Saturday, February 9, 2013

The Dangers of the Game

Eric Anderson

With the recent conclusion of the biggest American sports event of the year (obviously I am referring to the Bio Bowl), I feel that it is appropriate to discuss the controversial subject of brain trauma and player safety.  It is not until the recent years that this issue has been brought to the public’s attention, which is partially attributed to the fact that there was not much known about the permanent effects concussions can have on mental and physical health.  However, it is also because no one really wants to talk about how America’s favorite sport may be the cause of early retirement, or worse, death of its athletes.  But as football players keep getting bigger, stronger and faster, which some speculate is linked to performance enhancing drugs (yet another issue no one in the realm of football likes to discuss), the hits are becoming more violent.  Unfortunately, the big hits, in addition to making for more entertaining football, is what causes concussions.

What exactly causes a concussion?  And what makes them so dangerous?

The brain is contained inside the skull and is surrounded by a layer of cerebrospinal fluid.  The purpose of the fluid is to protect the brain by forming a cushion between the brain and skull.  But when a person’s head is subjected to a severe impact or a sudden change in speed, the brain can be forced through the fluid and collide the inside of the skull.  This can result in the bruising of the brain and damage to blood vessels and nerve cells.

But it gets worse…following the impact, billions of neurons in the brain will indiscriminately release their neurotransmitters.  This is extremely stressful for the brain.  The membranes of its cells become depolarized, as calcium ions rush into the cells and potassium ions rush out.  As a result, the cells need to work overtime in order to restore the membranes back to their resting potential, which is required for continued cellular function.  This causes an energy crisis because the proteins that pump ions across the cell membranes require energy in the form of ATP.  The cells are handicapped and not able to function at their optimal levels.  Consequently, it makes them very vulnerable to additional injury.  If a person is exposed to an additional injury while their neurons are in this vulnerable state, it may trigger a massive suicide of neural cells, resulting in permanent brain damage.

Short-term effects of concussions are pretty scary.  The injured person might lose consciousness, become confused, nauseous, feel like they are in a fog, and even forget events preceding their injury.  But as if that weren’t bad enough, the long-term consequences are much worse; especially for people previously exposed to head injuries.  Studies have linked concussions to chronic traumatic encephalopathy (CTE), dementia pugilistica (DP), Alzheimer's disease, amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), and Parkinson’s disease.  The most common disease for football players is CTE, which causes loss of memory, confusion, depression, and possibly death.

Now while there is still debate about weather concussions are an ultimate source of these neurodegenerative diseases, there is overwhelming evidence that suggests football players and participants of other high-impact sports, such as boxing and hockey, are more likely to suffer from one of these diseases.  One study found that NFL players with three or more concussions were three times more likely to develop significant memory problems than players that did not experience a concussion.  Additionally, there was and earlier onset of Alzheimer’s in retired NFL players compared to the rest of American males.  However, these athletes are being paid millions.  They know that there are risks involved with their profession and they chose it nonetheless.

But what about the youth?   

They are not being compensated for participating in this dangerous game.  If they are lucky they might earn a college scholarship, but the majority of high school football players will never play at the next level, let alone the NFL.  Yet, they are still being subjected to the same risks.  A study at Boston University looked at brain samples of deceased athletes who exhibited symptoms of CTE.  One of the subjects was an 18 year-old high school football player who had a history of concussions.  The researcher found evidence of CTE in his brain samples.  This type of damage is irreversible.

Image from: BU Center for the Study of Traumatic Encephalopathy
The brain samples from an 18 year-old football player with a history of concussions.
The black spots represent defective tau proteins surrounding blood vessels (holes), which is evidence for CTE

What can we do?

The NFL has been trying to limit the amount of impact the brain is subjected to during games by cracking down on helmet-to-helmet collisions.  Defensive players that deliver these types of tackles are subjected to fines and even suspensions.  The hope is that they can eventually change the culture and modify the way defensive players tackle opponents.  However, I believe this to be shortsighted and hypocritical.  Sometimes helmet-to-helmet collisions are unavoidable.  I don’t think you can expect a defensive player make a split second adjustment to avoid his opponent’s head when both players are running at full speed.  Especially, when that player probably grew up with his coach yelling at him to “lead with his head.”

For these reasons, I believe that the changes need to start with the youth and high school leagues.  Improvements to safety equipment can help improve player safety to an extent.  But players need to be taught proper techniques for tackling early on (and for the most part I think they are).  Furthermore, coaches and medical staff need to be better trained on how to recognize symptoms of concussions.  The Sport Concussion Assessment Tool (SCAT) is a tool that some teams use in order to diagnose concussions and schools like Mater Dei (California) have very strict protocols for when a player can return to the sport after suffering from a concussion.  But not all schools have the resources or knowledge in order to properly assess a head injury.  This is the biggest problem I see with football at this level.

In conclusion, I hate to see a sport that is so engrained in American culture be detrimental to its athletes.  I think there are steps that can be taken to minimize the severity of head injuries.  However, I feel that in order for the sport of football to retain its fundamental qualities, some of the harmful attributes have to be accepted.  I still get excited when I see a big hit like the one below, but I'm not sure that it’s a good thing.


Cantu R.C.  2007.  Chronic traumatic encephalopathy in the National Football League.  Neurosurgery 67: 223-225.

Giza, C.C. and D.A. Hovda.  2001.  The neurometabolic cascade of concussion.  Journal of Athletic Training 36(3): 228-235.

Guskiewicz, K.M., S.W. Marshall, J. Bailes, M. McCrea, R.C. Cantu, C. Randolph, and B.D. Jordan.  2005.  Association between recurrent concussion and late-life cognitive impairment in retired professional football players.  Neurosurgery 57: 719-726.

Lehrer, Jonah.  The Fragile Teenage Brain.  Grantland.  ESPN, 10 Jan. 2012.  Web. 6 Feb. 2013.  <>.

Omalu, B.I., S.T. DeKosky, R.L. Minster, R.L. Hamilton, and C.H. Wecht.  2005.  Chronic traumatic encephalopathy in a National Football League player.  Neurosurgery 57: 128-134.

Stern, R.A., D.O. Riley, D.H. Daneshvar, C.J. Nowinski, R.C. Cantu, and A.C. McKee.  2011.  Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy.  American Academy of Physical Medicine and Rehabiliation 3: S460-S467.

Talavage, T.M., E.A. Nauman, E.L. Breedlove, U. Yoruk, A.E. Dye, K. Morigaki, H. Feuer, and L.J. Leverenz.  2010.  Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion.  Journal of Neurotrauma: Oct 1 [Epub ahead of print].

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