The Truth About Concussions

NFL linebacker Junior Seau committed suicide on May 2, 2012 after playing for the NFL for more than 20 seasons. Seau’s family donated his brain to the NIH after his death. Eight months later, the scientists who examined his brain found that he had suffered from Chronic Traumatic Encephalopathy (CTE). More recently, a 25-year old former college player who passed away showed evidence of CTE, as did Tyler Sash, a 27-year old former Safety for the NY Giants. Dr. Bennet Omalu, the protagonist in the new “Concussion” movie said he “would bet his medical license” that OJ Simpson has CTE. The most alarming study was released in 2015, in which 96% of deceased NFL players’ brains were found to demonstrate symptoms of degenerative brain disease.

Since CTEs are often asymptomatic and without obvious injury, in the past concussion-related brain injury could only be diagnosed posthumously. Recent advancements in concussion research have been promising in utilizing a soluble plasma protein as a marker for detecting brain injury even without obvious signs of damage. This biomarker has not yet become a clinically diagnostic tool, but has the potential to lead to faster and more effective concussion diagnoses and to improve preventative measures and treatment in affected athletes. Rather than utilizing subjective symptoms to measure the amount of time before an athlete is able to return to the sport, these objective lab values will provide a more clear cut evidence-based approach to concussion protocol amongst various sports.

Concussions are a major topic of concern in high impact sports today, and new studies have surfaced to help show the short and long term effects of concussions and frequency in sports.

• Frequent low-intensity hits are correlated with a rise in undiagnosed concussions amongst football players. A recent study from Harvard and Boston University reported six suspected concussions and 21 so-called “dings” (hits to the head) for every diagnosed concussion. Interestingly, the study suggests that offensive linemen are more likely to experience neurologic symptoms of concussions such as dizziness and headaches, while also less likely to report their symptoms. Additionally, the study found that offensive linemen seemed to continue with play post head injury at a higher degree than players in other positions. This study highlights the fact that there may be increased risks associated with concussions amongst certain athletic positions rather than the entire sport as a whole. Some studies suggest that that once an individual has one concussion he or she is more susceptible to future concussions. The NCAA Concussion Study on Cumulative Effects Associated With Recurrent Concussion in College Football Players found that 35% of the concussions analyzed were repeat concussions. They also found that an individual with three or more concussions was three times more likely to sustain a concussion than an individual with no concussion history. These findings strongly suggest an increased susceptibility to future concussions following initial trauma. The study also found headache, dizziness, and cognitive delay as the most common symptoms and complaints for diagnosed concussions.

• Conversely, a study in the Journal of Athletic Training found no significant difference between those who had one as opposed to two concussions. The British Journal of Sports Medicine similarly found “no cumulative effects for one or two previous concussions.” However, it seems that it takes two concussions for athletes to exhibit symptoms. The best evidence for this is a study that found “subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.” Additionally, one study performed in March 2015, finds that there may be an increased risk of developing permanent neurologic injuries when an athlete experiences a second less severe concussion without having healed from a previous concussion.

Nonetheless, many athletes suffer far more concussions than that and there appears to be a correlation. Brett Favre, who has countless confirmed concussions, recently claimed that he has memory problems that could be linked to playing with concussions throughout his career. Researchers at the University of British Columbia analyzed the cumulative effect of concussions on brain function, reporting that each concussion could cause brain damage.

Despite all the daunting news there may be some surprising breakthroughs on the horizon, especially in terms of pain management and improving quality of life. Jim McMahon, quarterback of the famed ’85 Bears has had significant health problems stemming from concussions including memory loss. His depression, early onset dementia, and debilitations have been well chronicled. However, recently he has noticed a profound improvement in his symptoms due to both seeing a chiropractor to ensure his body and neck remains well aligned, improving the flow of blood and spinal fluid to his brain; and through an unlikely and still controversial medication—marijuana. McMahon has seen his symptoms greatly improve—less headaches, better quality of life. The combination has been more effective than pain medications he has taken in the past as well. These findings, especially in terms of neck alignment and improving flow to the brain, may also pose support for some of the more controversial and less-proven Osteopathic Medical principles and treatments. Perhaps this can provide some help to symptom management?

Lastly, the incidence of concussions isn’t limited just to contact sports or male sports, as researchers from the Union Memorial Hospital in Baltimore, MD found that women suffer from concussions at a similar—if not higher—rate as men in sports like basketball, soccer, and baseball or softball. It’s important to note that soccer is a global sport where there has been an especially growing concern of concussions.

As more is known about concussions in contact sports, more advances will be made to identify, diagnose, and treat concussions. Improvements in diagnostic technology as well as changes in the sports themselves such as improved helmet structure and improving rules will also make a difference in the safety of contact sports. Numerous research articles show that there is a clear correlation between concussions and degenerative brain disease. The severity of these head injuries deserves the attention it is getting. And improving diagnostics to create opportunities to diagnose, control, and ultimately treat CTE earlier will create new opportunities to improve quality of life and overall well-being for any athletes who suffer from a history of concussions.