Concussions in football: The long-term impact
By Mark Lazerus 648-3140 or mlazerus@post-trib.com August 18, 2011 11:02PM
Kankakee Valley's Paul Ferrand is brought down by Lowell's Jeremy Crocker and Spencer Kersey in Lowell. |Archive~Sun-Times Media
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Updated: January 23, 2012 3:23AM
Mark Leto won’t soon forget the sight — stunning black spots shrouding the brains of three elite athletes, on display for athletic trainers across the country at the national convention in New Orleans.
One of the cross-sections was from the brain of former Bears player Dave Duerson, who knew something was wrong with him and chose to kill himself by shooting himself in the chest, so others could benefit from an analysis of his damaged brain. Another was from a boxer who died in his 70s after a lifetime of headshots. The third was of a 21-year-old University of Pennsylvania football player, Owen Thomas, who hanged himself last October after what friends called a sudden, emotional collapse.
All three had dark spots on their brains, a sign of chronic traumatic encephalopathy (CTE), the result of relentless blows to the head over the course of their athletic careers.
And none could be diagnosed until they were dead.
“No scan can tell you that they have this going on,” says Leto, the Hobart athletic trainer. “Only when they do an autopsy. That’s why we have to keep studying brain injuries, because we need to learn more about what’s happening here.”
Leading the way in that area is Purdue University, where researchers Larry Leverenz, Eric Nauman and Thomas Talavage have used cutting-edge technology to study the effects of playing football on students at Lafayette Jefferson High School. Twenty-one players wore helmets that were equipped with six accelerometers, which gathered data on the amount of G-forces the players’ heads withstood on each play. Sometimes, it was more than a staggering 100 Gs. The researchers also used the ImPACT test that has become standard care for many schools, and functional MRI, a specialized MRI that measures blood flow in the brain.
Three of the 11 players who received the highest amount of blows to the head were diagnosed with concussions. But the most alarming discovery of the ongoing study — which was first presented in the Journal of Neurotrauma last fall — was that four of the other eight players suffered brain impairment without ever being diagnosed with a concussion, or showing any symptoms of a concussion.
So the repeated blows to the head — a lineman could endure hundreds every week throughout practice and games — have a cumulative effect.
“Half of the players who appeared to be uninjured still showed changes in brain function,” Leverenz concluded at the time. “These four players showed significant brain deficits. Technically, we aren’t calling the impairment concussions because that term implies very specific clinical symptoms, such as losing consciousness or having trouble walking and speaking. At the same time, our data clearly indicate significant impairment.”
The study grabbed national headlines, and certainly caught the attention of medical professionals in the football community.
“You had to believe something was going on, that all those multiple blows day after day for two or three months added up,” says Chesterton athletic trainer Bernie Stento. “I’ve had linemen that have had headaches and other symptoms that come to me and say, ‘I don’t ever remember one particular blow to the side of my head, or falling down, or hitting and somebody and having symptoms.’ They just develop over time.”
Stento was as jarred by the images accompanying the study as the result themselves.
“There was a picture of a kid’s helmet, a lineman, and it was all gouged and scraped and the paint was peeling off,” Stento says. “It’s one of those signs of the warrior to the kid, but in actuality, if you’re bumping heads and hitting helmet to helmet over and over again to cause that much superficial damage to the shell of the helmet, what happens to your brain from all that force?”
While some players averaged as few as 15 head shots per week, according to the study, some were hit more than 150 times — most of those hits coming in practice. Since that 150 mark seemed to be the range at which players began to show impairment, the research suggests that fewer contact practices could help alleviate the problem.
The study showed that linemen were at the greatest risk, because of the relentless collisions in the trenches after every snap. Stento says that the chewed-up helmet is a sign of poor technique — only the facemask and forehead of the helmet should be scarred if a lineman is staying low, keeping his head up and avoiding helmet-to-helmet contact.
But even perfect technique can only mitigate the damage all those G-forces can do over the course of multiple practices, multiple games and multiple seasons. And with many of these players failing to exhibit any outward symptoms of the damage caused by those blows to the head — and with the prohibitive expense of the technology used in the Purdue study — the risk of long-term impairment is very real.
“These individuals are unlikely to undergo clinical evaluation and thus continue to participate in football-related activities, even when changes in brain physiology (and potential brain health) are present, likely increasing risk of future neurologic injury,” the Purdue study concluded.
Right now, the only way to diagnose CTE is post-mortem. The Purdue research team continues to work with Indiana high school football players — expanding to other schools over the past year — in hopes of finding a better way.
“We’re still going to have head injuries, especially in a sport like football, there’ll always be head injuries,” Stento says. “But we need to keep educating parents, kids and coaches, and we need to keep learning about what’s happening here, so we can do a better job of preventing them, and of treating them. We’ve come a long way, but we still have a long way to go.”
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