Limiting Head Trauma is Logical


The research is starting to come in; the problem is that results and conclusions bring more questions that should be answered.  Naturally some will look at early evidence and make a 180 degree change on their attitudes about certain things.  We are talking about concussions and the research associated with it.  Unfortunately there is plenty of anecdotal and observational cases that sear into our memory, this perhaps shape our thought process.  Along with that there is gathering evidence that supports some sort of process change in how we handle this particular injury.

The need to make change is upon us, that cannot be debated; what can be debated is how or what the changes should be.  I recently read an article where Micky Collins of UPMC said something to the effect of current concussion concern is like a pendulum that has swung all the way to the other side.  Although the changes in sports and activities has certainly not taken that full swing the other way, the pendulum is on the way.  His feelings, like mine is that there is no evidence to suggest that a full swing to the other side is warranted, rather there needs to be competent and complete understanding of what we are facing.  Rather than making full sweeping changes that would be akin to digging up your backyard to rid your self of a mole; when placing traps and poisons and maybe only having to dig up a small section would fix the problem.

There are definitely things we can do as parents, players, coaches, researchers, doctors and concerned people in general to make a dent in the issue.  If we find that the changes are not working then taking another aggressive step may be necessary.  I guess the reason for the above rant is to reinforce the need for changes, but the right changes.  (As I wrote the last sentence I realized how do we know if the changes are the “right” ones; I guess we don’t but certainly what is happening now needs attention).

One of the small changes that can be made is very obvious to me; limiting head trauma as much as possible while still enjoying the sport and activities we love.  This was reiterated by Dr. Robert Cantu in a piece written by Christy Cabrera Chirinos of the Sun Sentinel (part of a special series in the Sun Sentinel);

“It’s risk vs. reward,” said Cantu, a co-director at the center. “I don’t think it’s a risk worth taking if it can lead to CTE. Youngsters shouldn’t make decisions for themselves if they can’t understand the ramification of head trauma. They shouldn’t be subjected to it.”[…]

“It’s controversial, no question but weekly, I see these kids who have been injured and I see individuals with CTE at an early age,” Cantu said. “I think it calls for more thought and reflection. We have pitch counts for Little League [baseball] players. That’s to prevent a ligament injury that is repairable. But we don’t have hit counts to the head of children playing youth sports and there’s no cure if they develop early signs of CTE. I think we need to rethink how we play sports and the way we look at them.”

Dr. Cantu is once again speaking about his belief that collision sports as they are played should be limited to older individuals, his age cutoff is 14 or freshman year in high school.  Along with the full contact sports he also advocates removing heading from soccer; the reasoning is that less head trauma at a younger age can only benefit brain health down the line.  It is an opinion that I share and advocate as well.

Sports are a necessary part of this world, if for nothing else to provide places where our ever-growing sedentary youth can be physically active and combat the expanding waistlines or for a positive outlet for those that need to be doing something positive with their time.  We as the protectors of our youth and children must make it safe.

If you add taking currently constructed collision sports out for the young with limiting contact through adolescents (like the proposals presented here) we have already created a culture change that will be better for everyone, and guess what it all costs NOTHING.  The only other logical next step to do without radically changing the sporting world in which we live is to get Certified Athletic Trainers at all events that include full collisions.  This last idea not only helps with the concussion issue but it addresses all the injuries that can be associated with sports in general.

The moral of the story is that we do need to make changes for the safety of our youth, however we must make informed decisions not radical processes that would throw the baby out with the bath water.

 

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7 thoughts on “Limiting Head Trauma is Logical

  1. joe bloggs May 31, 2012 / 12:14

    While I would take nothing spun out of UPMC or from Mickey Collins with any degree of seriousness due to their involvement in the Riddell Helmet claims and obfuscation regarding concussion in the professional ranks, the panic that surrounds the near constant drumbeat of CTE is of great concern.

    CTE has been identified in 13 professional football players according to public sources. Some evidence has been shown in hockey players. It was originally identified by Dr. Maitland in boxers where it is most common in 1928. Granted not everyone wants to donate their brain to research so these numbers are understated, however, the controls or population studies are lacking. Certainly, Omalu and McKee do science no favors by fighting over corpses and announcing study results prematurely.

    If CTE is such a threat why are the hospices/nursing homes not overflowing with high school and college athletes. We should be seeing an enormous spike in early onset dementia and various other pathologies traced to athletics. While research on athletic populations are very political and tend to attract less than gifted researchers, population statistics do not support an epidemic of neurodegenerative disease.

    Professional players have all sorts of problems above the neck that may have nothing to do with CTE. The players who died by their own hand may not been caused by CTE but by other pathologies.

    This is not to minimize the damage one can suffer from concussion. Post concussive disorders are poorly characterized and often misunderstood. While one may never a neurodegenerative disease, one’s quality of life can material suffer from depression, headache, memory impairment, anxiety, concentration etc.

    Should children be playing semi-professionalized sports before age 14? No. We know children are at higher risk for long-term damage than mature people. If a child elects to or a parent allows a child to participate in a collision sport, make sure the coaches are qualified and trained; an ATC, nurse or doctor is available, and equipment is up-to-date and maintained. Note: gender difference are real and require more research.

    Does the length of exposure and the intensity of play influence outcomes? Yes. The more the subject plays and the more concussions/subconcussions experienced the more susceptible the subject seems be. Duration and intensity of experience also seems to influence recovery times. It may explain the tragic circumstances that professional athletes often report after retirement as they have played for years often receiving substandard medical treatment. Too many people are being led to believe that contact sports will result in neurodegenerative disease based on a limited number of case reports on professional athletes. Even D1 college ball is a slow motion low kinetic version of the professional games.

    Nonetheless, the games need to change and people need to be responsible. Eliminating athletics is not a solution. Instead make the people who promote and participate accountable and financially responsible. It will eliminate much of the nonsense. In the meantime, it is best to let real scientists and engineers deal with the issues as opposed to parties more interested in self-promotion.

    • A Concerned Mom May 31, 2012 / 15:04

      Many youth sports leagues and clubs are run and coached by volunteers who are protected by various state volunteer immunity laws. As it stands right now, the youngest children participating in youth sports may very well be the least protected athletes. Some state youth concussion laws don’t even cover them.

      The only way to clean up youth leagues may be by informing parents that they need to conduct their own due diligence, because no one else is doing it for them. Perhaps there may be more incentive for change at the middle school level and above.

    • A Concerned Mom May 31, 2012 / 19:40

      According to Chris Nowinski’s book “Head Games,” “[t]he game is not the same as it was forty years ago. Not only are players bigger, stronger, and faster, but they initiate contact differently. During the late 1960s, tackling changed from dragging a guy down to knocking him down, and the record of that change must exist in the bodies of the players.” The book also indicates that “according to the NFL no active player retired from post-concussion syndrome before 1992.”

      I’ve read at a number of different sources that helmets and other protective gear can change the way various games are played (can make players more aggressive as well as change the style of play). Is it possible that we have not yet seen a spike in early onset dementia because we’re just now reaching the point where we’re 40 years out from when helmets started to be used as weapons? As helmets were improved over time, the pain that would normally be felt by initiation of contact with the head was removed, and the addition of and changes to the facemask most likely took away fear of facial injury.

    • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist June 1, 2012 / 01:24

      Hi Joe:

      The complete citation re H. Martland’s, M.D. classic article follows:

      Martland, H.S. (1928). Punch drunk. Journal of the American Medical Association, 91, 1103-1107

      The below excerpt re Dr. Martland was obtained online from

      Harrison Stanford Martland, MD (1883-1954),
      A Register of His Papers, 1905-1954.

      in UMDNJ Libraries-Special Collections Department

      excerpt:

      It was Dr. Martland who proved, back in 1928, that “punch drunk” prize fighters were suffering from a brain injury caused by the rupture of blood vessels. He did notable work in phases of cardiac syphilis and in the effects of bullet wounds on the body. Dr. Martland’s accomplishments also included the first paper establishing the lethal effects of beryllium poisoning, which led to implementation of regulatory reforms governing the use of beryllium in industrial plants.

      ==================================================================

      Along the same line, below is pertinent and related info cited directly from gplaw.com:

      Chronic Traumatic Encephalopathy (CTE), Dementia pugilistica
      Known by a whole host of different names, including punch-drunk syndrome, dementia pugilistica (DP) or chronic traumatic encephalopathy is a type of neurodegenerative disease or dementia caused by repeated concussive of sub-concussive blows (hits just below the force required to cause concussion).

      Forensic pathologist Dr. Harrison Stanford Martland was among the first to describe this condition in his article “Punch Drunk,” which was published in the October 13, 1928 issue of the Journal of the American Medical Association:

      [S]ome time fight fans and promoters have recognized a peculiar condition occurring among prize fighters which, in ring parlance, they speak of as “punch drunk.” Fighters in whom the early symptoms are well recognized are said by the fans to be “cuckoo,” “goofy,” “cutting paper dolls,” or “slug nutty.” Frequently it takes a fighter from one to two hours to recover from a severe blow to the head or jaw.1

      While boxing gave the condition a name, football players were experiencing similar injuries. In 1893, U.S. Naval Academy Midshipman and football player Joseph M. Reeves was warned by a Navy doctor that another blow to the head could cause “instant insanity” or death. Reeves commissioned a local shoemaker to create what is now believed to be the first football helmet, so that he could play in the Army-Navy game. (Fortunately for Reeves, he avoided further injury and would later become better known as Admiral “Bull” Reeves, the “Father of Carrier Aviation.”)

      In 1913, football coach Glenn “Pop” Warner commented that he had “many times seen cases when hard bumps on the head so dazed the player receiving them that he lost his memory for a time and had to be removed from the game.” The medical community was also becoming concerned over the damage repeated concussions have on physical, emotional, and mental health. The following list reflects just some of the long-standing knowledge surrounding the debilitating effects of CTE and dementia:

      1930s
      Millspaugh, J. A. “Dementia Pugilistica.” U.S. Naval Medicine Bulletin (1937) 35, pp. 297-303.

      Busse, EW, Silverman, AJ.”Electroencephalographic Changes in Professional Boxers.” Journal of the American Medical Association (1952) 149(17):1522-1525.

      1950s
      Strich S “Diffuse Degeneration of the Cerebral white matter in severe dementia following head injury.” Journal of Neurology, Neurosurgery and Psychiatry (1956) August; 19(3): 163–185.

      Corsellis JAN, Brierley JB. “Observations on the Pathology of Insidious Dementia Following Head Injury” Journal of Mental Science (1959) 105: 714-720.

      1960s
      Fisher CM. “Concussion amnesia.” Neurology (1966) 16:826-830.

      Payne, EE. “Brains of boxers” Neurochirurgia (1968) Sep;11(5):173-88.

      John Johnson M.D., M.R.C.P.E., D.P.M. “Organic Psychosyndromes due to Boxing.” The British Journal of Psychiatry (1969) 115: 45-53.

      Roberts, Anthony Herbers. Brain Damage in Boxers: A study of the prevalence of traumatic encephalopathy among ex-professional boxers. London: Pitman Medical & Scientific Publishing Co., Ltd., 1969.

      1970s
      Yarnell PR, Lynch S. “Retrograde Memory Immediately After Concussion.” The Lancet (1970) 295(7652):863-864.

      In 1973, a disabling and sometimes deadly condition involving the second impact concussion occurring before symptoms of a first concussion was described by R.C. Schneider. This later was coined the Second Impact Syndrome in 1984.

      Corsellis JA, Bruton CJ, Freeman-Browne D. “The Aftermath of Boxing.” Psychology Medicine (1973) Aug;3(3):270-303.

      Ommaya AK, Gennarelli TA. “Cerebral Concussion and Traumatic Unconsciousness: Correlation of experimental and clinical observations of blunt head injuries.” Brain (1974) 97: 633-654

      Harvey PK, Davis JN. “Traumatic Encephalopathy in a Young Boxer.” Lancet (1974) Oct 19;2(7886):928-9.

      Gronwall D, Wrightson P.”Delayed Recovery of Intellectual Function After Minor Head Injury.” Lancet (1974) Sep 14;2(7881):605-9.

      Gronwall D, Wrightson P. “Cumulative Effect of Concussion” Lancet (1975) 306 (7943): 995-997.

      Corsellis, JAN. “Posttraumatic dementia.” Aging (1978) 7:125-133.

      1980s

      Tysvaer A, Storli O. Association Football Injuries to the Brain: a preliminary report.” British Journal of Sports Medicine (1981) 15:163-166.

  2. A Concerned Mom May 31, 2012 / 16:36

    Oh my goodness, I just came across an insurance blog that made me wonder how youth sports (from volunteers leagues to high school) will ever be motivated to reduce impacts and take head injuries seriously:

    http://news.yahoo.com/end-youth-football-not-fast-181626601.html

    http://www.sadlersports.com/blog/concussion-lawsuits-wont-football/

    Will Oremus writes a well thought out explanation why concussion lawsuits will not end football. The main reasons cited are:

    “The initial medical expenses resulting from concussions and CTE are often not that high in most cases and symptoms take years to materialize; therefore, the Accident Medical insurance carried by colleges, schools, and youth football organizations will not be hit hard since such policies limit payouts for medical bills to those that are incurred within one or two years from the date of the injury in most cases. Most CTE symptoms will show up years after a football career is finished and the Accident policy will be off the hook by that time.”

    “In order to win a lawsuit, a player will need to prove negligence (1. Duty owed to act as reasonable governing bodies, administrators, trainers, coaches, etc. in protecting football players, 2. Breach of that duty by not following accepted safety standards, 3. Breach was proximate direct cause of the injury, and 4. Damages resulted). As result in the difficulty in proving negligence, the NFL lawsuits are alleging that the league knew about the dangers of CTE, but hid it from the players.”

    “Even if a public school or university as an entity, coach or other school employee is negligent, many states have governmental or sovereign immunity statutes that protect against liability or at least limit liability to an amount such as $300,000., $500,000., or $1,000,000. depending on the state’s version of the law (if any). These immunity statutes can be defeated upon proving gross negligence (i.e. wanton or willful disregard for safety of players).”

    “Some state concussion statutes also limit the liability of coaches, trainers, and other medical professionals when complying with the requirements of the statute unless they are grossly negligent.”

    “The assumption of risk defense to negligence can be a powerful defense tool if the players receive an adequate and documented risk warning of the dangers of concussions.”

  3. Stacey Gardner August 18, 2014 / 13:56

    Insurance companies do enforce restrictions in the insurance policy that require that sports teams use the proper safety equipment. Insurance rates will increase with any injury claims against the insurance policy. So in terms of insurance, it is also in the best interest of the sports teams to try to prevent injury.

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