The latest evidence is pretty hard to ignore. The research leader is Dr. Ann McKee, chief of neuropathology at the VA Boston Healthcare System and director of the CTE Center at Boston University. She examined the brains of 111 deceased NFL players. Of these, 110 had CTE, the degenerative disease caused by repeated blows to […]
via Brain Injury and Football — No Place to Run — CRAIN’S COMMENTS
This is a great little read from The Paris Review.
A few weeks ago, I woke up one day feeling awful. I inventoried my symptoms. I didn’t seem to be getting sick. I hadn’t had too much to drink. Was it food poisoning? No—the slight ache in my stomach wasn’t, exactly, physical. And then it all came crashing back over me, and I realized the truth: I had a gossip hangover.
You know, it’s funny, how humans can be. We genuinely want to be happy, and it makes us happy to see others happy. And yet, we go to great lengths to make others miserable. As though hurting someone else is really going to make us feel better.
In a way, I suppose it does. I mean, consider the popularity of combat sports (which, based on the recent head-hunting fouls by some players, may sometimes include football). MMA, classical martial arts, boxing, rugby… and more… Not to mention Twitter. Everywhere you look, you can find evidence that people seek to relieve their own pain by visiting it on others.
I’m also included in the ranks of fans of the combat sports listed above. I’ll happily sit down to watch an MMA bout, a martial arts contest, a whole night’s worth of boxing, or a afternoon and evening full of overly combative football (e.g. Steelers / Bengals). I’m less “into” rugby (which probably sits on the cusp of not being a combat sport, depending how you play), mostly because I don’t know all the rules and I never acquired a taste for it.
And when players get hit hard enough to get knocked out, yes, I cringe. But I also get a secret enjoyment from it.
Because I’m not the only person feeling battered, these days. And when the players get up and get back in the game, it tells me that I can, too.
Now, if we can find a way to provide this same sort of community and commiseration, without causing brain damage to the players we admire and support, and tossing their futures aside for the sake of the immediate moment…
TBI is real for folks who play collision sports. Call it “concussion” or “mild” TBI or whatever else you will. Call it “character building” and “just part of life”. But brain trauma goes hand-in-hand with slamming your body into other players on a regular basis.
Helmets will not keep brains from slamming against the insides of skulls. They literally can’t.
Coaches and parents need to get real about this, and understand the conditions they are helping to create.
Truly, I do not understand the rationale behind keeping kids playing collision sports — whether they’re young OR older. Helmets give you a false sense of security — which actually makes the situation worse, because a concussed brain can feel like a great brain. I know from many personal experiences, when I hit my head hard enough to alter my consciousness, after an instant of feeling like the lights went dim, when “the lights” came back up, I felt fantastic. Like I was superhuman. I’m not the only one.
The fact is that when you receive what I would refer to as a partial but playable concussion, there is a unique feeling of being high, of floating, of being numb to pain and unaware of other distractions. This produces a happy state that translates to a belief of invincibility and a superman complex. In some ways, it acts just like a drug. You become addicted to that feeling and want more of it. And when you get another hit, it feels even better. (read more here)
And as long as kids are wearing helmets, and parents and coaches are thinking that they’re safer because of it, we’re just creating more opportunity for kids to injure themselves — in the short and long term.
I’ve been accused of attacking football. Not really. What I’m guilty of attacking is our willful ignorance about what role concussion plays in our youth sports… and how that affects the well-being and futures of kids who are “safer” wearing the latest headgear.
It’s one thing to not know about the dangers. But when people tell you, plain as day, and you refuse to take note — or do something about it — well, that’s something else, entirely.
And that goes for all collision sports where headgear is supposed to protect the players.
Just found this:
If international expert Robert Cantu had his druthers, football teams would practice without helmets.
That would be the best way to teach players to avoid head-to-head collisions, utilize their shoulders and bodies more in contact, protect against the concussions and later-life brain maladies the brutal game creates at rates such scientists find alarming.
The same notion would apply for players from preps to pros, too.
“There may be one day a week you put them on,” Dr. Cantu said Friday in the first of a two-day, Duquesne University seminar entitled “Is Football Bad for the Brain?”
Dr. Cantu is a noted neurosurgeon and co-founder of the Boston-area Sports Legacy Institute that has helped to lead the NFL’s recent reform movement through its study of long-term brain damage in middle-aged or older athletes.
“Keep them off, so you don’t use your head as a battering ram,” said Dr. Cantu.
. . .
Also on the first day of the seminar, presented by the Cyril H. Wecht Institute of Forensic Science and Law:
• Dr. Cantu revealed his research found that a fatal form of follow-up concussion, called Second Impact Syndrome that kills three to four high-school players annually, can be detected by a CAT scan. Sports-related brain injuries never before revealed themselves in imaging.
• His co-worker at the Sports Legacy Institute, Dr. Ann McKee, announced the finding of another protein — TDP43 — that causes degeneration in the brains of such older athletes diagnosed with Chronic Traumatic Encephalopathy, the disease that results from a history of head trauma. The protein called tau also does that.
• Dr. Maroon’s research echoed Dr. Bailes’: Gobble up Omega 3 fatty acids, and they may help to prevent and cure the inflammation of a traumatic brain injury.
“Quite frankly, I think everybody should be on it,” said Dr. Maroon, who was part of a January 2009 study in which an NFL team showed reduced cardiovascular risk factors when regularly ingesting them
He proposed downing 2 to 3 grams of such fatty acids as DHA or EPA daily. “I think it’s like Vitamin B — it’s a natural anti-inflammatory.”
Read more: http://www.post-gazette.com/pg/10072/1042511-66.stm#ixzz0jPWG3R1P
Interesting, that they’re talking about Omega-3 fatty acids. I’ve been taking them for (I think) about a year, and that may be one of the things that’s really helped me. I haven’t taken 2-3 grams (more like 1,200 mg, or 1.2 grams). But I have been taking some.
Between that and my daily exercise, I’ve seen a big difference between how my brain functions now and how it functioned just a year ago. It’s also helped that I’ve been getting regular help from my neuropsych, and that I’ve had some really great breakthroughs in how I perceive my life and my place in it.
I only wish I had known about this, when I’d had my last head injury. For that matter, I wish I’d realized that I’d had a head injury, which affected me as much as it did.
Oh, well. I guess progress is better late than never. And I’m glad to see the football community getting on board with addressing concussion.
Follow these links for more writing (and thinking) about concussion vs. traumatic brain injury, including the reasons why I believe concussion and brain injury are two separate parts of an ongoing process. I also believe we should stop calling the whole process “concussion” and refer to it as Concussive Brain Injury, or CBI.
I’ve been reading up on University at Buffalo’s work with concussion rehabilitation, using regulated exercise to deal with post-concussive syndrome (or post-concussion syndrome).
I have to say, it’s probably the most exciting news I’ve come across in a while. With all the talk about the NFL’s new post-concussion guidelines (which may or may not make a difference), and the increasing awareness about head injuries, expecially mild traumatic brain injuries (MTBI), it gets a little depressing, thinking about all the people who are getting hit in the head and suffering for years as a result.
A lot of folks are talking about it being an epidemic, that concussions are no joking matter, and lots of people are getting on the helmet bandwagon (especially since Natasha Richardson died from a brain injury while skiing). Prevention is great. But concussion is all but unavoidable in sports — especially student athletics. It happens. All the time. Yet nobody seems to have come up with a reliable way of addressing it when it does happen. Aside from bed rest and taking it easy, suggests for howto deal with concussions/brain injury are few and far between.
We know concussions happen. We know head injuries are common. We know they can have serious long-term consequences. You can try to prevent them, but you can’t be successful 100% of the time. And if you do have a head injury, you have to be sidelined from your life/sport, with no guarantee that the “treatment” will actually work.
I was starting to get seriously depressed.
Then, suddenly, I was looking around the other day and I found that the University at Buffalo has been working with regulated exercise to treat — even heal — the after-effects of concussion. Post-concussive syndrome is, according to the definitions of Willer and Leddy (at UB), “persistent symptoms of concussion past the period when the individual should have recovered (3 weeks)”. According to them, post-concussive syndrome “qualifies as mTBI.”
This is interesting. I have heard a lot of people say that concussion is an mTBI, and the two are interchangeable. I am not a doctor, and I don’t have medical training, so I can’t throw my hat in the ring on that debate. But it is interesting to me, that people distinguish between the two.
At the UB web page on concussion research, there are some interesting papers, and they do talk about the difference between concussion and mild TBI.
Here’s what they have to say in the paper Retest Reliability in Adolescents of a Computerized Neuropsychological Battery used to Assess Recovery from Concussion (bold is mine)
A recent review … of concussion and post concussion syndrome provided a model for distinguishing concussion from mild traumatic brain injury (mTBI) and post concussion syndrome (PCS). The model uses the most commonly accepted definition of mTBI and the one proposed by the American Congress of Rehabilitation Medicine and the Centers for Disease Control: loss of consciousness for no more than 30 minutes or amnesia as a result of a mechanical force to the head, and a Glasgow Coma Score (GCS) of 13 to 15 …. The model also uses the most commonly accepted definition of concussion as established by the American Academy of Neurology (AAN): a trauma induced alteration of mental status that may or may not involve loss of consciousness …. Although not explicitly stated in the AAN definition, concussion is generally viewed as a transient state from which the individual will recover fully in a relatively short period of time …. In contrast, mTBI is viewed as a permanent alteration of brain function even though the individual with mTBI may appear asymptomatic. Post concussion syndrome was defined in the Willer and Leddy … model as persistent symptoms of concussion past the period when the individual should have recovered (3 weeks) and therefore qualifies as mTBI. Neuropsychological testing is often used to describe the impairment associated with mTBI and PCS and have done so with relative success ….
So, basically,
(Note: I think someone needs to fill in the gap about how PCS satisfies the criteria for mTBI, if they require that there be some loss of consciousness or amnesia involved. How lasting effects qualifies based on these criteria puzzles me. But for the purposes of this discussion, I’ll let this slide.)
I find this really compelling information, and it helps me make more sense of the whole “concussion thing”. I know I’ve sustained a bunch of concussions in the course of my life, and I also know that I have been diagnosed with “Late effect of intracranial injury.” But I could never really distinguish between the mTBI vs. concussion. I actually thought — and had been told — that they’re the same thing.
But that never made much sense to me, because when I look around at me, and I read that “An estimated ten percent of all athletes participating in contact sports suffer a concussion each season” And that’s just athletes. Plenty of people fall down, too, or are in car accidents. I’m not entirely sure what to make of it. Apparently, hundreds of thousands of people sustain concussions each year, yet the general population doesn’t appear to be completely crippled by TBI (though some people I know would debate that 😉 ) How is it possible, that so many people are sustaining concussions, especially in their youth and/or in sports, yet we’re not all running around impaired?
Making the distinction between a concussion that is transient, and a concussion that turns into an mTBI makes all the sense in the world to me. It makes it possible distinguish between someone who’s experiencing short-term issues, and someone who needs to deal with a broader-spectrum and deeper set of challenges. And in doing so, it de-stigmatizes concussion (at least in my mind), by steering clear of the “concussion = brain injury = brain damage” concept, which could be quite debilitating to a youth who has hit their head while playing a sport they love.
There are tons of potential ramifications and implications from being able to state that concussion is not necessarily an enduring brain injury. I may write more about this later, but it requires more thought.
The other very hopeful piece of this is that, by saying concussion is not always followed by brain injury, you’re opening a window to addressing concussions promptly so they do not turn into mild traumatic brain injuries. This, to me, is key. It not only makes sense of the two different kinds of injuries, but it also establishes that it may in fact be possible to treat the concussion to prevent it from becoming a more serious, long-term injury — the “gift” that keeps on giving. And by understanding concussion and brain injury this way, you also up the ante and really infuse the topic of prompt treatment with urgency. If acting promptly to address concussion makes it possible to avoid a lasting brain injury, then it’s in everyone’s best interest to become familiar with and properly trained in the recognition and treatment of concussion.
In this case, if mTBI is only present if concussion symptoms persist, and there’s no guarantee that concussion will result in a lasting brain injury, then prompt recognition and action may save the day.
Now, I’m still noodling over the idea that subconcussive impacts can seriously affect the brain over the long term, which Malcom Gladwell talked about in his article “Offensive Play“. But I am still hopeful. Because while subconcussive impacts may affect the brain, it could be that the damage takes place when no action is taken to address the injuries when they happen. Again, I’m not a doctor or a qualified medical professional, but it seems to me that if actively treating concussion helps with the really obvious issues — as the University at Buffalo has shown it does (albeit on a fairly limited scale) — then it might just help repair lesser damage done.
It might. I only wish I had the medical and scientific background and credentials to be able to speak as an expert on this. But apparently expertise is no guarantee of being able to help out, when it comes to TBI. The vast majority of experts haven’t had the wherewithall to state definitively what can actually be done about brain injuries, let alone recommend specific action that works, and there are thousands upon thousands, if not millions, of people suffering, day in and day out (along with their loved ones and co-workers) with the after-effects of concussion and mild traumatic brain injury.
So, somebody’s got to take the lead in finding a solution… Or at the very least think about finding one. The folks in Buffalo are up to wonderful work, and I can only hope that more folks have the gumption to take their lead and do something about this wretched hidden epidemic of ours.
Now, I’m off to address my own issues of the day.
I have been looking at my notes from the past days, seeing what I’ve gotten accomplished, and what I haven’t.
There is a whole hell of a lot I have not gotten accomplished, that I have been promising myself I would. Some of the things I have not done are serious. They are job-related. Survival-related. Pay-related.
I cannot NOT do them. But that’s what I’ve been doing.
Not.
I’ve also been thinking about how long it took me to realize that my fall in 2004 had affected me the way it had. Some call it “denial.” Some call it a “cognitive blind spot.” I call it “not sinking in because I have so many other things to think about.” Things like stray distractions that come across my path that for some strange reason I cannot resist following. Like a mynah bird. Magpie me.
The really freaky thing is, I ‘got’ that my concussions as a kid had affected me tremendously, when I was young. The discipline problems. The meltdowns. The outbursts. The getting kicked out of class because I was too much of a handful and nobody knew what else to do with me. I also ‘got’ that the concussions of my childhood had affected my development and made it difficult for me to really function as a regular adult throughout most of my life. Certainly, I did a great impression on the surface, keeping a job (well, a series of jobs) and getting married and settling down and doing important things.
But nobody on the outside ever saw what went on inside. And very few people ever knew what living with me was really like.
The fact that my spouse has stood by me all these years is nothing short of a miracle.
Anyway, the reason I bring up my cluelessness about the impact of my fall in 2004, is that it’s the same kind of obliviousness that I now sense, around my work and the things I have let slide. It’s like I’ve been in this haze, this wandering-about fog, where my brain is busy thinking about everything except what it’s supposed to think about. And that happily distracted piece of me is quite content to not give much thought to my work.
But I must change this. Because focused attention is what helps restore my everyday function, one task at a time. I hate that I have to approach just about everything I do like some rehabilitation exercise, but I do. I just do. I have to make extra effort to get things started, and I have to make extra effort to stay on track, and I have to make extra effort to finish what I start.
I don’t like it. I hate it, in fact. But that’s how it is. That’s how it is with me.
So, I’ll make the extra effort.
And yes, I’ve decided to drop my shrink, once and for all, because they keep encouraging me to not work so hard, not be so hard on myself, not expect too much of myself.
That’s no way to recover. I need to recover, and not give up. I need to treat each and every day like a chance to recover some part of me I’ve lost — or am in danger of losing, if I don’t pay extra attention. I just can’t end up like the football players and other professional athletes who end up demented and/or dead long before their time, because they had no idea what they were doing to their brains, and they never found out what they could do to fix them — or probably ever realized that they needed to fix anything.
Enough of the blind spots. Enough of the denial. Enough of letting things slide and acting like that’s okay. I have to keep sharp. I don’t want to fade away. I don’t want to end up demented and dazed, because I was too dazed and/or lazy to put in the extra effort to keep my brain healthy and engaged.
I need to be healthy. I need to be engaged. Like the nuns in the Nun Study in “Aging With Grace” I need to keep disciplined and focused and not give in to my lazy streak… the streak in me and my broken brain that loves to wander around and follow whatever little distraction comes along. My brilliant mind knows better than to do that all the live-long day.
I must do better. Each and every day is an occupational therapy opportunity. I need to get back what I’ve lost – and make sure I don’t lose what I’ve worked so hard to get.
These pictures are worth thousands of words.
Are you SURE you want your kids to play football?
Recently, someone posted about the Maher mouth guard being effective protection against TBI in sports. I don’t know enough about it to speak with any authority, but on the other side, there’s the impact of low-level hits to consider. I believe I’ve posted about this before, but it bears repeating:
When we think about football, we worry about the dangers posed by the heat and the fury of competition. Yet the HITS data suggest that practice—the routine part of the sport—can be as dangerous as the games themselves. We also tend to focus on the dramatic helmet-to-helmet hits that signal an aggressive and reckless style of play. Those kinds of hits can be policed. But what sidelined the U.N.C. player, the first time around, was an accidental and seemingly innocuous elbow, and none of the blows he suffered that day would have been flagged by a referee as illegal. Most important, though, is what Guskiewicz found when he reviewed all the data for the lineman on that first day in training camp. He didn’t just suffer those four big blows. He was hit in the head thirty-one times that day. What seems to have caused his concussion, in other words, was his cumulative exposure. And why was the second concussion—in the game at Utah—so much more serious than the first? It’s not because that hit to the side of the head was especially dramatic; it was that it came after the 76-g blow in warmup, which, in turn, followed the concussion in August, which was itself the consequence of the thirty prior hits that day, and the hits the day before that, and the day before that, and on and on, perhaps back to his high-school playing days.
This is a crucial point. Much of the attention in the football world, in the past few years, has been on concussions—on diagnosing, managing, and preventing them—and on figuring out how many concussions a player can have before he should call it quits. But a football player’s real issue isn’t simply with repetitive concussive trauma. It is, as the concussion specialist Robert Cantu argues, with repetitive subconcussive trauma. It’s not just the handful of big hits that matter. It’s lots of little hits, too.
That’s why, Cantu says, so many of the ex-players who have been given a diagnosis of C.T.E. were linemen: line play lends itself to lots of little hits. The HITS data suggest that, in an average football season, a lineman could get struck in the head a thousand times, which means that a ten-year N.F.L. veteran, when you bring in his college and high-school playing days, could well have been hit in the head eighteen thousand times: that’s thousands of jarring blows that shake the brain from front to back and side to side, stretching and weakening and tearing the connections among nerve cells, and making the brain increasingly vulnerable to long-term damage. People with C.T.E., Cantu says, “aren’t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play—repetitively doing this, year after year, under levels that were tolerable for them to continue to play.”
Speaking from experience, I don’t see how it’s possible to discourage kids who live, breathe, eat, sleep contact sports to give them up — even if it means they add years to their lives and they avoid the dementia and cognitive problems that can appear over the long term.
I, myself, have apparently had enough concussions in my life to make my brain increasingly vulnerable to damage. The fall I had in 2004 almost cost me everything, and it was totally a fluke — or divine intervention — that spared me and my family from complete ruin.
Parents and coaches and spectators alike should give the impact of repeated subconcussive impacts a good deal of thought, and weigh the immediate benefits versus the potential long-term costs to the next generation.
Just my two cents… on top of Malcom Gladwell’s amazing piece.
Just found this article about Jamal Lewis’ decision to retire from football after a concussion.
This sounds eerily familiar:
After calling time on his playing days, it’s reported Lewis was unsure his retirement from the NFL was the right decision, but after talks with his wife, he knew it was time to retire.
“I felt confused and did’t know where I was, or what I was supposed to be doing. That’s football though, Coach Mangini makes the calls, I just try and decipher them”.
After the hit, Lewis started to complain more of concussion symtoms which lead to the former Pro-Bowler being placed on injured reserve. “I had terrible headaches, night terrors, my vision was blurred, and I had black spots in my memory.”
“It felt pretty good for the most part. It allowed me to relax. I took some time away with my kids, I just wanted to forget football for a while.”
However after the heavy hit, Lewis forgot about football almost entirely. While watching a repeat of popular-sitcom Friends, he turned to his wife “We’ve got enough money, the kids are set-up for life, I can retire. Look at those guys, they never work, and the live in Manhattan. That could be us, baby.”
Mrs Lewis didn’t take this well. A source close to the situation revealed she screamed in his face “YOU’RE 30 YEARS OLD JAMAL. YOU’RE THE GOD DAMN RUNNING BACK FOR THE CLEVELAND BROWNS!”
“I was in shock. I couldn’t believe what just happened. She’s never spoken to me like that before” remarked the former 1000-yard rusher. “And that’s when it all sunk in. I really did play for Cleveland.”
“The concussion wiped parts of my memory, and I guess I’d forgotten all about that time in my life”.
Yes, folks, that’s what a mild traumatic brain injury can do to you. And you don’t even realize it at the time. That’s one of the thins that makes this kind of injury so frustrating and confounding. You think you’re fine. You really do… but others know better.
The lucky ones have people around them who will tell them what the deal is and set them straight.
Meanwhile, the rest of us have to find out the hard way.
The NFL has recently released new stricter concussion guidelines.
The new policy states, in part: “Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptotic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant.”
This could be a really good thing.
I hope.
Broken Brain - Brilliant Mind 