Pardon the Interruption – a concussion discussion

The arrival of September brings cooler weather, warm sweaters, harvest-themed activities, and feel-good coziness. But above all of that, we know it’s the start of the college football season. We grab our favorite sports gear, pack our cars, and go to tailgates. And then, revved up with all our friends and family, we stand with our team through their plight on the field.

But what if I told you that problems on the field extend beyond the repercussions of fumbles and turnovers? What if I told you there’s a looming threat over every player each time they set foot onto the field?

These dangers take the form of injuries and can happen to any player. Injuries usually involve fractured bones, tears, sprains, and strains. These are usually visible and unsightly, but growing public health efforts have recently focused on the injuries that are harder to see, namely, concussions.

Concussions (mild traumatic brain injuries) are caused by an impact to the head, which can disrupt normal brain functions. Concussions are tricky to diagnose because their symptoms can vary from quite mild (headache) to very severe (amnesia), but determining these symptoms can be subjective and often leads to unreported or misdiagnosed cases.

Researchers at the University of North Carolina at Chapel Hill conducted research on the number of concussions athletes received throughout their pre-season, season, and post-season practices and games.1 In addition to football, researchers observed men’s and women’s lacrosse and soccer, both of which are also high-impact sports.

Teams from high schools and colleges were observed throughout the year for concussions. Athletic trainers were in charge of diagnosing the concussion and recording the symptoms and severity at the time of the incident as well as at various follow-up assessments.

The study revealed that head-to-head collisions in football and soccer accounted for the most frequent type of concussion. Stick-to-head contact in both women’s and men’s lacrosse was the second most frequent type. Also, goalies in soccer were more likely to receive concussions than goaltenders in lacrosse.

Overall, football had the highest number of concussions than any other sport with nearly 64% (over two-thirds) of concussions occurring among these athletes.

Interestingly, the rate of concussions was the same among college and high school athletes and occurred more frequently during games than in practices. Although both had similar rates of concussions, the economic burden is greater among the 7.1 million U.S. high school athletes than the 380,000 college athletes.

Finally, and most astoundingly, the researchers found that if an athlete had previously experienced a concussion, the chances of receiving another concussion increased. This is perhaps due to dysfunctional neurotransmitter activities along previously injured neurons in the brain. It is also true that the likelihood of repeated concussions also depends on the playing style of the athlete or the team. Whichever the reason may be, more research should be dedicated toward uncovering the reasons for this connection.

If we know the economic burden is greater among high school athletes and the likelihood of concussions increases with prior concussions, what happens when we enroll children in tackle football? What are the effects of playing high-impact sports at younger ages? Are we exposing them to unnecessary and permanent neurological damage?

Between ages 10 and 12, the brain undergoes a critical phase of development, but long-lasting problems associated with trauma during this time are unknown. One research team from Boston University sought to find a connection between early-life exposure to high-impact sports and cognitive effects sustained throughout the years.

They tested 42 former NFL players aged 40-69 who were exposed to tackle football either before the age of 12 or after the age of 12.2 The athletes took tests that assessed their cognitive function, memory, reading, and word pronunciation abilities.

Both groups of former NFL players performed below average on the cognitive tests; however, the NFL players who began tackle football before the age of 12 performed significantly worse on all tests when compared to the players who began football after the age of 12.

Although athletes from both groups averaged over 350 overall concussions, this research did not focus solely on concussions. Instead, results from these tests generate awareness of general impairments as a result of head trauma at young ages.

Just because a child appears alright after games and practices, exposure to activities that disrupt brain development can affect the child in later years when the brain has to recruit those underdeveloped regions and fails to function normally. This can be seen with the poor cognition, memory, and verbal test results from the study as football players who were tested on activation of crucial brain functions resulted in dysfunctional and below-average outcomes.

As always, there’s a call for more research. What are the effects of early-life exposure to high-impact sports in both males and females? Brain development differs between genders and could result in different outcomes for female athletes. More research should be conducted in adolescents and young adults as they engage in high school and collegiate high-impact sports to solidify the real reason for increased concussion risk after a previous exposure?

Fortunately, we’ve seen a rise in the development of new helmets equipped with accelerometers and other data-collecting features. But what about sports without helmets, like soccer? How do we address preventive methods for soccer players? How about other sports like ice hockey and lacrosse that, although they require helmets, can also lead to concussions through different avenues (i.e. stick-to-head collisions)?

We love watching sports. We especially love watching football, whether it’s at the youth, high school, collegiate, or professional level. It’s a good time for everyone. But no one likes to see their favorite player get injured or sit on the sidelines for the rest of the season. Awareness of concussions and other sports-related injuries can help ensure that our favorite athletes are well-protected and that their coaches and athletic trainers know how to properly respond to any injury. The public also needs to be aware that these risks extend to their own young children engaged in team sports. More research leads to more awareness and education to best equip and protect our favorite players.

We all want to be able to wear our favorite team colors proudly and see our team, healthy and fit, take on the rivals. So let’s grab a seat, wear our war paint, grab a couple of BBQ wings, and cheer until we’re hoarse. May the best team win.

Stay healthy!

1 Marshall, S.W., Guskiewicz, K.M., Shankar, V., McCrea, M., & Cantu, R. (2015). Epidemiology of sports-related concussions in seven US high school and collegiate sports. Injury Epidemiology, 2(13), 1-10.
2 Stamm, J.M., Bourlas, A.P., Baugh, C.M., Fritts, N.G., Daneshvar, D.H.,…& Stern, R.A. (2015). Age of first exposure to football and later-life cognitive impairment in former NFL players. American Academy of Neurology, 84, 1114-1120.

Photo credit: Flickr user ‘clappstar’

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