which can be influenced by memory bias.
Additionally, most participants were from the United States and Canada, leaving open questions about how SHAAKE might vary in other regions or cultures. The researchers suggest that more future studies are needed to confirm their findings.
With these findings, researchers hope SHAAKE can become a recognized tool in identifying concussions more accurately and reducing risks for athletes.
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The study is published in Diagnostics.
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