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.
References
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. <http://www.grantland.com/story/_/id/7443714/jonah-lehrer-concussions-adolescents-future-football>.
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].
Very well written!
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