Concussions, Head Trauma Can Be Reduced, Experts Tell Conference
The message to the 192 in attendance, mostly of whom were medical, educational or athletic professionals -- doctors, nurses, emergency personnel, professors, instructors, administrators in school systems and sports organizations: we don't know everything about sports-related traumatic brain injury, yet. But we do know that athletes, at the earliest ages, do not have to take as many blows to the head as they do, and that there are no more excuses for why they are allowed to.
"We can have a way to reduce the number of hits in the head from 1,000 to 300, tomorrow,'' said Christopher Nowinski, a former college football player and pro wrestler who is co-director of Boston University's Center for the Study of Traumatic Encephalopathy.
Nowinski, one of 11 speakers at the conference, pointed to the efforts at every level of baseball to protect pitching arms against injury, such as mandated pitch counts in Little League -- where coaches, he said, actually have hand clickers to count the pitches. "How do we not have something like this in football?'' he asked.
The center at Boston University has studied the brains of deceased athletes and solicited active athletes to donate their brains for research after their deaths; it recently studied the brain of former Penn football player Owen Thomas, who committed suicide in April, and found signs of the degenerative brain disease chronic traumatic encephalopathy (CTE). At the time, Thomas, 21, was the youngest athlete found to have the disease; researchers revealed Friday that signs of the same disease were found in an 18-year-old high school player.
The damage to Thomas's brain, said Ann McKee, also a co-director of the Boston University center, was "nothing you would ever expect to see in a normal individual.''
That they were found in athletes well before the professional level -- and that it is now being discovered in those who had not previously reported concussions -- has led to the belief that all head impact, including "sub-concussive'' blows, can play a role in the emergence of the illness, although little is still known why it appears in some athletes but not others.
"Unfortunately, you can only diagnose CTE in the heads of someone like Owen, after someone has died,'' said Robert Stern, another co-director of the Boston University center, as well as director of the school's Alzheimer's Disease Center.
The Center for the Study of Traumatic Encephalopathy received a $1 million grant last spring from the NFL to study brain injuries -- after the league had gone to great lengths over the years to dismiss or downplay the center's findings. Yet brain trauma is evident well below the pro level, Stern reiterated Friday. Of all the known degenerative brain diseases, including Alzheimer's, CTE is the only one that is "fully preventable,'' he said, adding that even with the new findings, it still is not known what other factors contribute to it.
"In other words, we have a lot to do, and we have to do it quickly,'' Stern said. "We have to do it with some urgency.''
The answer, speakers explained, was not eliminating or outlawing football, but adjustments in how players train, how they practice and how often they can be made. Players take more blows to the head in practice than they do in games, studies show, and the number of times they practice has increased at all levels. The fact that drills that date back to earlier last century -- Oklahoma and bull-in-the-ring were given as examples -- are still routinely used is not helping, Nowinski said.
"I don't know when that situation ever happens in a game,'' he said, as he showed a video clip of two youth league players at practice, colliding one-on-one after a running start. "I say eliminate that. It's a dumb drill.''
Improved helmet technology is not a cure-all either, the speakers said -- many designs are already capable of being fitted with sensors to monitor the frequency, type and magnitude of blows to the head, but they are not, never have been and cannot be designed to prevent them. In fact, one study cited that brain traumas were not reduced during practices with helmets-only and no pads, as opposed to practices in full gear; the same results emerged from so-called non-contact drills compared to ones with contact.
More important, said Richard Greenwald, an adjunct engineering professor at Dartmouth and co-founder of the bioengineering and advanced-equipment designing company Simbex, was that everybody involved, from players to coaches to parents to medical personnel, understand the symptoms of possible concussion. Not understanding is what leads, according to several studies cited Friday, to concussions that were never reported -- as significant a problem as the volume of blows to the head themselves.
Alluding to a study that said a significant number of concussion-level impacts were not diagnosed as such, Greenwald said, "We ask ourselves, 'What have we been missing?''
Players, coaches and others also must overcome the resistance to reporting them, follow the guidelines for treating them and for keeping athletes out of action for the proper time -- and, as Nowinski said, monitor the number of times the head is exposed to injury, the same way pitchers' arms are managed. The advances in diagnosing and treating injuries to other parts of the body, he said, are far ahead of those involving the brain.
"I hope we can get to where we can prevent these injuries, rather than just respond to them when they occur,'' Greenwald said.
Among the other deceased athletes studied by the Boston University center who were found to have suffered from CTE are Pro Football Hall of Fame offensive lineman Lou Creekmur and longtime Vikings linebacker Wally Hilgenberg. The dementia they developed, years after their careers had ended, was distinct from other forms, but the damage to their brains and others' was similar to that of men much older, McKee said. In addition, Hilgenberg developed Lou Gehrig's disease, which is now believed to be accelerated by repetitive brain trauma.
Some 350 athletes, from all sports and including amateurs, have agreed to donate their brains to the Boston University center since the program's inception last year; its goal is 750 donations. Meanwhile, six retired pro athletes are participating in a study in which their brains undergo state-of-the-art imaging tests, and they already have produced evidence of lost brain tissue compared to non-athletes.
Next month, the center directors said, 200 retired NFL players of all ages and years of experience will begin a program of neurological, psychiatric and medical study that will include spinal taps, to track potential brain injury and disease and find other ways that they can be diagnosed.
Boston University's Sports Legacy Institute, an organization co-founded by Nowinski to advocate for improved policy on brain injuries in athletes, has proposed numerous guidelines for federal and states to follow, and has pushed for football rules to protect players to be instituted and enforced. What is at stake, he said, cannot be overstated.
"What we're dealing with is a potential public health epidemic,'' Nowinski said.