What do we know about head trauma in high school and college football?
Traumatic Brain Injury ( mTBI) encompasses the clinical entity of
concussion. Concussion is defined as a trauma induced alteration of
mental status with or without loss of consciousness.
research has been published regarding concussion and recently
research has been published about the multiple blows to the head that
occur in all levels of football in the absence of a recognized
concussion. These "sub-concussive blows" have become the target for
various types of brain imaging and cognitive function testing and the
results have raised concern about the long term effects on the brains of
highs school and college players.
Some of what we know is :
conventional MRIs and CTs in concussed high school and college football
players are normal , Diffusion Tensor Imaging (DTI) and functional MRI
have shown abnormal findings some of which may persist for weeks or
months. Additionally subtle impairments of verbal memory and other
cognitive tests have been reported in concussion cases persisting past
the time during which the player has any symptoms.The long term significance of these finding is not known.
imaging findings and cognitive testing results are being reported in
high school and college players after a season of participation in
football even thought the players had no reported concussive event.
3.We know that football helmets do not prevent concussions.
know that at least some college level contact sport athletes decades
later show abnormal white matter by Diffusion tensor imaging and lowered
test results on cognitive testing but again we don't know if these changes are a predictor of later symptoms of CTE.
Some of what we don't know is :
do not know what pathological changes underlie the imaging findings. Do
the scan results indicate transient damage and tissue repair without
likely long term sequelae? Is there a recognizable subset of these
players with these findings who if they continue to be exposed to
multiple head blows over many years will develop Chronic Traumatic
encephalopathy (CTE)? How can those who may be destined to develop CTE
be distinguished from the vast majority of players who never will have
From the wide range of head hit
exposures in those NFL players who have been diagnosed with CTE the
obvious implication is that there must be a fairly wide range of
thresholds. There are reports of NFL players with as little as five
years of play showing typical pathological findings at autopsy. Further
there has been at least one case of a college player diagnosed with
2.the long term cognitive changing on
various tests and brain imaging abnormalities have been demonstrated
in contact sport athletes in college and high school who did not experience a concussion.
After the last high school football season ending there were reports of 13 fatalities. This is about average for the years following the meaningful
changes made in the rules and the instruction of techniques of blocking and less
dangerous ways to tackle. Better helmets probably prevent skull
fractures but not concussions.Can you imagine the outcry if high school boys were forced to take part in an activity that results in deaths each year?
See here for details of some of those deaths. Tragically it seems that two were due to heat stroke, all were not due to head injury.In reading over the cases it seems reasonable to designate two of the deaths to the second hit syndrome.
You see the same parents
who carefully made sure their kids did not ride tricycles without
wearing helmets are some of the same ones watching and yelling at Friday
night football games and probably do not see the irony of common practice of
there being an ambulance at the stadium. If their son is the victim of
the second hit syndrome, probably an ambulance won't help.
Note: Much of this posting is a rewrite of another commentary from last year which I shamelessly re-post now with only a few additions because this topic is one I obviously feel strongly about .I used to really enjoy watching professional and college football on tv now I only occasionally watch just to sample the action to notice obvious head trauma. Professional players increasingly are able to make some effort at an informed decision to play with considerations of the risk to their brains, high school kids and younger much less so.