Head injuries in sport

[54ny77]

Fascinating, if not troubling, study here:

https://www.nytimes.com/interactive/2017/07/25/sports/football/nfl-cte.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=photo-spot-region&region=top-news&WT.nav=top-news

"Dr. Ann McKee, a neuropathologist, has examined the brains of 202 deceased football players. A broad survey of her findings was published on Tuesday in The Journal of the American Medical Association.

Of the 202 players, 111 of them played in the N.F.L. — and 110 of those were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.

C.T.E. causes myriad symptoms, including memory loss, confusion, depression and dementia. The problems can arise years after the blows to the head have stopped.

The brains here are from players who died as young as 23 and as old as 89. And they are from every position on the field — quarterbacks, running backs and linebackers, and even a place-kicker and a punter."

[gasman]

The study is very troubling but CTE has been known for years and denied by the NFL until only recently.
My wife and I started watching the movie Concussion last night. Will Smith does an excellent job and the script is well written. Worth the time to watch.

[Ken Robb]

my dad was born in Scotland in 1908. He played soccer as a kid and retired as a professional in 1948. He headed many heavy wet leather balls and probably had a few concussions from on-field collisions. He died at 81 having suffered from increasing dementia in his later years. We assumed it was Alzheimer's but these new studies make me think Dad's problem may have been a result of many hits to his head. I like that idea because head hits aren't hereditary. I hope. :)

[weiwentg]

Deeply troubling. I've come to think that because football rewards really large players and immensely powerful hits, it is equivalent to a blood sport. I question if it should be allowed to exist in its current form. I would abolish it if I were writing the rules, but I'm an extremist.

Not sure what can be done to ameliorate the damage in football. If rubgy is safer, then diverting players to rugby may help young men in general.

Cycling is far from exempt. Remember Chris Horner in the 2011 TDF (https://theconcussionblog.com/2011/08/03/remeber-chris-horner/)? I am thinking something like mandatory exams for riders who crash, mandatory withdrawal if they have any level of concussion, liberalize rider replacement rules. Consider allowing crashed riders to skip one stage under some conditions (e.g. easy days).

[FlashUNC]

Football has pretty much always killed people.

But the on-field deaths during the Teddy Roosevelt era have been replaced with something happening much further in the future.

[numbskull]

Did the study have controls and was the examiner "blinded". If not it doesn't necessarily tell you what you think it does.

[Jgrooms]

American football will die a slow death imo. Parents are already refusing to allow boys to play as more & more studies confirm CTE. Of course, this is a class situation. Affluent parents weigh the risk and say nope. The less than affluent, who see football as an escape, will in many cases accept/ignore the risk.

I follow the college game & you see this dynamic quite often.
White player gets to his 3 rd concussion & he quits, despite a promising continued college career w a shot at the NFL. African American players keep 'living the dream.'

https://sports.vice.com/en_us/article/eze4gj/footballs-war-on-the-minds-of-black-men

Of course I could be wrong, a culture that's traded religion for the Sunday gladiators may find its violence fix too hard to let go of & accept the sports PR campaign - aka smokescreen - to lessen the incidence of CTE.

And the Will Smith movie is quite good.


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[MattTuck]

There is no doubt that the game has to evolve and make some serious rules changes to make the game safer and limit the number of hits. Can the game survive? I think so.

I heard someone say (it might have been on here) recently that they are much more concerned about the soldiers that fight in our armed services in the name of our nation, and the trauma that they endure, than CTE related injuries to professional (or college) football players.

Yes, youth participation is an issue, of course.

At the end of the day, the NFL players have a union and a collective bargaining agreement. The science is out there and the risks are (now) well documented -- and the players are reasonably well compensated. If they choose to participate, who am I to say they are wrong, or take away their livelihood?

Contrast that to the damage done by alcohol, sugar, opiates, sending people to war, etc... seems that energy would help more people if directed to these more serious problems.

[dustyrider]

Don't see this ending anytime soon in rural and inner city America. As a public school teacher, I get to accommodate all those concussions that happen during school endorsed and funded sporting events like football, soccer, and lax. Most of them think it's their ticket out of where they are and that brain injuries are just like any other injury. In fact, mental health is barely an after thought here. Most of the student athletes in the sports that seem to cause the most damage to their brains have figured out how to juke the concussion protocols to their "advantage" and they're not even at the college level yet.

But hey there's a solar eclipse coming...! :(

[ptourkin]

Did the study have controls and was the examiner "blinded". If not it doesn't necessarily tell you what you think it does.

They can only study the brains that have been donated. As stated, the percentage of those that are positive for CTE is staggering. Further, the percentages from high school and college players are also overwhelming.

As there is currently no test for living brain matter, this will have to suffice for now.

[ptourkin]

There is no doubt that the game has to evolve and make some serious rules changes to make the game safer and limit the number of hits. Can the game survive? I think so.

I heard someone say (it might have been on here) recently that they are much more concerned about the soldiers that fight in our armed services in the name of our nation, and the trauma that they endure, than CTE related injuries to professional (or college) football players.

Yes, youth participation is an issue, of course.

At the end of the day, the NFL players have a union and a collective bargaining agreement. The science is out there and the risks are (now) well documented -- and the players are reasonably well compensated. If they choose to participate, who am I to say they are wrong, or take away their livelihood?

Contrast that to the damage done by alcohol, sugar, opiates, sending people to war, etc... seems that energy would help more people if directed to these more serious problems.

TBI in combat and CTE in athletes come from different phenomena. Increasingly, the research is showing that CTE comes from the thousands of micro-impacts experienced every day in practice and games. As such, rule changes may not be able to save participants from injury as heads will knock whenever there is contact unless you outlaw blocking, for instance.

TBI comes from one big hit. Football players may also experience TBI from big hits, but the CTE issue is not analogous to combat.

[William]

There was a related article out yesterday concerning females in sport closing the gap...


Female Athletes Are Closing The Gender Gap When It Comes To Concussions

Gina Mazany grew up in Anchorage, Alaska. And that's where she had her first fight.

"It was right after I turned 18," she recalls.

A local bar had a boxing ring, and Mazany decided to give it a shot. Her opponent was an older woman with a "mom haircut."

"She beat the crap out of me," Mazany says. "Like she didn't knock me out, she didn't finish me. But she just knocked me around for three rounds. And I remember, later that night I was very, very nauseous. I was throwing up that night."

It was her first concussion....

http://www.npr.org/sections/health-shots/2017/07/24/538294331/female-athletes-are-closing-the-gender-gap-when-it-comes-to-concussions








William

[MattTuck]

TBI in combat and CTE in athletes come from different phenomena. Increasingly, the research is showing that CTE comes from the thousands of micro-impacts experienced every day in practice and games. As such, rule changes may not be able to save participants from injury as heads will knock whenever there is contact unless you outlaw blocking, for instance.

TBI comes from one big hit. Football players may also experience TBI from big hits, but the CTE issue is not analogous to combat.

I was talking more generally about the injuries to soldiers, not just head injuries. I have way more concern for the soldier that comes back from war, having put his life on the line for us, than I do about a guy making 500K+ a year as a football player. It's a dangerous job that they are well compensated for.

Yes, probably the offensive line and defensive line will start standing up, and some rules about leading with your head. You can't remove every head to head contact, but you can move in the right direction. With the technology and understanding today, there should actually be pretty good ways to tell if a rule change is having the desired effect by measuring impacts in the helmet.

[FlashUNC]

American football will die a slow death imo. Parents are already refusing to allow boys to play as more & more studies confirm CTE. Of course, this is a class situation. Affluent parents weigh the risk and say nope. The less than affluent, who see football as an escape, will in many cases accept/ignore the risk.

I follow the college game & you see this dynamic quite often.
White player gets to his 3 rd concussion & he quits, despite a promising continued college career w a shot at the NFL. African American players keep 'living the dream.'

https://sports.vice.com/en_us/article/eze4gj/footballs-war-on-the-minds-of-black-men

Of course I could be wrong, a culture that's traded religion for the Sunday gladiators may find its violence fix too hard to let go of & accept the sports PR campaign - aka smokescreen - to lessen the incidence of CTE.

And the Will Smith movie is quite good.


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This is the single biggest problem for the NFL is all this: The talent pipeline starts to dry up, and the quality of the on-field product declines, it starts to become less enjoyable for fans to watch.

That's all they really care about long-term. Player health isn't even a concern for them, outside the realm of the impacts on the future of the business.

[saab2000]

American football will die a slow death imo. Parents are already refusing to allow boys to play as more & more studies confirm CTE.

This is the way it is. It will take a while, but it will happen I think. Remember when boxing was big? Now it's kind of a fringe sport.

Pro football is way better managed but eventually the head injuries will be impossible to ignore.

It won't happen tomorrow or even in ten years but I think pro football will eventually decline, and massively so.

[Jgrooms]

^boxing is good point. But we traded it for cage fighting. Maybe hydrid of arena football further parred down mixed with cage fighting. Something that can be contested on a basketball sized field. Think of the savings in overhead.


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[numbskull]

They can only study the brains that have been donated. As stated, the percentage of those that are positive for CTE is staggering.

On this you are wrong. They could have (and absolutely should have) easily obtained age matched control brain tissue from any of several "brain banks" to be studied along with the football brains. Likewise the brains need to be examined by several different neuropathologists to help eliminate observer bias. The chief investigator runs a center dedicated to CTE research. She has a very strong self-interest to produce results that enhance her center's funding. This is unavoidable and normal but because of it she has an ethical and scientific obligation to be sure those findings are scientifically valid and reproducible. Unless a trial design accounts for observer biases (be they conscious or unconscious) the trial's results are likely to fail this test.

All that said, I have not yet seen the study methods published so perhaps my skepticism is misguided.
To be clear, my intent is not to minimize any concerns about traumatic head injury ( I have no doubt it is an underestimated risk) nor defend the sport of football (which I do not follow).....I only cringe when poor science is sensationalized.

[gasman]

On this you are wrong. They could have (and absolutely should have) easily obtained age matched control brain tissue from any of several "brain banks" to be studied along with the football brains. Likewise the brains need to be examined by several different neuropathologists to help eliminate observer bias. The chief investigator runs a center dedicated to CTE research. She has a very strong self-interest to produce results that enhance her center's funding. This is unavoidable and normal but because of it she has an ethical and scientific obligation to be sure those findings are scientifically valid and reproducible. Unless a trial design accounts for observer biases (be they conscious or unconscious) the trial's results are likely to fail this test.

All that said, I have not yet seen the study methods published so perhaps my skepticism is misguided.
To be clear, my intent is not to minimize any concerns about traumatic head injury ( I have no doubt it is an underestimated risk) nor defend the sport of football (which I do not follow).....I only cringe when poor science is sensationalized.

Numb-

Here's a link to the full study: http://jamanetwork.com/journals/jama/fullarticle/2645104

The authors admit that the study is a convince sample of 202 brains, the 4 neuropathologists followed the latest guidelines developed to diagnose CTE and they were blinded to the behaviors reported in the patients. It seems like it's a well done study that while it has limitations it is valid and well done. No study is perfect and clearly definitive but this adds immeasurably to the body of evidence.

Glancing at just a few of the papers published from the world wide brain banks there are very few diagnosis of CTE-mostly Alzheimer's, Lewy body dementia, etc.

To deny the reality of CTE at this point reminds me of a post-doc I worked with in a toxicology lab in medical school (1979) who was adamant that it had not been proven that smoking caused lung cancer. His bias was he smoked. I don't want to imply that you have a bias, you want good science done. I do too.

Heck, even the NFL says that the risk of CTE from playing professional football is 23 %-and you know they are trying to minimize any connection. They are already paying out $1 billion in compensation to former players and it's not because they are altruistic.

I think American football will continue but further rule changes need to be made to protect the players.

Gasman who also makes patients numb;)

[numbskull]

Numb-

Here's a link to the full study: http://jamanetwork.com/journals/jama/fullarticle/2645104



Thanks for the link. I should have searched this myself before commenting.

What it seems to "show" is that if you have played football and develop behavioral disorders or dementia sufficient to concern your family (and hence your brain is donated) there is a significant incidence of CTE that increases with age and years played.

I agree this is concerning and strong further evidence that CTE may be causative or strongly contributory to cognitive and behavioral problems.

What the study does NOT show, however, is the incidence of CTE in football players in general (the subset of football players that develop CTE might be very small or quite large....you can't conclude anything about that from this study).

[Jgrooms]

^ Hey sure the NFL paid out & continues to do so wo any linkage to causation. They have pretty good lawyers?


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[paredown]

my dad was born in Scotland in 1908. He played soccer as a kid and retired as a professional in 1948. He headed many heavy wet leather balls and probably had a few concussions from on-field collisions. He died at 81 having suffered from increasing dementia in his later years. We assumed it was Alzheimer's but these new studies make me think Dad's problem may have been a result of many hits to his head. I like that idea because head hits aren't hereditary. I hope. :)

I think the doctors might agree with you--my sister-in-law suffered a full-on TBI in a car accident. Did the full course of rehab, and had permanent long-term impairment to a degree.

The one thing the doctors were emphatic about--she had to quit playing soccer for just this reason--the chance of re-injury it was too great. So she took up rowing...

And if it is the cumulative effect of series of minor jostles rather than full-on hits that cause blackouts or TBIs then no amount of coaching about how to hit in football will save the sport.

[Elefantino]

The NFL only professes to be concerned about head injuries because it was caught ignoring head injuries and attempted (and, for a brief time, succeeded) to impugn the character and qualifications of anyone who made the connection between the NFL and head injuries.

Protect the shield.®

[buddybikes]

>>>All that said, I have not yet seen the study methods published so perhaps my skepticism is misguided.
To be clear, my intent is not to minimize any concerns about traumatic head injury ( I have no doubt it is an underestimated risk) nor defend the sport of football (which I do not follow).....I only cringe when poor science is sensationalized.

this was a fact based study on whether the brain has CTE not a drug comparison. Just happened to be 110 out of 111. Only question in detail is the extent of CTE and perhaps comparing to the general public if this just occurs through lots of people's lives.

[gasman]

>>>All that said, I have not yet seen the study methods published so perhaps my skepticism is misguided.
To be clear, my intent is not to minimize any concerns about traumatic head injury ( I have no doubt it is an underestimated risk) nor defend the sport of football (which I do not follow).....I only cringe when poor science is sensationalized.

this was a fact based study on whether the brain has CTE not a drug comparison. Just happened to be 110 out of 111. Only question in detail is the extent of CTE and perhaps comparing to the general public if this just occurs through lots of people's lives.

Read the study. It's good but not perfect science. They looked at 202 brains, 111 of them played in the NFL. The rest were college and HS level.

This is a problem that should be studied more but it sure seems like a real problem.

[fiamme red]

New York Times: Playing Football Before 12 Is Tied to Brain Problems Later (https://www.nytimes.com/2017/09/19/sports/football/tackle-football-brain-youth.html)

[19wisconsin64]

Hey, we are (mostly) in the USA on this forum, where big business sort of rules most things.

Change won't occur until lots of law suits occur with big dollar payouts. Football is a multi-billion dollar sport.

A lot of Americans live in denial of things, and head injuries is just one of those things.

A while back I made a posting offering to pay a thousand dollars for a helmet that protected my brain. The response was more of one being laughed at than taken seriously.

Unfortunately I suffered some brain trauma when I was younger, and now that I am 53 it's really beginning to affect me in a not good way.

It's tough to tell kids not to play football, or to head the ball during soccer. It will tougher to let them know that we knew about the dangers but didn't warn them properly. Hope things improve.