Can a tap/light slap to the back of the head cause mTBI (concussion)?
 

Hey! I am back with yet another paranoid concern for my mental health! On a quick side note, if you're experiencing deja vu regarding this type of question within this category and even my profile, there is a perfectly plausible reason for this. My previous thread from not too long ago was: "Can you get a concussion from turning your head too fast?"

And btw, thank you so much for your thorough replies. I am still grateful for them at this time. It's so delightful to know I can always turn up on this forum if my worries exceed my capacity to comprehend it.

Something I am currently wondering, since I've been so anxious about the question specified in the title, during to agitation being triggered by merely a friendly intended slap on the back of my head, by a acquaintance in school. He tapped me 3 times to be precise, now this might just be me overestimating my memory of the "impact", but it felt pretty rough to be considered taps to the head. So to be on the safe side, I would say it was taps at the brink of being slaps.
Ofc, there is no way I, or anyone, can prevent or foresee the actions and urges of other people, friendly intended or not. He is a very nice guy and could've in no way known I am very fragile about my brain. You guys know the taps you do to signal: "Hey, everything's gonna be alright"?, it was one of those, if you guys can follow me :D. Which leads me to think that my slightly altered perception of the world after the slaps/ rough taps is really my anxiety spiking?

Also, doesn't soccer players head the ball at much higher impact and mostly only at risk for sub concussive impacts even then?

So well, to wrap it up, since I've had no deficits in physical symptoms nor cognitive symptoms, emotional symptoms such as anxiety must've been caused by natural reactions in the body? I mean, I've always thought that anxiety/depression is a complication of mTBI in extreme cases, and something that only rarely manifests itself in PCS.

You said "I mean, I've always thought that anxiety/depression is a complication of mTBI in extreme cases, and something that only rarely manifests itself in PCS."

Anxiety is likely the worst and most common symptom of PCS. It appears to have a firm grab on you. Many who suffer a concussion already have a propensity for anxiety. For these, a very minor concussion with mild symptoms can often be almost overwhelming.

Regarding these taps and concussions or other. It does not make any difference. If these taps, head turns, etc. cause symptoms, then they should be avoided. When they can not be avoided, one needs to learn how to move on and just deal with the symptoms. To paraphrase the saying, Hits happen. Same letters, just a different order.

When these friendly touches happen, I would start with a firm statement. "Do not touch my head." There is no justification for such a behavior, even as a friendly gesture. For me, it is not the touch that is the problem. It is the head jerk afterwards that can effect my head or my neck.

And please try to stop trying to label everything. It is a negative effort. Concussions and mTBI's are just terms to define clusters of symptoms after an impact to the head. It is only the symptoms that matter, especially at the lower end of the impact scale.

Alright, another thing that bothered me was if pressure is put on the skull, is it possible to cause brain damage? The diagnostics for a concussion is a severe and violent shake of the head, but what if there is no movement of the head, but instead simply a bit of pressure on the skull. Isn't the skull build to withstand pressure without the brain getting affected? A demonstration could be, taking the palm of your hand and pressing down on your head hard. Could this in theory affect the brain? Or does it just feel that way. So yeah, my question is pretty much, can pure pressure reach the brain, from external forces, i'm not talking intracranial pressure just so you folks are aware.

No pressure against the skull will not cause a brain injury unless that pressure fractures and crushes the skull. Even then, the brain's ability to be pliable and moldable would mean it would take a severe crushing to damage the brain.

The discomfort felt is the skin and related nerves on the outside of the skull.

Hi Minimac,
It might be helpful for you to look up the anatomy involved. It might help explain certain things that are worrying you.

Also, between the skull and the brain lies the meninges and that acts as a cushion of sorts. The thickness of the skull varies somewhat from individual to individual as well. In my case it was noted that I had an extra thick cranium :rolleyes: . At the time I found that an odd thing to be told but in retrospect it probably saved me. There are also differences in skull shape to be considered.

Here's a nice user friendly link with pik of anatomy:

http://www.medicinenet.com/head_injury/article.htm

It just feels like when I put pressure against my head it affects the inside of the skull, but I guess the body can't differentiate from nerves covering the skull and the inside, in terms of discomfort. So even when it feels like pressure transmiting some kind of weird energy into the inside of my skull it doesn't? It's impossible for the skull to put pressure on the brain without it fracturing then? I read somewhere that the skull can withstand more pressure than the human is capable of putting on it (with their hands of course), so yeah, what I am really worried about is if the skull can move if pressure is put on it, like it suddenly starts bending a bit inward irritating the brain? Or do you literally have to crack your skull for it to change in shape?

EDIT: Isn't a sudden impact resulting in brain shake a type of sudden skull pressure too?

The skull has a natural ability to absorb forces that cause very minor changes in skull shape. Those minor changes do not affect or injure the brain. The brain has too much flexibility. It has the consistency somewhere between a bowl of jello and a hard boiled egg. It can change shape when under pressure but returns to its original shape. Studies suggest the brain can tolerate 60 G's of impact force without sustaining noticeable damage. Some say this tolerance level is as high as 90 to 120 G's for very short periods (microseconds). Boil an egg and carefully peal it and see how much the egg can deform. The egg does not tear or show signs of tearing yet you can deform it quite a bit.

Minimac, You need somebody to help you with these anxieties. They are not healthy for your brain. They are not rational. They create stress chemicals that delay healing. We live in a very imperfect world. There is risk everywhere. Most of that risk can be easily tolerated. Some of us need help to learn how to put that risk into a healthy perspective.

My best to you.

Yeah, I realize time and time again that my fears and symptoms turn out to be the product of anxiety. But does what you're saying mean that the brain also can withstand 60 G's in concussion scenarios too? So the brain has to slam into the skull at a speed of approximately 60 G's for an average person to produce a concussion? Or is that pure pressure?

You would never be able to put forces equal to 60 G's against the skull without causing serious structural damage. The 60 G's is force transmitted through a football helmet where the force is spread across the skull.

It appears you do not understand G forces. When you are standing still, you are exerting 1 G of force on the ground through your feet. If you jump off a chair onto the ground, you feet might hit the floor with 20 to 60 G's. At 20 G's, your toes think they are holding 20 times your body weight. They can not do this so they collapse and your knees bend to absorb these forces.

If you are running or jogging, you foot hits the ground and experiences a load of 2.5 to 3 G's, as if you are 2 1/2 times your actual weight. This is just a momentary force, maybe 1/5 of a second.

An adult brain weighs about 3 pounds. If it hit the inside of the skull at 60 G's, it is as if a 180 pound object hit the inside of the skull, but only for milliseconds. It there is no rotational forces, this 180 pound impact is tolerable if inside a helmet that spreads the forces across the entire skull and across a longer time period.

The entire brain and skull weighs about 8 pounds. It it hits a brick wall at 60 G's, it hits like a 480 pound object hitting at a small point. I can't explain it in ways you would understand except to say, these forces will be far more damaging to the skull and brain inside.

For those of us who have already experienced concussions, we may not be able to tolerate anything near this 60 G level. I know that I can't.

None of this applies to you unless you engage in activities where you impact your head into solid objects or whip it back and forth violently.

There is no way to relate G forces to pushing against you skull with your hands or such.

To help explain how you lack of understanding is causing you unnecessary anxiety, please read this web page then tell me if you are afraid of DHMO ?
http://www.dhmo.org/facts.html

The facts don't state this but excessive DHMO in the brain can be fatal.

Then, I will tell you why you don't need to fear DHMO.

Wait, so even doing a head stand will put more pressure on the skull than you are able to do by pressing down with your hand? Is it still only 1 G force when doing head stand because I am standing still? Or is it my weight that plays a role here then?

Many people do head stands everyday and their skulls seem to be able to withstand this huge amount of pressure coming from their own bodyweight. What I'm wondering is if you can press down harder on your skull, creating a bigger pressure with your hands, than your own body weight is capable of (in a head stand).

You said that there were nerves outside the skull? So its those that makes me feel this occasional discomfort and as if there is some kind of constant pressure/tightness after pressure on the skull.

As in terms of DHMO, yeah I am a bit concerned considering it can be in food and such, but its more the thought of head injuries from external forces that gets on my nerves, because here you have a some control depending on how careful you are, and it's so easy to blame oneself for harming your own health due to stupidity.

DHMO is water. That site is a humor/gag site to fool people.

Mark is illustrating the persuasive power of the internet. ;)

Yeah that's what I thought, according to the chemistry formula DHMO = H2O.

EDIT: I just found out that since the head is shaped like an arch form it is very resilient towards a slowly/gradual increase in pressure as opposed to a sudden blow. I read that 50 psi can crush the skull in a sudden impact opposed to a gradual increase in pressure where 400 psi is required!

Anyways, totally stupid thing to worry about, but what are the symptoms of a fracture in the skull, would you definetely know if you had one? Or could you have it without even knowing...

mrsD is right. Minimac, the point is you need to put all of these issues in perspective based on complete factual information. There is a huge difference between doing stupid things and living a life in a very imperfect world. Hits happen. We can only do so much to reduce this risk.

Bumping ones head on a car door frame is an accident, not stupid behavior. We may struggle with balance and coordination and bump into things. That struggle is not stupidity. There are plenty of other accidents that can happen that are just accidents, not stupidity. Now, if one were to engage in risky activities and suffer a head bump, that would be poor decision making. There are ways to improve decision making skills.

We need to be able to live our lives without thinking everything we do is going to hurt us.

Regarding DHMO, Water is necessary for life. We live with it every day. We accept responsibility to minimize risks by not driving fast on wet slick roads, etc. But, we don't curse water and fear it at every turn.

The Serenity Prayer addresses these issues. Google it. You'll see what I mean.

My best to you.

I know it will always be uncertain circumstances, but I do wish to ask one final question, just to be sure I got the facts right. Gradual increasing pressure on the skull (applying pressure on the skull with weight as in using your hands) and a sudden forceful impacting blow to head causes the same kind of pressure on the skull right?

Sudden impact, and slow gradual exposure to pressure is the same thing am I right? Both scenarios apply pressure to the skull each in their own way?

Say for example you fall, the impact from the fall causes the same kind of pressure as in if you press down with your hand right? Of course the fall will result in far worse damage since speed, g force and a load of other stuff has to be taken in account. But principally the two things expose the skull to suffer from the same kind of thing? A blow and applied pressure has the same effects on the skull?

I may be repeating myself, but this pressure couldn't reach the brain without skull fracture right?

This'll be my last question, because I fear my thoughts will keep spinning for assurance which I simply cannot get as you implied :)

There is no comparison between pressure against the skull and the skull suddenly stopping when it hits a hard object. It is not the skull that is primary issue. It is the acceleration and deceleration of the brain and what happens when it hits against the inside of the skull.

I don't understand the purpose of this question. Are you letting somebody press on your head ?

No I accidentally pressed too hard down on my own head to correct my hair because it was popping out, pressed so hard it caused discomfort for a short while. And well yeah, it basically made me worry.

The pressing on your head did not cause anything other than a surface irritation. Your anxiety has turned it into a multiday waste of your time and emotional energy. You seriously need to find someone who can teach you anxiety reducing skills. Your life will be miserable unless you can get control of your anxiety ridden thoughts.

You also need to learn to just trust people who are more knowledgeable then you. You don't appear to have the reasoning skills to properly understand concepts like this. That is understandable. Not many people can grasp the complex issues of G's forces and pressure. So, please try to stick with the hard boiled egg analogy. It is probably the best way to understand the pliability of the brain.

My questions and concerns have been more infrequent lately, which definitely is a huge positive for me, and I plan to keep it that way. Though something has come up even though I slowly refrain from using this forum for answers, as it actually does end up making it worse if it gets too excessive, so i'm gonna have to use this forum in healthy moderation as goes for everything.

These last days a very small but hard metal object hit my head, well actually I was holding the metal object in my hand and had to scratch the back of my head when the blunt grip of the knife accidentally hit my head. My question is this, would a small moving object impacting the head only affect the skull since the actual head isn't moving at all? I mean the smaller the object the less impact frequency right? The less the head moves. I am sure my head didn't move at all during the impact so does the skull simply do it's job and absorb all of the forces? Or can a concussion actually still potentially occur in such a case? And another little concern is the hair roots and follicles. Can they get damaged during blunt or sharp edged trauma? I think I might have stabbed my head slightly with the pointy edge of the knife too, no bleeding or anything, but could it still permanently damage the hair roots? Or are the roots sitting at the bottom of the scalp? I am worried they are placed at the surface. And also, does a sharp edge increase the odds of a concussion? Generally I believe a knife is too lightweight to cause any concussive blow and also it wasn't even sharp enough to cut through skin, only the pointy edge was somewhat sharp which unfortunately came into contact with my scalp too.

It does not sound like the forces were even close to being a sub-concussive blow. The point of the knife concentrated the energy but still was not intense enough to cause a problem. Hair follicles are quite resilient. It takes serious skin damage to scar over the follicles. I doubt this happened.

My best to you.

Probably my thoughts deceiving me as usual. Though the blunt part of the knife hurt a bit and caused quite a loud sound, but it felt almost like the equivalent force of your hand knuckle bones knocking on your head, kind of the same sound occurs with both, just a bit more noisy with the knife probably due to the material and the fact that it's not covered in skin like the bones are. Regarding the pointy edge it caused quite an itchy feeling after, like as if my skin got pressed down and a small dot mark appears. But my guess is that the skin covering the skull is a bit more tough than that of ordinary skin? Maybe a bit like leather similar to that of the skin on the elbows?

EDIT:
When you mention: "concentrated energy" do you refer to the event of such a hard focused blow temporarily changing the shape of skull or fracturing it? I mean how's it possible that a hard blow to a small area can cause sub concussive impact if there is no movement of the head itself? If that's what you meant. Can the skull move even though the head doesn't when the energy is concentrated to a small area?

Concentrated energy means all of the force is concentrated on the small surface area of the tip of the blade. That concentrated force is why you felt the contact. If the tip of the blade had a larger size, you would hardly notice the contact.

This was not a sub-concussive impact.

How is you search for help with your anxieties going ?

Scratching the back of your head with a sharp pointed knife? :thud:

No you're getting the wrong idea of it. Well yeah I was kinda scratching the back of my head, but not with the knife on purpose. It just kinda stabbed my head quickly, that's it. Wasn't meant to touch my head with it, just one of those times where stuff happens and you realize you never should've wielded a knife while touching your head with the same hand, sounds obvious, but really didn't think about it at the time.

Haha enough explanation. A last question, is concentrated force more likely or less likely to cause a concussion? If it was spread across the skull instead of a small area, would the odds of concussion be higher or lower? Or is concentrated energy what causes local concussion injury in one area of the brain and spread energy causes, well, spread brain injury? Or does that have no relation at all?

Since there was no acceleration or deceleration of the head I can be sure no concussive injury happened? Or is there other factors to consider? Cause I've never been told that any other phenomenon can produce it.

The 'concentrated' force has nothing to do with concussion. I was only mentioning it regarding the pain you felt to that small area of your skin.

The rest of your questions do not even make sense regarding this knife issue.

It is apparent you either don't understand the basic concepts of force/physics or don't want to accept the basic concepts of force/physics because they conflict with your anxieties.

There is no point in further discussion regarding these concepts. Your issue is not about forces against your head. The issue you need to resolve is the anxiety you have and how it causes your mind to twist and distort information to try to make it support you anxieties.

You need to find help with your anxieties. No amount of discussion of the forces will resolve your anxieties.

I'm doing everything I can to subdue my anxieties, and it's slowly working, but this is one of those times where it's an occasional setback.

If say, I did fracture my skull from doing it, it would hurt like hell right? I would get a terrible headache even though it's only a tiny hole due to the pointy edge of the knife. I mean, my nails almost hurt equally much if pressing on the head. But if it hypothetically did penetrate the skull in any way, even by a tiny bit, signs and symptoms would always occur right? No longer scared of the blunt part of the knife impacting the head, now it's more if it could've. stabbed through the skull creating a small hole I wouldn't notice or feel.

EDIT:
It sounds like I stabbed myself in my head with a sharp focused blow, but its nothing like that. More like the force of dropping the knife from a low altitude impacting with the tip of the knife.

Yes.

Yes.

The main sign of having stabbed oneself in the back of the head with a knife would be bleeding... lots and lots of bleeding.

If you penetrate your skull with a sharp instrument, your major worry would be infection, IMO.

example:
http://columbianeuroicu.org/diseases/infections.html

Yes. I recently slipped and fell backwards and slammed the back of my skull into the edge tile of an outside unsealed terracotta step (known for holding moisture and moss). The amount of blood loss was grossly scary for such a smallish wound. The thing I was most concerned about the actual wound itself after they cleaned it out and stitched it up was infection because some of the debris was still imbedded in the skin around the wound.

btw Minimac, you would need to penetrate the skin before you got to the skull.

Yeah but what if it penetrated the skin without me knowing? Would it still cause lots of bleeding by such a small wound? I mean the skin covering your skull feels fairly thin, only the forehead seems to have a thicker layer of skin covering. Please don't judge now, but I tried with the same strength on the forehead with the somewhat sharp object, it didn't penetrate the skin on the forehead, don't even think it left a noticeable mark indicating any kind of impact. But just worried that the skin is much thinner at the back of the head or top of it.

Yes. The head bleeds more than other parts of the body because there are more blood vessels.

Minimac, this is not the first time you have attempted to harm yourself to prove a point to yourself. I'm not judging you, I'm concerned about you.

We've talked about this before... about the obsessive thoughts leading to the compulsive actions.

It would take a lot of force to cause more than a skin injury from a blunt knife. The skull has been known to deflect bullets when hitting at an angle. It is a tough chunk of bone.

Keep in mind that before you can injure your skull, you need to penetrate the skin. The skin over the skull has a lot of blood flowing through it. Cut it and it bleeds bad. You'd be bleeding awful bad before you ever did any damage to the skull. It would take a strong direct stabbing action to penetrate the skull. The knife blade would likely break first, before any serious penetration beyond just a nick.

With all due respect....

You don't just have "skin" on your forehead. You have a thin layer of 3 types of skin, followed by a thin layer of muscle, then a sheath of tough fibrous fascia, then the periosteum of the skull bone (which has nerves and blood vessels mixed thru it which feeds and maintains the bone), then the skull bone, then the dura mater which protects the brain.

It takes considerable force to penetrate all this. The fibrous areas are tough and for a good reason.

Why in heavens would you use a knife on yourself to experiment this way? Where are your parents?

Minimac
I am not sure if you have seen our other forum community but you may find it beneficial http://forums.psychcentral.com/

specifically the OCD forum
http://forums.psychcentral.com/ocd-trichotillomania/

and the anxiety forum
http://forums.psychcentral.com/anxiety-panic-phobias/

It's a blunt knife as stated yeah, and thanks for the links. Probably time I switch over, not so relevant to actual concussion anymore.

But since we're discussing it anyways, I want to direct it back to hair follicles to get it fully covered. I'm fairly sure now that it could've never penetrated the skull or skin. But a last question I still struggle to label an answer on. In what of the three skin layers are the hair follicles, most importantly the roots located, and would for example hitting your head on a sharp edge of a table or something permanently damage some hair roots? Or to stay on track, a blunt but with an edgy knife/object? I picked up that it took serious skin damage, but to what degree? Bleeding?

If the knife didn't pierce all the way through the skin, the skull would only experience blunt trauma if anything, right?

I vow I'll be transferring to one of the forums above, if need be for future concerns, as soon as I get this straight.

I doubt the skull would suffer any trauma. Only the skin would suffer trauma.

Mac,

It sounds to me like you're suffering from extreme Obsessive Compulsive Disorder and you should be seen by a Psychiatrist to help you with the anxiety. I can relate to your thought patterns. Seek help from a professional and you will feel better! Just try to look at this thread from the beginning and realize what you have been talking about.

IF, in the extreme unlikely event I hope, the skull was pierced by a pointy or edged object. The person experiencing the trauma would be able to distinguish between skin trauma and skull trauma, am I right? It would feel differently. And also, if the skull was impacted by a pointy or edged object it would likely be stuck in the head if it penetrated it, no? It's just that I read it more easily can be damaged by low velocity objects as opposed to blunt forces which is what it only effectively can protect from.

Yeah I can see the worrisome pattern. I've read through some other of my threads also, and since I no longer fear those subjects I can easily spot how my concerns emerge and direct those threads offtrack