Concussion issue continues to grow

With the wrongful death suit against the National Football League by the family of former NFL linebacker Junior Seau, the issue of concussions is once again a prime topic of discussion.

Here is a story I did for the National Football Foundation last fall.

Imagine a  football game at the youngest level—Pee Wee, Pop Warner, Midget—where not only is the score kept, but there is also a category known as a “hit count”  which is as closely monitored as managers and coaches keep track of a pitch count in baseball.

Imagine a world of amateur football in which any serious contact was banned until the high school level.

Crazy stuff? Perhaps. But is there  more of a hot button topic in football at every level these days than the issue of concussions?

Before we get to what the future is regarding the diagnosis and treatment of concussions, we have to step back and look at what the perception was and how it was formed.

It’s a hot topic. There’s a lot of stuff out there that is not universally accepted. Part of the problem with concussions is that a lot of people for many years have argued about  the definition of concussions.

For the longest time, the perception was that you had to be knocked out to have a concussion.

Whether it is coaches, doctors or trainers or even players, the consensus  is that such a perception is both antiquated and wrong.

Still perceptions are reality in the minds of many people and when that happens the problem increases since it is tougher to come up with a solution when you can’t identify the definition.

That has changed dramatically in the last few years with more and more people examining and discussing the issue, not only locally, but nationally and internationally.

Experts from all over the world gathered.

In recent years, that group has grown with more and more people doing research on not only concussions but brain injuries.

Also included in the examination of the ramifications of concussions were several national outlets, including the Sports Legacy Institute which is based in Boston.

The point man for SLI is a former Harvard football player and professional wrestler named Chris Nowinski.

Nowinski has turned his condition—postconcussion syndrome-into a crusade. As the coordinator of Boston University’s center for the Study of Traumatic Encephalopathy,Nowinski’s group has studied the brains of deceased athletes for signs of the degenerative disease chronic traumatic encephalopathy.

As a former football player at Harvard and a wrestler for WWE (World Wrestling Entertainment) for a few years, Nowinski has been treated for depression, headaches and memory loss.

“I’m definitely not the same guy I used to be,’’ Nowinski told Boston University Today.

Working with a group called Cemter for the Study of Traumatic Encephalopathy and SLI, which Nowinski co-founded with Robert Cantu, one of the leading authorities on concussions, research has been linked with several high-profile cases of former NFL players with severe and often deadly symptoms of post concussion syndrome.

SLI and Nowinski have traveled across the country, doing what seems like ghoulish, but incredibly important research, involving the collectings the brains of athletes who have died or asking players who are still living and even still playing to donate their brains for medical research.

What has caused concern among the medical experts is that there is more and more information being gathered which strongly suggests that some people who take repetitive blows to the head suffer significant and often life threatening life-shortening long-term injuries.

The unsettling part of the research is that there is no set pattern to any of these issues. Some people who have had long careers in professional football with all of the violence which that includes, are perfectly fine, with no effects or symptoms.

But then there are  players who lead  unusual and often disturbing post career lives. Often those type of behavior are related to a condition called Chronic Traumatic Encephalopathy, a progressive degenerative concussion related injury.

What they are discovering is that some of the brains they have examined are related to this issue. The experts are trying to figure out what causes it and why  some athletes are affected and others aren’t.

The first  conclusion was that there were a number of hits that players took during their career and the possible problem you might have with this condition.

What has caused some uncertainty is that they have also discovered that CTE also showed up in players  as young as college or high school who have had only limited amounts of physical contact.

That has thrown a curve at researchers who always thought it was a cumulative effect which happened to someone who had played Pee Wee, junior high, high school, college and professional football over an extended amount of time.

Maybe it wasn’t just repeated blows, but perhaps linked to genetic condition which made more players vulnerable than others.

This prompted Nowinski’s group at SLI to propose a plan for younger players that there be a hit count, which is almost impossible to monitor. SLI recognizes this dilemma and has countered with a limitation  of contact drills for younger players.

One conclusion reached is that the younger the player, the more vulnerable they are to injuries to the brain.

Football has adjusted slowly, but steadily to the new studies on head injuries with changes in equipment, with the theory being that better equipment will lessen more serious injuries

But a National Athletic Trainers Position paper on Sudden Death in Athletes, stated that “”Protective sports helmets are designed primarily to help prevent catastrophic injuries and not concussions.”

Which leads to the next misconception which still remains—that the force of the hit is directly related to concussions.

According to conclusive research done by many groups, the G forces that occur in a direct helmet to helmet hit are not linked to whether you get a concussion or not.

The consensus now is that it is not the FORCE of the conclusion, but it’s the rotation forces which often trigger a concussion and NO helmet made can prevent concussions. It is the angular velocity rather than just the velocity which are giving people concussions.

Buying a better helmet to prevent concussions is one myth which has been dispelled.

Still, the NCAA has taken strong steps to mitigate any serious injuries after a collision which draws attention.

If  the training staff decides that a player is displaying concussion-like symptoms, the player is done playing in that game.

But that begs a larger question, one that medical staffs at almost every program must evaluate quickly and accurately.

Symptoms must be outwardly displayed. Some are obvious. Most schools use what is called a symptom check list.

Research has shown that about 8 to 12 are most telling. Some obvious ones are headaches, nausea, fatigue, drowsiness, amnesia, sensitivity to light, vision changes.

Sometimes the athlete will not say anything, preferring to tough it out, even if he is not feeling right.  But a coach or a teammate will notice.

The first test for the trainers is simply to talk to the athlete involved, with a series of on the field testing done such as balance and awareness. Trainers also use what is called an SAC—Standard Assessment of Concussion, which is a list of questions.

In that area, each training staff has what is called a base line of questions with responses given by the athletes when they first report to training camp. After what is perceived as a hit which may have caused a concussion, the trainer will ask the same questions, checking the answers and the responses with those on file.

In terms of assessing concussions, there is no one single tool which works for everything. It is a combination of all sorts of things which help the training staff determine if a player may have suffered a concussion.

The next question is just as basic. When are kids better and when will they be able to return to play.

All of this is an ongoing process and research is being constantly updated to improve both awareness and treatment.

The first rule in recovery is to not even consider a return to the playing field until ALL the symptoms of the concussion are gone.

The athlete is checked each day and given a series of physical and mental tests.

Sometimes, athletes, anxious to return, will fudge the answers. But there is more of an awareness now than there ever was about the dangers of concussions, so the answers tend to be more honest.

Still, certain tests will be administered in which the kids can not lie, such as balance tests.

With all of that, there are far more questions than answers. Why, for example, do some players recover so much quicker from a concussion than other players?  Why do some people develop symptoms of CTE following a minor hit, while others who have spent years banging heads during games, have no ill effects?

There are many tools in the tool box to use, but there is not one fool-proof item that can come up with a definitive conclusion for all concussions.

There is danger in that as well.  Some lesser funded programs will use a basic computerized test to see if a player is ready, not taking into account that some players simply do not test well. That player may be perfectly healthy, but because he does not test well he will be held out longer than he should.

Watching all of this are the coaches, whose jobs are often dependent on getting the best players on the field.

Some coaches are old school, simply assuming that if a player has no visible signs of suffering from a concussion, he is ready to return.

But all are aware of the dangers involved.

LSU coach Les Miles is acutely aware of the dangers even on a long-term basis. “I think it’s important that you recognize what would be chronic trauma,’’ said Miles. “As long as you are taking care of your kids, you pull them out when they have signs and you take time to heal.

“I think mistakes have been made in the past. It’s something that as coaches and trainers are responsible to address. It’s a very serious issue.’’

Still, some schools cut corners to get athletes back sooner rather than later, especially when some athletes return quicker than others. But again, every case is different.

What is also not widely recognized is that players who are being treated for concussions are limited in what they can do in ALL phases of their lives, not just football or athletics.

Most schools will require a 24 hour symptom free period before even the next steps are begun, which include riding on the stationary bike, doing weight lifting, and then some run, and then some non-contact drills followed by contact drills.

During that period if any symptoms re-occur, the process goes back to Square 1.

At each level of football, the process speeds up. High School recovery time is slower than college, which is slower than professional for a variety of reasons.

What doctors have learned in the recovery process is not just no physical activity, but limited cognitive activity.

Class schedules are adjusted. Texting is discouraged. Having a  kid sit in class and taking a test or reading a book can be as problematical in the recovery process as running for 30 minutes.

New methods of treatment are constantly being evaluated and used. One of those is the use of  Fish Oil, which has two active ingredients which actually help in brain healing.

While it has not been totally accepted as a treatment, doctors can find no down side to the use of Fish Oil, which is used for cardiovascular treatment.

A company called Brain Armor is selling a product using Fish Oil which it claims can be taken before games and used as PROTECTIVE measure.

Once a player has suffered a concussion, it is part of his permanent record and there is a growing concern about a condition labeled Second Impact Syndrome.

If a player returns too quickly and he suffers a second injury, the consequences can be fatal, or at the very least prolonged and permanent career endings, life-threatening symptoms.

Once a player suffers one concussion, the chances of suffering another concussion are astronomical, in the 80 to 90 percent range.

The severity of concussions has no degree of seriousness. The terminology of labeling concussions in grades or categories no longer exists. Nobody grades concussions any more since it is pointless. They are all the same and it is a step by step return to play.

The problem of concussions and their after effects are being studied at every level. The Pittsburgh Steelers, for example, have become the first NFL team to start a campaign of concussion awareness for youngsters, with packages being sent to young football players throughout Western Pennsylvania,

“We’re talking about the Pittsburgh Steelers here,’’ said Dr. Mickey Collins, the clinical and executive director of UMPC’s sports medicine concussion program.

Part of the awareness and preventive  program now being implemented in youth football in the Pittsburgh area is limiting teams to 14 padded (shoulder pads) practices a week during the regular season with the last three padded practices spread over a six-week period at the end of the season.

Collins has looked at studies of concussions—as many people have and estimates that there are more than 300,000 concussion related injuries each year and 72 percent are of the helmet to helmet nature.

Steeler coach Mike Tomlin, who initiated the slogan “don’t hit the head, don’t use the head’’ when talking about contact drills for young players,  has two sons who play youth football.

“I think it’s a great game,’’ said Tomlin. “I think there’s many life lessons to learn from playing the game of football if done properly. Hopefully this initiative is one that puts parents at ease.’’

Even with the latest reports, almost everyone concedes that the study of concussions is in its infancy.

But the awareness factor of what could happen is growing.

In college football, almost every conference initiates concussion awareness programs. The NCAA issued a directive telling all leagues to have a concussion management program in place.

One off shoot of more concussion awareness are more conditions caused by concussions, which has led to more law suits, especially from former NFL players who are now enduring the consequences of those countless hits.

But in the competitive  world of active NFL players, injuries such as concussions are concealed. Or at least the attempt is made.

One player  Pittsburgh’s All Pro safety Troy Polamalu admitted on the Dan Patrick Show that hiding such injuries is still a common practice.

“”When you get your bell rung,  hey consider that a concussion,” said Polamalu. ” I wouldn’t . If that is considered a concussion I’d say any football player at least records 50 to 100 concussions a year.’’

Studies, of course, have shown that the severity of the hit may not have anything to do with a concussion.

“Somebody may say, “Is your knee messed  up,’ ‘ said Palamalu. “It may be kind of messed up, but you kind of push yourself to be out there with your brothers. I wouldn’t say there are many major lies where I totally lied my way out of a concussion. In fact, during concussions, if it is serious enough, you can’t even be conscious enough to lie.’’

With that in mind,  administrators have taken a step to keep the athletes out of the decision-making process.  A new NCAA rule is simple and basic: If you lose your helmet on any play, you come out of the game for one play. No debate.

An NFL  survey of the issue revealed that 6.1 percent of retired players over the age of 50 reported diagnoses of Alzheimer’s or other memory related diseases as compared to 1.2 percent of comparably aged men.

Congress is considering the idea of holding hearings on head trauma in the NFL.

Other experts such as Ann McKee, the chief neuropathologist for the VA, Boston University’s Alzlheimer Disease Center, the Framingham Heart Study, the New England Centenarian Study and  CTSE are also working on full-time solutions, as well increasing awareness

Chris Nowinski feels that he is  making progress in increasing awareness,  if nothing else. “It’s always with a heavy heart that you see the evidence,’’he told BU Today. “What we’ve seen with our 10 elite football player brains very much support the idea that NFL players under 50 have a 19 times greater rate of  CTE.’’

Nowinski has heard the criticism that his study is going to “kill’’ football   His response is unwavering.

“”If science can kill football, then maybe football deserves to be killed,’’ he told BU Today. “It’s not like we’re blowing up Pop Warner Headquarters. The whole point here is to give everybody a choice, especially when you’re talking about your kids futures. If something you sign your kid up will really hurt later on, you should know and think twice. If fewer people choose to play, the more power to them.’’

Nowinski was asked if he could envision a time when football would be “safer.’’ “Football’s been reformed multiple times in history,’’ he said.  “In 1905, coaches from Harvard and Yale  and Princeton went to the  White House to see Teddy Roosevelt to convince him that football could be played safely by inventing the forward pass and other rules. I think we’re at that stage again. The proof in the brains. It’s dangerous as it is. The NCAA  recently changed the rules on two a days, which when I was playing was two hitting practices a day for the last three weeks before the season. They changed it to one practice could be hitting and one couldn’t. You could be cutting out hitting in practice to once a week outside of games and cut traumas to the head by 50 percent.  You could do that tomorrow if  the will was there. You can have age limits, better diagnosis on the field. You can see a structure where the game could survive.’’

The game will indeed survive, but it is also clear changes must be made in not only how the game is played, but in how those who play it are protected and treated.

Each time a high-profile former player such as former NFL All Pro linebacker Junior Seau commits suicide or dies with head trauma as part of their history, the awareness factor increases and so does the push to make things better—and safer—for the next generation of players that are just beginning to play the game, as well as those that make a living from it.

The Seau case has drawn the most attention, including Seau’s family filing a wrongful death suit against the NFL.

So the search for information continues, as well as awareness of a growing  problem that football at all levels will have to confront.

© Copyright 2013 Mark, All rights Reserved. Written For: A Jersey Guy