College football players are not healthy, says study

College football players may appear healthy, but this is not the case. A significant number have abnormalities in coordination and inflammation, according to a new study.

December 16, 2021

Source:

Northwestern University

Summary:

Collegiate football athletes with a decade or more of experience with the sport have related abnormalities in inflammation, energy production and coordination that are apparent before the football season and across the season, a new study has found. The abnormalities are related to routine repetitive head impacts from tackling and blocking.

College football players may appear healthy and successful on the field, but a number of biological measures say otherwise.

A new study between Northwestern Medicine, Pennsylvania State University and other collaborating universities has found collegiate football athletes with a decade or more of experience with the sport have related abnormalities in inflammation, energy production and coordination that are apparent before the football season and across the season. The abnormalities are related to routine repetitive head impacts from tackling and blocking.

Most head trauma studies tend to focus on injury being severe enough to cause a clinical concussion, as opposed to assessing the routine effect of repeated tackles or blows to the head over a season. These findings argue that impact sport athletes, regardless of history of concussion, have chronic problems.

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These problems were found in measures that show abnormal regulation of inflammation, less coordinated movement and abnormalities in how cells produce energy. These three measures are significantly related to each other before the football season and to changes observed across the football season. They were also related to the number of head impacts a player received over the season.

"These findings support over a decade of reports about the negative effects of repetitive head impacts along with studies of animal brain injury," said co-senior author Dr. Hans Breiter, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "At this point, it appears the canary is dead in the coal mine."

"This problem affects much of youth and professional impact sports in the U.S., along with training of U.S. military personnel," said co-senior author Dr. Semyon Slobounov, professor of neurosurgery at Penn State College of Medicine.

A new study between Northwestern Medicine, Pennsylvania State University and other collaborating universities has found collegiate football athletes with a decade or more of experience with the sport have related abnormalities in inflammation, energy production and coordination that are apparent before the football season and across the season. The abnormalities are related to routine repetitive head impacts from tackling and blocking.

Most head trauma studies tend to focus on injury being severe enough to cause a clinical concussion, as opposed to assessing the routine effect of repeated tackles or blows to the head over a season. These findings argue that impact sport athletes, regardless of history of concussion, have chronic problems.

These problems were found in measures that show abnormal regulation of inflammation, less coordinated movement and abnormalities in how cells produce energy. These three measures are significantly related to each other before the football season and to changes observed across the football season. They were also related to the number of head impacts a player received over the season.

"These findings support over a decade of reports about the negative effects of repetitive head impacts along with studies of animal brain injury," said co-senior author Dr. Hans Breiter, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "At this point, it appears the canary is dead in the coal mine."

"This problem affects much of youth and professional impact sports in the U.S., along with training of U.S. military personnel," said co-senior author Dr. Semyon Slobounov, professor of neurosurgery at Penn State College of Medicine.

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Routine hits playing football cause damage to the brain

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Date:

August 7, 2019

Source:

Carnegie Mellon University

Summary:

New research indicates that concussions aren't the sole cause of damage to the brain in contact sports. A study of college football players found that typical hits sustained from playing just one season cause structural changes to the brain.

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New research led by Carnegie Mellon University and the University of Rochester Medical Center indicates that concussions aren't the sole cause of damage to the brain in contact sports. A study of college football players found that typical hits sustained from playing just one season cause structural changes to the brain.

The researchers studied 38 University of Rochester players, putting accelerometers -- devices that measures accelerative force -- in their helmets for every practice and game. The players' brains were scanned in an MRI machine before and after a season of play.

While only two players suffered clinically diagnosed concussions during the time they were followed in the study, the comparison of the post- and pre-season MRIs showed greater than two-thirds of the players experienced a decrease in the structural integrity of their brain. Specifically, the researchers found reduced white matter integrity in the midbrain after the season compared to before the season. Furthermore, and indicating the injury was specifically related to playing football, the researchers found the amount of white matter damage was correlated with the number of hits to the head players sustained.

The study is published in the journal Science Advances.

"Public perception is that the big hits are the only ones that matter. It's what people talk about and what we often see being replayed on TV," said senior study author Brad Mahon, an associate professor of psychology at Carnegie Mellon and scientific director of the Program for Translational Brain Mapping at the University of Rochester. "The big hits are definitely bad, but with the focus on the big hits, the public is missing what's likely causing the long-term damage in players' brains. It's not just the concussions. It's everyday hits, too."

The midbrain, located in the center of the head and just beneath the cerebral cortex, is part of a larger stalk-like rigid structure that includes the brain stem and the thalamus. The relative rigidity of the midbrain means it absorbs forces differently than surrounding softer tissues, making it biomechanically susceptible to the forces caused by head hits. The midbrain supports functions like eye movements, which are impacted by concussions and hits to the head. While head hits are known to affect many parts of the brain simultaneously, the researchers decided to focus the study on the midbrain, hypothesizing that this structure would be the "canary in the coal mine" for sub-concussive hits.

"We hypothesized and found that the midbrain is a key structure that can serve as an index of injury in both clinically defined concussions and repetitive head hits," said Adnan Hirad, an M.D./Ph.D. candidate at the University of Rochester's Medical Scientist Training Program and lead author of the study. "What we cataloged in our study are things that can't be observed simply by looking at or behaviorally testing a player, on or off the field. These are 'clinically silent' brain injuries."

Each player in the study received an MRI scan within two weeks of the start of each season and within one week at the end. The helmet accelerometers measured linear and rotational acceleration during all practices and games, recording all contact that produced forces of 10 gs or greater. Astronauts on the space shuttle experienced 3 gs during lift-off. Race car drivers feel the effects of 6 gs, and car crashes can produce brief forces of more than 100 gs.

The 38 NCAA Division III players experienced nearly 20,000 hits across all practices and games. Of those hits, the median force was around 25 gs, with half of the hits exceeding that amount. Only two of the nearly 20,000 hits resulted in concussions.

"We measured the linear acceleration, rotational acceleration and direction of impact of every hit the players sustained. This allowed us to create a three-dimensional map of all of the forces their brains sustained," Hirad said.

The MRI scans measured structural changes in the brain that took place over the course of each season. They found that rotational acceleration (impact causing the head to twist) more so than linear acceleration (head-on impact) is correlated with the observed changes in the structural integrity of white matter in the midbrain.

"This study suggests that midbrain imaging using diffusion MRI might be a way in the future to diagnose injury from a single concussive head hit and/or from repetitive sub-concussive head hits," said Dr. Jeffrey Bazarian, professor of Emergency Medicine, Neurology, Neurosurgery and Public Health Sciences at the University of Rochester Medical Center and a co-author of the study.

The second part of the study served as an independent means to validate the researchers' approach to the football cohort. This group included 29 athletes from various other contact sports who had a clinically defined concussion and 58 who didn't.

The concussed participants underwent MRI scans and offered blood samples within 72 hours of injury. Like the football cohort, those players exhibited reduced structural integrity in the midbrain. In addition, they exhibited increased tau, a protein, in their blood. As structural integrity in the brain decreases, tau increases.

"Tau is an important marker of acute changes in the brain and is thought to be, in the long term, implicated in neurodegenerative diseases like chronic traumatic encephalopathy, also known as CTE," Hirad said.

Given this new insight on repetitive head hits, what should we do?

"Our research, in the context of prior research over the past several years, is beginning to indicate that the accumulation of many sub-concussive hits is instrumental in driving long-term damage in football players' brains," Mahon said. "Future research will be required in order to translate our findings into concrete directives that are relevant to public health. An important direction for future research will be to carry out larger-scale longitudinal studies of contact sports athletes in various ages groups."

"We also need to re-evaluate how we make return-to-play decisions," Hirad said. "Right now, those decisions are made based on whether or not a player is exhibiting symptoms of a concussion like dizziness or loss of consciousness. Even without a concussion, the hits players are taking in practice and games appear to cause brain damage over time."

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From the Introduction:

When You Watch Your Next Football Game...

Free Stock Photo

From high school to college to professional levels, football dominates American sports and exposes millions to head traumas on practically every play.

It is a paradox of wide proportions. From opening day in September to the Super Bowl in February, the National Football League (NFL) dominates American sports and wins television ratings far beyond any other program--sports or otherwise.

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Increasingly, though, discussions of football (and other sports) include the medical terms concussion and chronic traumatic encephalopathy (CTE), a long-term degenerative and incurable brain disease. Although military personnel and others are vulnerable to the disease, the highest risk is among athletes involved in contact sports in which hits to the head are considered “part of the game.”

Ten years ago, few would have predicted that the movie “Concussion” starring Will Smith would be made. Fewer would have predicted that brain injuries would one day dominate the sports headlines. When former NFL star Junior Seau committed suicide in May 2012, the media focused almost entirely on whether the thousands of head blows he endured during his 19-year career as a middle linebacker were a contributing factor.

More than 3,000 former NFL players sued the league for allegedly misleading them about the risks of brain injury. The players and the league settled for more than $1 billion in damages. New policies and studies aimed at protecting the brains of athletes seem to be announced every week. But it’s not just professional athletes who are the focus of attention. No fewer than 40 states have passed laws requiring athletes in schools and recreational programs to schedule a doctor’s appointment when a concussion is suspected.

A progressive, degenerative brain disease, CTE can present itself  in athletes and others with a history of repetitive brain trauma months, years, or even decades after injury. Memory loss, confusion, depression, aggression, impaired judgment or impulse control, and, eventually, progressive dementia may result.

With this increasing awareness about the dangers of concussion, parents face tough choices about which sports their children should be allowed to play. Some of the more

New rules have since been designed to lessen brain trauma; but with every new horror story that emerges on the sports pages, parents worry even more.

dangerous sports for the brain, such as football, soccer, ice hockey, and lacrosse, are also the most popular. Although everyone agrees that brain trauma may have lasting and debilitating effects, and science continues to make slow progress toward understanding the disease, we cannot yet entirely quantify those effects. As a result, parents and even medical professionals are left to search their hearts and scour Web sites for answers. But a decade’s worth of research has made one thing clear: We need to find better ways to protect the brains of athletes.

Difficult to Measure

Concussions suffer from a perception problem. On the surface, they might not seem to have a lasting, serious impact. (In fact, sports programs and commentators continue to celebrate the most impactful “hits,” using euphemisms such as “getting your bell rung.”) They are an invisible injury: There is no blood, there are no displaced bones, and the patient rarely complains. Even when an athlete is knocked unconscious and observers react with panic, the concern quickly fades. Ninety-nine percent of concussed athletes wake up in seconds or minutes and then seem fine. When symptoms persist beyond the day of injury, in the vast majority of cases they dissipate within a month. The injury seems as if it is gone forever, leaving no scars or overt indication that it ever happened.

Children at Risk

Most brain trauma in the industrialized world occurs in children playing sports. Since participation is voluntary, and the rules of recreational sports are malleable, it seems reasonable to make every effort to reform each individual sport....

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Playing football before age 12 could have long-term health effects

Date:

September 19, 2017

:

Playing American football before the age of 12 may have long-term consequences for players' mood and behavior, according to a study involving 214 professional and amateur football players. Source: BioMed Central.

Football players who started playing before age 12 had more than twice the odds for clinical impairment in executive function (including analyzing, planning, and organizing tasks), regulating their behavior, and apathy, compared to players who started playing at age 12 or later.

Credit: © cfarmer / Fotolia

Researchers at Boston University School of Medicine, USA found that football players who started playing before age 12 had more than twice the odds for clinical impairment in executive function (including analyzing, planning, and organizing tasks), regulating their behavior, and apathy, compared to players who started playing at age 12 or later. They also had more than three times the odds for depression. The effects appear to apply to players of all ages and levels of education, no matter how long they had played for (duration) and whether they were professional or amateur players (level of play).

Dr Robert Stern, the corresponding author of the study said: "Overall, our study provides further evidence that playing American football before age 12, and being hit in the head repeatedly through tackle football during a critical time of brain development, is associated with later-life problems with mood and behavior."

This is the first study to show a relationship between age of first exposure to football and clinical dysfunction in a sample that included both professionals and amateurs who played only through high school or college. Previous research had only examined small samples of professional football players.

In order to investigate age of first exposure to American football and possible associations with long-term clinical implications, the authors scored self-reported measures of executive function, depression, behavioral regulation, and apathy that had been obtained by online questionnaire from 214 former American football players, who were 51 years on average at the time of the study. Cognitive function was assessed using a standardized, objective test administered over the telephone. All players took part in the Longitudinal Examination to Gather Evidence of Neurodegenerative Disease (LEGEND) study which investigates the long- and short-term consequences of exposure to repeated head impacts in athletes.

The researchers were surprised to find no association between age of first exposure and cognitive function (such as reasoning, memory, and attention) but they note that this may have had to do with how they gathered their data.

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Dr Stern said: "Cognition was measured using a brief test that was administered over the telephone, rather than a more thorough, in-person neuropsychological examination, such as that used in previous research."

The authors also caution that the findings cannot be generalized beyond to female players or other contact sports. Because this is a cross-sectional observational study, it does not allow for conclusions about cause and effect.

Dr Stern said: "It is important to note that participation in youth sports can have many benefits, including the development of leadership skills, social skills, and work ethic, not to mention the tremendous health benefits. The goal is to make sure that children can take advantage of all of the benefits of sports participation without the risk of long-term brain injury or disease. More research on this topic is needed before any recommendations on policy or rule changes can be made."

Dr Stern added: "However, other research suggests that incurring repeated head impacts can lead to long-term consequences, and we should be doing what we can at all levels in all sports to minimize these repeated hits."

Playing American football before the age of 12 may have long-term consequences for players' mood and behavior, according to a study involving 214 professional and amateur football players, published in the open access journal Translational Psychiatry.

Mothers: Would you let your son play football?

Excerpted from Healing the Brain: 
Concussions and CTE

Introduction

When You Watch Your Next Football Game...

Free Stock Photo

From high school to college to professional levels, football dominates American sports and exposes millions to head traumas on practically every play.

It is a paradox of wide proportions. From opening day in September to the Super Bowl in February, the National Football League (NFL) dominates American sports and wins television ratings far beyond any other program--sports or otherwise.

Increasingly, though, discussions of football (and other sports) include the medical terms concussion and chronic traumatic encephalopathy (CTE), a long-term degenerative and incurable brain disease. Although military personnel and others are vulnerable to the disease, the highest risk is among athletes involved in contact sports in which hits to the head are considered “part of the game.”

Ten years ago, few would have predicted that the movie “Concussion” starring Will Smith would be made. Fewer would have predicted that brain injuries would one day dominate the sports headlines. When former NFL star Junior Seau committed suicide in May 2012, the media focused almost entirely on whether the thousands of head blows he endured during his 19-year career as a middle linebacker were a contributing factor.

More than 3,000 former NFL players sued the league for allegedly misleading them about the risks of brain injury. The players and the league settled for more than $1 billion in damages. New policies and studies aimed at protecting the brains of athletes seem to be announced every week. But it’s not just professional athletes who are the focus of attention. No fewer than 40 states have passed laws requiring athletes in schools and recreational programs to schedule a doctor’s appointment when a concussion is suspected.

A progressive, degenerative brain disease, CTE can present itself  in athletes and others with a history of repetitive brain trauma months, years, or even decades after injury. Memory loss, confusion, depression, aggression, impaired judgment or impulse control, and, eventually, progressive dementia may result.

...

Children at Risk

Most brain trauma in the industrialized world occurs in children playing sports. Since participation is voluntary, and the rules of recreational sports are malleable, it seems reasonable to make every effort to reform each individual sport, with the goal of reducing risk of concussions and CTE. As logical as that sounds, adoption of brain trauma limits and other protections for athletes has been remarkably slow. Based on what we know today, there are a number of steps we can take to lower the risk of concussion and CTE.

New rules in both these sports have since been designed to lessen brain trauma; but with every new horror story that emerges on the sports pages, parents worry even more. What sports should I allow my child to play? What power do I have to protect my child on the field? To evaluate the risk, simply compare how that sport is played at the youth versus adult level, and consider the safeguards professionals are provided. Football is a prime example since, amazingly, 6-year-olds play by essentially the same rules as professionals. Right now we have a healthy national discussion about whether the NFL is too dangerous for adults, yet we pay less attention to the risks of youth leagues, despite the fact that football is far more dangerous for kids.

We need to consider the way the human brain develops and recognize that children are at an anatomical disadvantage compared with NFL players. A child’s axons, which connect brain cells to one another, are not fully myelinated (in other words, insulated), and his or her brain cells are more sensitive to the neuron-damaging shock of concussions, making each impact and concussion potentially more damaging to the brain.

When asked about the future of the sport he loves and through which he supported his family, a recently retired coach from the University of Albany, NY, said “No doubt in ten years it will be a very different game, if it exists at all. And in this case parents have to make the decision to allow their child to play. To the great worry of the NFL, increasingly parents are saying no.”

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Table of Contents

Dedication…….....7

Introduction: When You Watch Your Next Football Game….…..8

1. Nurturing Strength and Confidence……..…12
2. Exploring the Brain in Words and Pictures…….....19
3. Use It or Lose It: Maintaining Brain Health……..….35
4. The Power of Emotions……...38
5. Wounds that Time Alone Won’t Heal: The Biology of Stress……….41
6. Substance Abuse: Saying No Is Very Hard to Do……...57
7. More than Just the Blues: Depression Is a Real Illness……….86
8. Teen Suicide: Death in Life’s Springtime……...108
9. Concussions and CTE: Healing a Broken Brain……..114
10. Minority Stress and LGBT/Q Health…………………..134
11. The Great Brain Books……..137

Appendix I: A Glossary of Key Brain Science Terms…...149

Appendix II: Maps of the Brain…...168

Appendix III: Learn More About It: Resources on the Brain…...173

National Drug & Alcohol IQ Challenge…………… ….187

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Should kids play football? No.

In this excerpt from the Dana Foundation's blog post by Dr. Guy McKhann, he looks at the choice faced by parents regarding letting their kids play football. We cover this topic in our new book, Healing the Brain.


“Don’t Let Kids Play Football” is the title of a New York Times OpEd column by Bennet Omalu. Dr. Omalu gets credit for being the first to recognize the distinctive neuropathology associated with repeated head injuries in an NFL player. Omalu was on call when an autopsy was needed for former Pittsburgh Steeler Mike Webster.

Not being a football fan, Omalu was one of the few adult males in Pittsburgh unfamiliar with Webster, a star center for 17 seasons. Some time after Webster’s retirement in 1990, he gradually began to deteriorate mentally, first with depression and paranoia, then gradual loss of cognition, so that at the time of his death, he was essentially demented. Because of his football notoriety, his troubles were documented in the local newspapers.

Omalu realized that he was seeing a very unique pathology. The gross brain appeared normal, but when he cut into it and made stained sections, he noted the marked accumulation of the protein tau. Tau, in the form of tangles, is one of the hallmarks of Alzheimer’s disease, as is the accumulation of another protein, beta amyloid, in the form of plaques. In Webster’s brain there were very few amyloid-containing plaques and the tau accumulation was in a different distribution than what one would see with Alzheimer’s. Omalu and his colleagues published two papers in the journal Neurosurgery: one on Webster and another on fellow Steeler Terry Long. They described their findings, suggesting that repeated head injuries might be associated with this pathology. All hell broke loose. The NFL powers that be were not happy that their sport might be associated with brain damage. Several physicians involved with NFL teams wrote the journal asking that the papers be withdrawn. (Withdrawing a paper rarely happens, and is done when there is clear misconduct such as fraud). The papers were not withdrawn.

Deciding that challenging the powerful NFL was an impossible task, Omalu left Pittsburgh and became a medical examiner in California, out of the limelight. However, Dr. Ann McKee, a well-regarded neuropathologist in Boston, picked up the slack and let the world know she and her colleagues were available to do the neuropathology on athletes, and military personnel, with head injuries. She was joined by a neurosurgeon, Robert Cantu, and Chris Nowinski, a former Harvard football player and professional wrestler, who became concerned about his own history of head injuries. Chris has become the liaison between the Boston investigators and the athletic world, active in obtaining permission and access for the Boston group to do autopsies.

As of September 2015, they’ve analyzed the brains of 91 former NFL players and found the distinctive pathology in 87 (96 percent).

The clinical course in the others is much like that of Mike Webster: exposure to a series of head injuries over years, a period of normal functioning after retirement, and gradual decline in cognitive functions. What’s going on in these brains? We really don’t know. However, one possibility is that the accumulation of tau is initiated by head trauma. Even after the trauma stops, the accumulation continues until tau reaches a level that is toxic to nerve cells. This process may take years and might be exacerbated by the person’s use of alcohol or drugs.

So should kids play football? I have nine grandchildren. My youngest, twin seven-year-old boys, are into gymnastics and swimming, so they’re not at risk of head injuries (though they enjoy pummeling each other). The others are into soccer, lacrosse, mountain climbing, and cross country skiing. What would I tell them? I think that there is a lot of hand-waving about the susceptibility of the developing brain. In some instances the younger brain is more resistant to injury. An eight-year-old can survive and make a remarkable recovery from a stroke, while a similar stroke in an 80-year-old would be devastating. However a diffuse injury (one that is spread more widely), associated with a head injury, may have effects on brain development.
I don’t know where to draw the line regarding age. I suggest that prior to age 18 kids play less violent forms of football, like touch or flag football, to significantly reduce the chance of head injury.

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