Written by Liv Osby
Staff writer, Greenville News
Article
A sharp staccato whistle pierces a sunlit autumn afternoon, and Mauldin High School?s Mavericks charge across the practice field.
Sporting their trademark orange, white and brown uniforms, the players toss footballs at one another, grunting as they stretch to make a catch.
On the sidelines, coaches bark out commands as the players go through the drills in preparation for the big game Friday night.
It?s a scene played out in thousands of American towns every fall, perhaps nowhere with more fervor than in the South, where the stands are packed with spirited fans shouting for their team to take down the opponent in what can be a violent collision sport.
But on the heels of reports of depression, dementia and even suicide among former professional football players comes new research that these star athletes are nearly four times as likely as the general population to develop Alzheimer?s, ALS and other neurodegenerative diseases.
And there are growing concerns that these injuries could start in childhood during recreational and high school sports such as football, hockey and soccer.
It?s hard to miss the headlines.
Former NFL linebacker Junior Seau committed suicide last May at 43.
Former Chicago Bears defensive back Dave Duerson, who killed himself in 2011, suffered from chronic traumatic encephalopathy, or CTE ? a condition resulting from repeated head trauma.
Other players, including former Dallas Cowboys quarterback Troy Aikman, have left the sport because of repeated concussions.
And the injuries keep mounting. Oakland Raiders wide receiver Darrius Heyward-Bey just returned to play after a concussion earlier in the season, according to USA TODAY.
Last month, after new research linking the sport to neurodegenerative diseases appeared in the journal Neurology, the National Football League donated $30 million to the National Institutes of Health for research into CTE, concussion and other disorders.
Nationwide, there are 3.8 million sports- and recreation-related concussions each year, according to the Brain Injury Association of South Carolina.
What?s more, the number is likely underestimated because some players don?t realize they have concussions and others hide their injuries to keep playing, says Dr. Kyle Cassas, a sports medicine physician at the Steadman Hawkins Clinic of the Carolinas.
Some studies show up to one in four players suffers a concussion during the season, he says.
More than 40 percent of high school athletes return to play before they are fully recovered, says Joyce Davis, executive director of the injury association. And the number of youth athletes seen in emergency rooms for concussions doubled between 1997 and 2007.
A concussion is a traumatic injury that occurs when the brain shifts violently inside the skull, says Dr. Sandip Jain, a neurologist with Greenville Hospital System.
In the past, only injuries with loss of consciousness were considered concussions. But today, it?s known that?s not true. And subconcussive injuries are thought to be almost as dangerous, Jain says.
Back when he played high school ball, concussions weren?t even talked about, says Mauldin head football coach Doug Shaw.
?I remember vividly playing high school football ? and not getting knocked out 100 percent, but being in la-la land for a little while,? he says. ?Back then, we?d say a player got his bell rung. He?d sit out for a little while and they?d put you back in. And I went back in.?
Growing up in Pittsburgh, Jain relished Steelers games. Now when he watches, he says, he can?t help but think about the potential consequences when a player takes a hit.
?You see some of these things and think, they need to take him out of the game,? he says.
In recent years, scientists have come to think that many players suffer from CTE, a constellation of Alzheimer?s-like symptoms marked by impaired memory, personality changes, depression and dementia, as well as increased domestic violence, drug and alcohol use, and suicide, Jain says.
And while Alzheimer?s typically strikes people older than 65, CTE is seen in players a decade after retirement, or in their 40s and 50s, he says. Speed positions, such as wide receiver, running back and quarterback, are most vulnerable.
Other studies show that football players with three or more concussions have a higher risk of memory loss and mild cognitive impairment, he says.
But similar symptoms are seen in other sports as well, including soccer, hockey and boxing, Jain says, adding it?s thought Mohammed Ali may have CTE, which is also found in military personnel with head injuries.
Brain trust
CTE results from the deposit of a certain protein in the brain that leads to the breakdown and death of nerve cells, says Dr. Robert Cantu, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University.
Center scientists have studied 130 brains, he says. More than 50 of them have come from football players, and 90 percent of them had CTE, he says. And the youngest cases have been in people 17, 18 and 21. Comparison brains from non-players do not show the damage, he says.
How many concussions does it take?
?There is no evidence of how many is too many,? says Cassas. ?But in my mind, really any is too many.?
Cantu says CTE can develop not only from concussions, but from cumulative brain trauma.
?There are cases where athletes took a lot of brain trauma over their careers, but not concussions,? he says. ?Thousands of subconcussive blows count. Total brain trauma appears to be what?s important. All the violent shaking that doesn?t necessarily lead to concussion can produce CTE as well.?
Simply put, the pounding that players? bodies take can also damage their brains, Jain says.
?Football players are known to have knee problems ? chronic arthritic conditions, and back problems because of all the stress they?re putting their bodies through,? he says. ?Well, they?re putting their heads through the same stress and for that reason, we have to expect that the brain will suffer somewhat from that.?
And because the brain isn?t fully developed in a middle school or high school student, he says, it takes longer to heal.
Cantu says current diagnostic techniques are inadequate. Center researchers are looking for imaging methods, exams and biomarkers, such as a blood test, that will tell doctors when someone?s had a concussion, when it?s healed and when he?s headed for CTE.
Meanwhile, he says, more needs to be done to protect young athletes.
Safety first
Sonnie Freeman, a devoted fan who played football for Southside High as a teen, attends as many of his son?s practices and games as he can.
?I love football, and I try to keep an eye on him a little bit,? he says of 17-year-old Charles, a Mauldin Maverick.
But he?s not blind to the potential dangers associated with the sport, from broken bones to concussions.
?Jim McMahon ? he?s doing real bad right now,? Freeman says of the 53-year-old former Chicago Bears quarterback who?s suffering from early dementia. ?He took some real bad hits.?
Nonetheless, he?s fine letting Charles, a defensive tackle, on the field because of precautions taken to safeguard his health.
?I feel real comfortable letting him play,? he says. ?These trainers out here, they?re on top of things. And you don?t touch the field until you pass the test.?
In Greenville County, high school rules forbid players from leading with the helmet or face mask, says Bill Utsey, the district?s athletic director. Still, he says, there are accidental hits.
An athlete suspected of having a concussion is kept off the field until he can be medically evaluated, Cassas says. And trainers use software called IMPACT ? which assesses memory, reaction time and other brain functions ? to help determine whether a player has had a concussion and when he can return to play.
Certified athletic trainers, who attend every practice and game, watch for physical and cognitive signs of concussion, says John Thorpe, a trainer and manager for Steadman Hawkins Sports Medicine.
?It used to be losing consciousness,? he says. ?Nowadays we realize it?s ? lesser injuries too.?
Still, he says, there are no fast rules about how many concussions a player can sustain before he is pulled from the sport.
?It?s completely subjective and individual,? Thorpe says.
In the year ending Sept. 30, trainers evaluated 752 of the district?s 14,133 athletes for concussion. Thorpe says the number confirmed is unknown.
At his practice at Children?s Hospital of the King?s Daughters in Norfolk, Va., sports medicine medical director Dr. Joel Brenner sees at least four new concussions a day in student-athletes from all sports, ranging from football to cheerleading.
?I saw a 13-year-old last week who?d had three concussions over the past two years, but I?ve had others with three in a six-month time span,? says Brenner, who also chairs the American Academy of Pediatrics? council on sports medicine and fitness.
?But do we really know what these kids are going to be like 10, 15 or 20 years down the road? Especially those who?ve had multiple concussions,? he says. ?We don?t know.?
Limited contact
In August, Brenner says, Pop Warner programs nationwide adopted new guidelines limiting contact during practices. While that?s an important advance, he says, it won?t eliminate concussions. And it hasn?t filtered down to all high school and recreational leagues.
Utsey says a clinic on the long-term effects of repeated concussions was recently held for all coaches. And Shaw, who says there are more head injuries at all levels today because players are bigger and faster, notes coaches also take an online course on concussions.
Along with regular strength training, he says, there?s emphasis on building neck muscles to help protect the head. Players are properly fitted with the best equipment and taught optimal ways to tackle, he says. And they?re warned about concussions.
?But sometimes kids can get concussions just because they get hit the wrong way,? Shaw says. ?Football is a collision sport. And anybody could get hurt on any given play probably. But there are less injuries because they play like they do.?
Decisions about returning to play are left to the doctors, he says.
Greenville County School Board members Roger Meek and Chuck Saylors say they haven?t seen a groundswell of concern from parents about head injuries or the mounting research. But they add the district?s athletic departments are always mindful that safety is the top priority.
And concussions are taken more seriously than ever before, says Easley High School head football coach Chad Smith. Athletes use state-of-the-art equipment and are taught the proper way to block and tackle.
?As a parent of four boys myself, I think it?s a good thing we?re being cautious,? he says. ?If our trainer thinks they have a concussion, they?re out.?
And they can?t return until they?ve gone a week without symptoms, he says.
So far this season, he says, one player had to sit out a game because of concussion. A player who has two, he says, is probably out for the season.
?The kids? safety is always first at Easley,? Smith says.
Cassas says that while helmets have been designed to diffuse the blow, they can?t prevent concussions. In fact, he adds, there were probably fewer concussions when players wore leather helmets because they weren?t using their heads the way they do now.
Cantu says helmets can?t protect against the most damaging hits, those that cause a swiveling of the head on the neck.
?And that?s what you get in football,? he says.
All in the game
Other factors come into play as well.
Because a concussion can also be caused by a blow to the side of the face or the body and result from a collision or by an athlete?s head hitting the ground, they?re difficult to prevent, Cassas says.
?You can?t prevent collisions because that?s part of the game,? he says.
And while the stakes can include multimillion dollar contracts at the pro level, there are teammates, coaches and sometimes pressure from parents and potential scholarships to consider at the high school level, he says.
So players may conceal their injuries, rolling the dice that they won?t suffer another, potentially life-altering injury.
Both Cassas and Jain say multiple concussions, which are more likely to lead to long-term damage, are cause for a serious discussion about the potential consequences and how they may affect a child?s future.
And the Academy recommends withdrawal from contact sports for any athlete who?s sustained multiple concussions or had post-concussive symptoms for more than three months.
Cantu says more also should be done to reduce the number of subconcussive impacts, such as abandoning tackle football, heading in soccer and full-body checking in ice hockey in kids younger than 14.
?We know from instrumented helmets that youngsters at the high school level are often receiving impacts at 20 times the force of gravity or greater, many over 1,000 of them over the course of a season,? he says.
Davis says South Carolina needs a concussion law to set uniform standards for identification and treatment of concussions and govern return to play because schools around the state do things differently.
Forty states already have such a law, she says.
Bills that would set minimum guidelines were introduced last year by Sen. Mike Fair of Greenville and Rep. Peter McCoy of Charleston, Davis said. But neither advanced in a session crowded with budget and ballot issues.
Fair says it?s important to have a medically qualified individual at all games and to have athletes medically cleared before playing again. He plans to prefile his bill again in December.
?This will ensure that no child will go back to play if they exhibit concussive symptoms,? says Davis, ?and ? a student believed to be concussed must be evaluated by an appropriate health care provider.?
Head start
A concussion law would give athletic directors another tool to protect students, says Thorpe, adding that they sometimes deal with parents, coaches and even players who want to continue after a head injury.
?We have some that have aspirations of a scholarship or beyond, talking about their son?s career who?s 14 years old,? he says. ?But we?re there for the safety of the kid ? not for a winning season. We?re more concerned about their son?s cognitive ability and life. So we will err on the side of caution.?
Cantu says he fears there?s a ?silent epidemic? of people whose career and life paths have been stunted by head traumas.
?It?s possible that many individuals who have received trauma have been set back on their trajectory,? he says, ?but we don?t know about it.?
Jain says from a pure numbers standpoint, the chances of not suffering a serious injury are better than sustaining one. But with all the emerging research, he says, many parents will have to face some tough choices.
Now, he says, along with broken bones, damaged knees and hurt shoulders, they need to consider a head injury that can alter the course of their child?s life.
Freeman says his main concern is that his son, who?s never had a concussion, never get one. But he?s confident the coaches and trainers are doing all they can to ensure player safety, both in proper training and in watching for injuries.
And he?s told Charles to speak up if he?s hurt because his education and his future are paramount.
?These are nothing but kids out here,? he says, gesturing toward the field. ?And a kid can get a concussion on Friday night and come Saturday, that one little injury can turn out to be something critical.?
Source: http://steadmanhawkinscc.com/2012/10/youth-contact-sports-raise-concerns-about-brain-injury/
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