This is a story about athletes and concussions.

When you read that sentence, what picture popped into your mind:  250-pound football players… or 10-year-old girls with ponytails?  According to research published in The American Journal of Sports Medicine, the severity of symptoms after a concussion is–in part–dependent on the age and gender of the patient. Girls and young women suffer worse symptoms than men, and young people suffer more than older people.

The study tested young athletes for balance and verbal and visual memory. Researchers tracked the athletes for two years. In that time, about 300 of the athletes received a concussion and were tested again. Results showed that high school athletes performed worse for their age than college-aged athletes, and that female athletes with concussion had more symptoms and worse visual memory than male athletes with concussion. In addition, symptoms lasted longer in younger athletes than in older athletes.

According to an article in The New York Times:

The findings suggest that because of anatomical differences that make them more vulnerable, female athletes, and younger athletes in particular, may need to be managed more cautiously after a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State University and the lead author of the report.

“Parents need to understand that if their daughter has a concussion, that they may potentially take longer to recover from that concussion than their son who is a football player,” she said.

Experts think that younger brains suffer greater damage from concussion because they haven’t fully developed…and because we tend to treat them as miniature adults when it comes to sports and expectations. According to Mark Hyman, author of “Until It Hurts: America’s Obsession With Youth Sports and How It Harms Our Kids” (Beacon Press, 2009):

“The brain and head of a small child are disproportionately large for the rest of the body,” he said. “The result is that their heads are not as steady on their shoulders. When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls. That’s when concussions occur.”

RESOURCES

To read an abstract of the article in The American Journal of Sports Medicine, click here:  The role of age and sex in symptoms after concussion

To read the full article in The New York Times, click here:  Concussions May Be More Severe in Girls and Young Athletes

“]”]In the medical world, Chronic Traumatic Encephalopathy (CTE) is a rising star, sure to become a household name. And the turning point in CTE’s infamy may have just been reported this week, with the report that former hockey great Rick Martin had CTE at the time of his death. First, some background:

CTE is a kind of central nervous system damage that happens when people suffer repeated head injuries, typically soldiers or athletes in high impact sports, such as football or ice hockey. Early symptoms of CTE include memory problems, difficulty concentrating, and disorientation. As the disease progresses, people with CTE show behavioral problems—poor judgment, aggression, sexual compulsiveness, erratic behavior, and drug and alcohol abuse—as well as increasing nervous system symptoms, including tremors, staggering gait, deafness, and dementia. Unfortunately, the only way to definitely diagnose CTE is to examine the brain of the affected individual during an autopsy.

The organization that is at the forefront of research into CTE is the “brain bank” run by the Boston University Center for the Study of Traumatic Encephalopathy (CSTE). Some athletes who believe they may have CTE donate their brains to the brain bank for examination after their death. That was the case with former football pro Dave Duerson, who committed suicide by shooting himself in the chest to preserve his brain for examination and diagnosis. (To read more about Dave Duerson’s story, click here: Football Player Donates Brain to Research.)

WHAT’S NEW THIS WEEK

An article in The New York Times reported that former NHL star Rick Martin had CTE when he died last March of a heart attack at age 59. What makes this revelation a game-changer is that Martin was not known for being an on-ice fighter, and he only had one known concussion, way back in 1978. His head ht the ice, and he experienced immediate convulsions.

“Rick Martin’s case shows us that even hockey players who don’t engage in fighting are at risk for C.T.E., likely because of the repetitive brain trauma players receive throughout their career,” said Chris Nowinski, a director at the center and co-founder of the Sports Legacy Institute, which seeks to advance the study, treatment and prevention of brain trauma in athletes.

The thought is that although Martin had only one documented concussion, he had several more head impacts—trivial, but cumulatively damaging.

For everyone, the message is simple:  Protect your head!  This new information suggests that any blow to the head could contribute to long-term problems. You never know which blow with be the one to send your brain over the edge to permanent, progressive damage.

To read the full article in The New York Times, click here:  Former Star Had Disease Linked to Brain Trauma

On July 21, 2011, we posted a blog about the lawsuit brought by former pro football players against the National Football League (NFL) for concealing information about the harmful effects of concussion from players, coaches, and trainers. And not only did the NFL drop the ball (pun intended) on its duty to inform players of the risks, they also failed to protect players from known risks.

According to a recent article in The New York Times, the lawsuit may become the first concussion-related class action against the NFL. A group of players is seeking damages for injured players, but also changes in the medical monitoring of players. The latter is the groundbreaking part of the lawsuit. According to the group’s lawyer, Larry Coben, while there have been improvements in the way concussions are analyzed and treated, there is much room for improvement in identifying injuries.

Specifically, Coben cited the use of blood tests as a way to diagnose concussions, saying the United States military has already begun using the technique and contending that such tests would increase player safety in the N.F.L.

Coben also asserted that the N.F.L. should be using testing procedures that examine genetic markers for indications of whether a player may be more at risk for developing chronic traumatic encephalopathy later in life.

“Modern technology is advancing,” Coben said in a telephone interview. “We need to get past just using doctors on the sideline and in the locker rooms to see if a player has been hurt.”

Class action lawsuits are tricky stuff, but the medical side of this lawsuit may be even more difficult. Some experts don’t believe that blood testing for head injuries is not quite ready for widespread use. But monitoring seems like a wonderful idea in a sport where the injury rate is 100 percent. However, according to the article in The New York Times, not everyone agrees that extra monitoring is important, or even necessary.

Jets linebacker Josh Mauga, who sustained a concussion last season, said the current concussion management program was thorough and sufficient. Mauga described the series of tests he had to pass (including balance and visual exams) before he could resume exercising after his concussion. And, when he felt symptoms during light jogging, he said he was sent back to the beginning of the process each time.

“I did those balance and vision tests so many times,” he said. “Because any time I started to feel anything, I had to start all over again. It took me three weeks.”

Still, it’s a lot to put the entire load of concussion recognition on young, eager-to-please athletes who might not be willing to sit on the sidelines while his teammates play to glory. But, as we’ve been reporting for months now, concussion is not a small or insignificant injury. Repeated concussions can lead to chronic traumatic encephalopathy, which is a progressive neurologic condition. Football players have a right to be concerned. We’ll be watching the status of this lawsuit, and will report back when there is news.

To read the entire article in The New York Times, click here:  Concussion Suit Seeks Better Health Monitoring

On July 21, 2011, we posted a blog about the lawsuit brought by former pro football players against the National Football League (NFL) for concealing information about the harmful effects of concussion from players, coaches, and trainers. And not only did the NFL drop the ball (pun intended) on its duty to inform players of the risks, they also failed to protect players from known risks.

According to a recent article in The New York Times, the lawsuit may become the first concussion-related class action against the NFL. A group of players is seeking damages for injured players, but also changes in the medical monitoring of players. The latter is the groundbreaking part of the lawsuit. According to the group’s lawyer, Larry Coben, while there have been improvements in the way concussions are analyzed and treated, there is much room for improvement in identifying injuries.

Specifically, Coben cited the use of blood tests as a way to diagnose concussions, saying the United States military has already begun using the technique and contending that such tests would increase player safety in the N.F.L.

Coben also asserted that the N.F.L. should be using testing procedures that examine genetic markers for indications of whether a player may be more at risk for developing chronic traumatic encephalopathy later in life.

“Modern technology is advancing,” Coben said in a telephone interview. “We need to get past just using doctors on the sideline and in the locker rooms to see if a player has been hurt.”

Class action lawsuits are tricky stuff, but the medical side of this lawsuit may be even more difficult. Some experts don’t believe that blood testing for head injuries is not quite ready for widespread use. But monitoring seems like a wonderful idea in a sport where the injury rate is 100 percent. However, according to the article in The New York Times, not everyone agrees that extra monitoring is important, or even necessary.

Jets linebacker Josh Mauga, who sustained a concussion last season, said the current concussion management program was thorough and sufficient. Mauga described the series of tests he had to pass (including balance and visual exams) before he could resume exercising after his concussion. And, when he felt symptoms during light jogging, he said he was sent back to the beginning of the process each time.

“I did those balance and vision tests so many times,” he said. “Because any time I started to feel anything, I had to start all over again. It took me three weeks.”

Still, it’s a lot to put the entire load of concussion recognition on young, eager-to-please athletes who might not be willing to sit on the sidelines while his teammates play to glory. But, as we’ve been reporting for months now, concussion is not a small or insignificant injury. Repeated concussions can lead to chronic traumatic encephalopathy, which is a progressive neurologic condition. Football players have a right to be concerned. We’ll be watching the status of this lawsuit, and will report back when there is news.

To read the full article in The New York Times, click here:  Concussion Suit Seeks Better Health Monitoring

In order to reduce the number of injuries–especially brain trauma–in college football players, Ivy League schools announced today that they will be changing the rules for practices. According to an article in The New York Times, the new rules are being implemented because research shows that college players sustain more total hits to the head in practice than during games. And, of course, the more head hits, the greater the risk of brain injury.

The new rules stipulate that teams can only hold two full-contact practices each week during the season (N.C.A.A. guidelines suggest a maximum of five full-contact practices per week). Other practices, then, cannot include contact or live tackles, and players cannot be “taken to the ground.” In pre-season two-a-day practices, only one practice per day can be full-contact.

According to the article in The New York Times:

“Because of the seriousness of the potential consequences, the presidents determined the league needed to take proactive steps in protecting the welfare of our student-athletes,” said Robin Harris, the executive director of the Ivy League.

This is a terrific new set of rules. Anything to help protect the brains of young, active adults is welcome, especially in the super-tough world of college football. After this up-coming football season, statistics will show whether this tactic actually works. If so, no doubt more colleges and universities will adopt similar rules.

To read the full article, click here:  Ivy League to Limit Full-Contact Football Practices

Military personnel who have exposed to blasts often exhibit signs and symptoms of brain injury…and yet the results of MRI and CT scans appear normal. It has been puzzling for physicians.

Now, The New York Times reports that a highly sensitive type of magnetic resonance imaging is able to show evidence of subtle brain injuries, damage specific to blast injuries. The injuries are poorly understood, and sometimes produce lasting mental, physical and emotional problems.

“This sort of mild traumatic brain injury has been quite controversial,” said Dr. David L. Brody, an author of the new study and an assistant professor of neurology at Washington University in St. Louis. “Is it due to structural abnormalities in the brain, chemical dysregulation, psychological factors or all three? We show that at least in some there are structural abnormalities.”

The pattern of the damage differed from that found in head injuries not caused by blasts, and matched computer simulations predicting how explosions would affect the brain, Dr. Brody said. If the new findings hold up, he added, they may eventually influence the design of helmets to provide more protection against blasts.

The injuries were discovered with a special MRI technique called “diffusion tensor imaging.” It measures the movement of water in nerve fibers in the brain; abnormal water movement suggests injury to those delicate nerve fibers.

Katherine Helmick, deputy director for traumatic brain injury at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, said the Defense Department was eager for information that would “help us understand what blast is doing to the brain, and help us get what we really want in diagnosing traumatic brain injury, which is objective markers.”

Victims also want the new technique to work. Veterans who experience blast trauma can be left with problems involving speech, memory, balance, and thinking…but without objective medical evidence of brain damage, they may not receive the treatment they need. They also may not be believed, and could end up with occupational and relationship difficulties.

The scans are still in development, but everyone hopes they will be found to be a useful tool. If diffusion tensor imaging is proved to be a reliable and valid diagnostic tool for blast injuries, the next step will be to prove its value for other types of subtle brain trauma–the kind caused by auto wrecks, blows to the head, falls, or other types of personal injury. We’re looking forward to having another way to help our brain injured clients get the medical and legal help they need.

To read an abstract of the original study, click here:  Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel

To read the full article in The New York Times, click here:  Brain Injuries Are Seen in New Scans of Veterans

With Brain Injury Awareness month coming to a close, there is one final bit of good news: Pro hockey may finally recognize that game violence puts players at risk for concussion, and–here’s the exciting part–there are talks about how to curb head injuries. Perhaps they could take a lesson from the National Football League (NFL) and think big. Like, with a poster.

This past football season saw a new emphasis on concussion prevention, sideline diagnosis, and appropriate treatment. The NFL started its 2010 season by hanging posters in all team locker rooms describing the symptoms of concussion and clarifying the NFL’s position on how they should be reported and treated. Next, the NFL announced fines for helmet-to-helmet hits. During the first week after the fines were announced, three players felt the hurt: Two players received fines of $50,000, and one player–James Harrison of the Pittsburgh Steelers–was fined $75,000.

Those changes were implemented because concussion is no longer thought to be just a minor bump on the noggin. Recent research suggests that repeated concussions may be more than just a passing pain–they may cause early dementia and neurologic wasting similar to Lou Gehrig’s disease. Repeated concussions have also been linked to some recent suicides. It now seems irresponsible not to change the rules of the game to protect players.

Well, football season is over, and now its hockey’s turn to try to make a difference.

According to an article in The New York Times, change won’t come easy. There are two extremes in the concussion debate:

…general managers, sponsors and fans who favor a ban on hits to the head and their old-school counterparts who see such a drastic rule change as potentially robbing the league of its rugged appeal just when its popularity is growing.

Interestingly, head-hits are totally banned by the International Ice Hockey Federation, the National Collegiate Athletic Association, and the Ontario Hockey League.  And yet, the NHL still feels the need for debate. There is a partial ban, which outlaws blindside hits to the head and deliberate head shots. But checks to the head from straight-on are still legal. That’s right: It is perfectly legal for players to hit each other in the head as long as they deliver the head-check from straight ahead. Some are defending this Neanderthal practice. As reported in the article in The New York Times:

A leading voice among traditionalists is Toronto Maple Leafs General Manager Brian Burke, who has spoken often about the need to preserve “the fabric of our game.”

Recently, Burke said: “We want that hit in our game. What’s distinctive about our game from anywhere else in the world is the amount of body contact. So we have to try to take out the more dangerous hits and make it safer for the players, but keep hitting in the game.”

But many others see new rules to protect players against concussion as inevitable…and logical. There was a time when people debated whether players should stay on the ice the whole time, or if substitutions would be allowed…and there was a time when helmets were controversial. Everything changes over time, even sports. In this case, medical science has discovered that concussions can be a serious health risk; it’s up to the NHL to respond with appropriate safety regulations. Broken bones heal, but brain injuries can cause permanent and life-altering damage. We challenge the NHL to emulate pro football’s response to the concussion threat.

To read the full New York Times article, click here: Regulating Hits to Head Tests N.H.L. Tradition

In a series of articles, The New York Times has been telling the story of Dave Duerson, a 50-year-old former Chicago Bear and father of four who killed himself earlier this month. Duerson’s final wish, expressed in his suicide note and in a voicemail message to his ex-wife, was that his brain would be given to the National Football League’s (NFL) brain bank.

Duerson’s death, and his final gift, will likely expand the national conversation about the effects of repeated concussion on football players’ brains…and what should be done to protect athletes of all ages.

The “brain bank” is the nickname of the Boston University Center for the Study of Traumatic Encephalopathy (CSTE). The CSTE was created in 2008 as a collaborative venture between Boston University School of Medicine and Sports Legacy Institute (SLI). Its is to conduct state-of-the-art research on chronic traumatic encephalopathy (CTE)—a form of progressive dementia—through the study of neuropathology, pathogenesis, clinical presentation, disease course, genetic and environmental risk factors and prevention. It’s research is done on donated brain and spinal cord tissue, with the hope that scientists can develop tests for diagnosing CTE in living people, and treatments for people who show signs of disease.

When Duerson took his own life, he shot himself in the chest, not the head, so that his brain could be donated intact.

According to The New York Times:

Players who began their careers knowing the likely costs to their knees and shoulders are only now learning about the cognitive risks, too. After years of denying or discrediting evidence of football’s impact on the brain — from C.T.E. in deceased players to an increasing number of retirees found to have dementia or other memory-related disease — the N.F.L. has spent the last year addressing the issue, mostly through changes in concussion management and playing rules.

Duerson was active in helping ex-footballers with disability. He served on a panel that helped administer the NFL’s disability plan and the 88 Plan, a care fund for families of players with dementia. There is no doubt that Duerson knew of the link between repeated head injury and dementia and neurologic disability…and it is likely that he believed he suffered from CTE. Friends say he had memory problems, and sometimes had a difficult time thinking of or writing the correct words.

Again, from The New York Times:

Duerson sent text messages to his family before he shot himself specifically requesting that his brain be examined for damage, two people aware of the messages said. Another person close to Duerson, who spoke on the condition of anonymity, said that Duerson had commented to him in recent months that he might have C.T.E., an incurable disease linked to depression, impaired impulse control and cognitive decline.

It will be awhile before we know whether Duerson suffered from CTE, or if he was suffering from depression without brain damage. Regardless of the outcome of the autopsy, Duerson’s death puts new focus on the effects of football on brain health and brain function. Pro athletes play under great risk, but some say the greatest risk is reserved for youth athletes, whose still-developing brains may suffer bigger consequences from smaller hits.

The conversation about how to prevent brain damage in athletes of all ages will be difficult. Fans love the raw aggression of the game, and those with money at stake may balk at taking the danger out of the game for fear of losing viewers and revenue. Will we see new safety equipment? New helmet designs? A change in the rules? This should be an interesting year for parents, coaches, football players, and the N.F.L.

Our hope is that Dave Duerson’s tragic death has meaning, that safety becomes the paramount concern, and that this is the last time a football player dies as the result—directly or indirectly— of what really is just a game.

Resources

Links for the two articles from The New York Times:

N.F.L. Players Shaken by Duerson’s Suicide Message (February 20, 2011)

A Suicide, a Last Request, a Family’s Questions (February 22, 2011)

To learn more about brain injury, check out the HensonFuerst website: http://www.lawmed.com/

According to an article in The New York Times, the National Football League (NFL) is not sticking to their new policy of protecting players from concussion and head injury.

One player was tackled square in the face with the helmet of an onrushing opponent. Another, fighting for one last yard, took a polyurethane bash to the head. Still another player spent 10 minutes mostly motionless among dozens of praying players before medics carried him away on a stretcher after a helmet-to-helmet hit. [from The New York Times]

No flags were thrown for these controversial hits…all hits were deemed legal…and all of the hits probably caused traumatic brain injury to the players involved.

But the N.F.L.’s recent movement toward eliminating particularly dangerous tackles suggests that some of the collisions like those seen Sunday night could be forbidden as early as next season. Given how youth and high school football tend to follow the N.F.L.’s lead, the changes could affect more than just professionals.

Football is a violent sport, and players of all ages are encourage to “hit hard.”  Any serious move toward protecting players’ brains would require pulling back from the level of violence, and it’s not clear that anyone is willing to do that. It’s a $9 billion business, and fans live for televised clashes. Still, research has shown that multiple concussions (also known as mild traumatic brain injury, or MTBI) can lead to neurologic dysfunction, early dementia, and even death.

We’ve seen the outcome of head trauma, and we firmly believe that no game…no sport…no job should encourage—tacitly or explicitly—the kinds of activities that regularly cause concussion or more serious brain injuries. The NFL created pretty posters about concussion and vowed to take a tougher stance on head-hits. Thus far, this has all been nothing but “wah-wah-wah” background noise that everyone is ignoring.

According to Dr. Thom Mayer, medical director for the players union:

“Anything that can be done to improve the safety of our players really should be done, short of stopping playing the game.”

We agree. Hey…what if there were a fine against the team owners every time a player got a concussion during the course of a game? Hitting the big guys in their wallets wouldn’t be as painful as a head-hit, but it might at least start a serious discussion of how to stop the injuries.

Just food for thought.

To read the full article in The New York Times, click here: Big Hits, No Flags

At the end of the summer, the National Football League (NFL) decided to take action to reduce the number and potential effects of concussions. It created a poster that outlined the organization’s position on concussion, including the fact that players should know the symptoms, report them, get checked out, and basically start taking concussions seriously. After all, recent research suggests that repeated concussions may be more than just a passing pain–they may cause early dementia and neurologic wasting similar to Lou Gehrig’s disease.

As the football season started, health officials watched to see how the NFL would really respond to head-hits. The first few weeks weren’t good. Players were put back in the game after only a cursory examination…including Stewart Bradley, a Philadelphia Eagles player who staggered and and then collapsed on the field after attempting a tackle. He was put back into play after 3 minutes (but taken out at halftime).

But finally it looks like the NFL is putting money where its mouth is…its players’ money, that is.

According to an article in The New York Times,

A day after saying it would consider suspending players for helmet-to-helmet hits, the N.F.L. decided Tuesday to fine three players involved in a string of injurious collisions last Sunday.

The N.F.L. wants to give players and teams fair warning that it plans to ratchet up discipline for violations of players’ safety rules, the league spokesman Greg Aiello said. Players, coaches and teams will be told Wednesday that future disciplinary actions will be harsher, setting the stage for possible suspensions.

Two players received fines of $50,000. The worst fine was for a serial trouble-maker, linebacker James Harrison of the Pittsburgh Steelers, who was fined $75,000.

It’s probably going to take a while for players and teams to fully embrace the new rules. From the time they first pick up a football in Pop Warner games, players learn to hit hard, and they learn how to take body hits. After a lifetime of learning to tough it out and walk off pain, this new culture of caring about concussions is going to take some getting used to. It’s about time. How many brains and lives have been put at risk for the sake of a sport? Now that everyone knows better, we applaud these fines as a good start. We’re not sure where the fines are going, but it would be great if the money could be donated to brain injury research.

Hey, NFL! We have a list of worthy research groups, if you need some ideas.

(For a list of great brain injury support and research organizations, see our website: HensonFuerst Brain Injury page)

Information Sources (click titles for direct link)

The New York Times: “N.F.L. Fines Players for Hits to Head”

Previous HensonFuerst blog: “NFL is All Talk, No Proper Action”

Previous HensonFuerst blog: “Brain Trauma May Mimic Lou Gehrig’s Disease“