Extracted from an article from AANS regarding traumatic brain injury (TBI) data from 2012:
Defensive backs in
American football are at the greatest risk for both fatal head injury
and serous cervical spine injury.:
"The majority of catastrophic injuries occur while playing defensive
football. In 2012, two players were on defense and one was in a weight
lifting session. Since 1977, 228 players with permanent cervical cord
injuries were on the defensive side of the ball and 55 were on the
offensive side with 44 unknown. Defensive backs were involved with 34.6
percent of the permanent cervical cord injuries followed by member of
the kick-off team at 9.2 percent and linebackers at 9.5 percent."
Spending
even a small amount of time watching high school,college and
professional football on TV makes it seem obvious that the vast majority of
high impact collisions occur in the defensive zone involving defensive
backs and either runners or receivers and on kickoffs.Quarterbacks
receive many hits with the helmets impacting the ground and have a
significant risk of concussion but apparently have lower risk of fatal
injury or injury leading to permanent disability.Offensive and defensive linemen may
receive more sub-concussive head blows over a game or a season and
whatever the long term consequences of that may be seem less likely
to regularly be involved in high impact collisions and therefore less
at risk for serious brain or cervical spine injury. There is a reason for ambulances to be parked near the playing field of high school football games attesting to the cognitive dissonance of some of the parents cheering them on.The EMTs are not on site to help manage sprained ankles.
Don't let your babies grow up to be defensive backs.
Notice: This is a lightly edited and altered version of an earlier commentary on this blog. As I see high school kids on the practice field in early August in Texas with heat indices pushing 105 my antipathy to high school and youth football flares again.
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Another football season begins, what do we know about sports related head trauma
What do we know about head trauma in high school and college football?
Mild 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.
Considerable 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 :
1.While 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.
2.Similar 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.
4.We 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 :
1.We 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 those problems
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 CTE.
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.
Mild 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.
Considerable 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 :
1.While 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.
2.Similar 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.
4.We 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 :
1.We 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 those problems
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 CTE.
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.
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