Brain Injury: It’s Not Just a Concussion Issue
Football training camp has begun! The sport of kings has returned, as both NFL and NCAA teams prepare for the upcoming season. In the background of every football season sits the issue of head injury and concussions. In fact, the NCAA has actually reached a settlement totaling $75 million for a group of college athletes which has new stipulations for concussed college athletes.
Huge institutions like the Mayo Clinic and Cleveland Clinic are integrating with the NFL to develop testing and return to play protocols to address the issue of concussion. But what if the effects of brain injury weren’t strictly a concussion issue?
For those of you that have been following my blog for the past year, you know that I’ve written about concussion and traumatic brain injury more often than any other topic. For those of you new to the blog, you can check out those previous articles here:
Generally speaking, the world is becoming much more aware of the devastating impact that head injury can have on the lives of the injured, and their families. Much of this is due in part to professional sports taking a stronger stance on managing head injuries due to the looming possibility of massive class action lawsuits. Just seeing outrage on social media over the mismanagement of the concussed German soccer player Christoph Kramer during the World Cup Final lets us know that head injury is becoming a house hold topic.
However, a common misconception about brain injury is that it is strictly a concussion issue. While a one time concussive incident is certainly one of the most common ways to suffer a traumatic brain injury, research is showing that our brains can be damaged by an accumulation of sub-concussive forces.
People started noticing this trend when neurological symptoms started appearing in athletes that had no recorded history of a single concussive event, particularly in NFL linemen. While positions like quarterback, wide receiver, and running back are positions on the football field with a high risk of a concussive event, positions on the offensive and defensive line are exposed to repeated subconcussive impacts. Even though these linemen have avoided a full concussion, they have not avoided the threat of the chronic brain diseases that have been inflicting numerous NFL alumni.
What’s going on with these subconcussive events? Can they really do that much damage?
According to Timothy Gay, author of The Physics of Football, an average sized defensive back can generate as 1600 lbs of force when making a tackle on another player. The impact of a hit also generates tremendous amout of G-forces onto the body when compared to other well known accelerators. Source: Popular Mechanics
Walking = 1 G
Roller Coaster = 5 G’s
Fighter Jet = 9 G’s
Extreme Football Impact = 150 G’s
A vicious hit in football is about 15x the accelerating force of flying in an F16 Fighter jet.
When you think about it, it’s actually pretty astonishing how much the body of your average football player can handle and still be functional. Of course, not every hit is going to be at 150 G’s, but certainly plenty of impacts will generate 20-30 G’s on a repetitive basis, which is still 2-3 times the force of a fighter jet!
The Physiology of non-concussion head impacts
In a world where concussions stopped happening on the playing field, the ground is still fertile chronic neurodegeneration. Here are just some of the things that happen with a head impact.
1. The brain and nerves do not want to move. There are threshholds of movement that will cause deformation of the nerves in the brain and spinal cord without obvious symptoms. This was found when rugby players, football players, and fighters. It took specialized imaging called diffusion tensor imaging to identify these small lesions.
2. Head impacts can stimulate parts of your innate immune system to become active and primed. Proteins called the Complement Cascade are known to activate with brain movement, and the white blood cells of your brain called microglia also become more sensitive with each head impact.
Repeated bouts of inflammation can create structural changes in the brain.
3. You cannot have an impact to the head without having an affect on the neck, especially at the area of the Atlas. The atlas is the vertebra that connects the head and neck. Where every other vertebra is locked in place by a disc and facet joints, the atlas is only supported by ligaments and muscles.
When the head gets jarred, then the atlas can shift and create changes in the ligaments, muscles, and blood vessels of the head..
This in turn affects the drainage system of the head, and leads to those inflammatory chemicals staying within the brain causing chronic inflammation.
The NFL and NCAA are taking strong steps to address concussed athletes, but what happens to the athletes who take a big hit to the head but don’t fit the signs and symptoms of concussion? Because after all, when you’re diagnosing a concussion on the field, all you have to go by are the patient’s symptoms.
Research has shown that people who have had one concussion can be asymptomatic but perform more slowly on cognitive tests than people who have never had a concussion. Symptoms are just the tip of the iceberg of a big problem.
As you can see, there can be strong physiologic changes happening in the brain but not every athlete will show the overt signs of brain injury. So the athlete gets onto the field, takes another subconcussive hit, and more tissue damage and inflammation is spurned.
When performed for years, it can gradually lead to brain degeneration with the similar symptoms of Alzheimer’s, Parkinson’s, MS, and other forms of dementia.
Of course, no NFL team or player is going to come off the field if they think they feel fine. The best of the best athletes are who they are because of their ability to push through pain and still perform at an elite level. Plus, their career and livelihood is determined by their perceived durability.
Neurology centers and concussion experts can do their best, but in the end, the professional athlete is going to do whatever they can to stay on the field.
What we need to do is protect our youth athletes. The young and developing brain is the most susceptible to the forces of brain trauma, and are more likely to have a worse symptomatic outlook.
A growing number of horse riders, high school football players, soccer players, and cheerleaders are showing Secondary Conditions like chronic headache, dizziness, neck pain, and even depression/anxiety due to head trauma, but no one is paying attention because they never got diagnosed with concussion.
Here are some tips:
1. If your child is subject to repeated head contact (soccer, MMA, tackle football), make sure they are getting enough rest periods. After a substantial hit, it may be worth while to take some plays off so the brain is better able to recover and drain even if no concussion signs are visible.
2. Supplments like Omega-3 Fish Oils have shown some promise in providing the building materials to recover from neurodegeneration in animal models. Most people will benefit from Omega 3’s regardless, but it’s also a good idea to take advantage of some of it’s anti-inflammatory effects with a high quality supplement, or even better, eating more wild caught fatty fish.
3. Head impact and neck impact go hand in hand. While I believe that everyone should have their neck checked for Atlas Displacement Complex, it’s even more important for kids who are subject to repetitive head trauma.
Not only is it safer to take on head impacts with a structurally sound neck, it’s also an effective way to prevent the neurological problems associated with head injuries.