Understanding the dark side of head injuries in sports Understanding the dark side of head injuries in sports
The issue of concussions in sports has attracted considerable media coverage in recent years. The early focus was on professional football, a game built... Understanding the dark side of head injuries in sports

The issue of concussions in sports has attracted considerable media coverage in recent years.

The early focus was on professional football, a game built around high-speed and full contact between heavy, powerful players, but the scope of reporting and research has expanded widely to include sports at every level.

Reporter Alan Schwarz of the New York Times highlighted the history of concussions and their consequences in the National Football League over the past decade. The league responded by banning some high-risk hits. Further action was taken by investigating a ‘bounty pools’ scandal.

A bounty pool occurs when a team pays bonuses to players who are willing to injure their opponents.

A traumatic brain injury, most commonly referred to as a concussion in sports, is defined as a blow or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain. Traumatic brain injuries can result when the head suddenly hits an object, or when an object pierces the skull and enters brain tissue.

Retired players continue to pursue legal action and raise awareness of the issue, particularly with cases of former players suffering from early-onset dementia that can result from repeated brain trauma, but very little was done before tragedy struck the professional football world. In January 2013, the National Institutes of Health concluded that former NFL linebacker Junior Seau, who committed suicide in May 2012, had been suffering from a degenerative brain disease.
According to ABC news, a team of scientists who analyzed the brain tissue of Seau concluded the football player suffered a deliberating brain disease likely caused by two decades worth of hits to the head.

The sports world was left in shambles upon hearing the news. Seau was only 43.

Another rough and physical sport involving devastating head trauma is ice hockey. In Canada, hockey causes 44.3% of all brain injuries among Canadian kids. “It’s not surprising that kids are getting head injuries from the physicality involved in Canada’s National sport, but it shows we still need to make major inroads in preventing head injuries,” said Dr. Michael Cuismano, a neurosurgeon at St. Michael’s Hospital.

Over the years, players in the National Hockey League have experienced career-altering injuries as a result of fights, and/or dirty hits that have proven to have short and long-term effects on the brain. NHL all-star Sidney Crosby was out for the better part of a year, beginning in 2010, because of a severe concussion. While Crosby’s injury was a minor setback in his hockey career, the long-term consequences of such injuries can be dire.

Former NHL “enforcer” Derek Boogaard, who died in May 2011, suffered from chronic traumatic encephalopathy, a degenerative disease directly linked to repeated brain injuries. During his 9-year professional hockey career, Boogard was involved in 27 fights, and threw over 200 hits to opposing players.

While repeated physical contact to the head seems to be an obvious way to sustain a head-related injury; researchers have discovered non-contact sports may still cause brain trauma. During the 2012 National Basketball Association Finals, Oklahoma City star James Harden suffered a concussion just before the beginning of the playoffs. In Major League Baseball, concussions ended the careers of Mike Matheny (now the manager of the St. Louis Cardinals) and Corey Koskie (Canadian, and former Toronto Blue Jays shortstop). They also cost Minnesota Twins star Justin Morneau to miss a season of play. The league instituted a disabled list for players with concussions in 2011 and continues to work on the issue.

Concussion risk may be highest in professional sports, but it starts at the youth level. As children grow up playing amateur and competitive sports – the risk grows. Football, ice hockey as well as baseball, soccer, boxing, gymnastics, horseback riding, skiing and cycling — any sport with potential for hard contact have risks attached to them. The best evidence still continues to raise questions about whether schools and teams are doing enough to protect athletes at a young age.

Two studies were conducted in 2014 by The American Journal of Sports Medicine to determine as much. One study was based on a survey of 1066 college students and concluded that “although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed”. Another paper about protective equipment at the high school level found that among 2081 players enrolled during the 2012-13 football seasons, some 206 (9%) sustained a total of 211 concussions.

That study notes that, regardless of the type and brand of protective equipment, risk for concussion remains the same. The study also suggests it is the nature of on-field play that remains at issue. Because of specific concerns over youth football, Virginia Tech and Wake Forest have started a ratings system for helmets.

According to the Centers for Disease Control and Prevention, U.S. emergency departments annually treat an average of 173,285 sports- and recreation-related traumatic brain injuries among children. Such emergency visits have increased 60% over the past decade. In 2009 alone, there were 248,418 such cases.
New research from Harvard has called into question whether current study techniques are suitable. In addition, the long-term effects of head injury are only partially understood. The Boston University Center for Traumatic Encephalopathy received a $1 million donation from the NFL in 2010, and continues to examine the brains of deceased athletes to research and compile case studies on the long-term effects of concussions; the center also conducts other inquiries and publishes academic studies in this field.

Finally, in 2014 a study was published in the journal of Medicine & Science in Sports & Exercise providing new evidence that high school athletes may be returning to the field too early after suffering a concussion.

Former Ontario Hockey League defenceman, and Brock University Badger, Kevin Christmas is a victim of retuning to play too early after suffering a concussion. At the time of the injury, he wanted to get back as soon as possible and never considered the long-term effects it would have on his brain.

“I had my first concussion when I was 16, and I’m still feeling the effects today… I forced myself to play because I didn’t want to let my team down, and when you’re young you only care about winning… I went against my doctors orders and to make matter worse, I got into a couple of fights… definitely not the smartest decision I’ve made,” said Christmas.

Christmas continues to suffer from dizzy spells from time-to-time, and often forgets simple daily tasks.

According to Dr. Ann C McKee, professor of neurology and pathology at Boston Univerity, post-mortem brains have taught us a lot about the effects of brain trauma sustained over an extended period of time; specifically to help analyze the damage done to an athlete’s brain.

“We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects, including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour…. Although there are many issues that require more thorough investigation, this study clearly shows that for some athletes there may be severe and devastating long-term consequences of repetitive brain trauma that has traditionally been considered only mild.”

Although sports injuries only partially contribute to fatalities, the leading cause of death from sports-related injuries is traumatic brain injury. In the US, about 21 percent of all traumatic brain injuries become fatal for children and adolescent athletes.

This poses the question, is the equipment used in contact sports safe or dangerous?

Anne-Christine Duhaime’s study in October 2012 analyzed the clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets. Her findings included forty-eight separate concussions found in 44 individual players. The results were shocking to say the least.

“Players experienced mental clouding, headaches, and dizziness moments after experiencing head trauma…Thirty-one cases were associated with an identified impact and in 17 cases no specific impact event was identified…Most had no external observed signings,” said Duhaime.

This finding indicates there were no physical, or noticeable side effects in athletes Derek Boogaard and Junior Seau until their brain could no longer function properly. The only way to tell if they had severe brain damage was to analyze the damage caused to their brain tissue.

The approach to manage and care for an athlete with a concussion, or severe head injury can be challenging. Physicians caring for these athletes often question specific types of neurologic, psychological, or radiographic imaging methods used to make a decision in treatment.

“New legislation will undoubtedly increase physician visits for these athletes to return to play. Thus, the goal is to review the latest guidelines regarding concussion management to help all physicians who care for athletes do so appropriately,” said Dr. John K. Su.

Moving forward, it is important for sporting leagues all over North America and the world to implement new and properly structured guidelines. These guidelines must be put in place to urge doctors to be conservative in treating sports-related brain injuries and to not allow someone who has been injured to return to activity that involves risk of further injury until completely free of symptoms. Many athletes over the years have sustained serious injuries, made worse by a lack of knowledge, and understanding from coaches and trainers. This needs to change. If athletes continue to not receive the proper care they need, the injuries that may seem moderate now will likely require rehabilitation and include physical and occupational therapy, speech and language therapy, medication, psychological counseling, and social support. If you know anyone suffering from post-concussion symptoms, please take them to a doctor – you may be saving their life.

Michael Czulo