Football-related brain injuries: Are our children at risk?
The recent findings that former NFL star Junior Seau suffered from chronic traumatic encephalopathy (CTE), caused by repeated hits to the head, has football under a microscope again.
It appears likely the sport is about to get its bell rung, which ironically is a term despised by Cleveland Clinic’s Department of Neurological Surgery Chairman Edward Benzel, M.D., who is helping create national guidelines as part of the newly formed Pediatric Mild Traumatic Brain Injury Guideline Workgroup.
“We are at a crisis mode,” Benzel told us, adding:
“It’s important and in reality the guidelines probably aren’t going to tell us a lot but they’re going to keep everybody aware. Of course, it’s not good to hit your head. We know that there are some football players who have died from head and brain injuries that have been caused by on-field injury. Having said that, I think a corollary of that is, is there an accumulative effect of repetitive, apparently non-significant injury on the brain? Although I can’t prove that, I think we’re seeing increasing anecdotal and clinical evidence that supports the notion that there is an accumulative effect that seems to progress after the trauma stops in some cases.”
Purdue Biomedical Engineering Professor Eric Nauman has studied the impact of brain injuries on high school football players.
“Right now, nobody can demonstrate a direct link between repetitive head trauma and things like CTE because it would take 30 years and a huge cohort of subjects,” Nauman told us. “What we can say is that head impacts cause substantial and long-term changes in neurophysiology even in the absence of a diagnosed concussion. Between our work and the work of others, there is strong evidence that too many head impacts lead to an increased risk of neurotrauma.”
Brain injuries and football: Are our children at risk?
Naturally the long-term discussion revolves around college and professional athletes, but what about the risk of brain injuries for children and teenagers participating in tackle football? Benzel said a recent study indicated between four and 4.5 million children in the United States play the sport annually.
Benzel added that the harmful effects from gridiron concussions in recent years has led to plenty of parents deciding whether the reward is worth the risk for their youngster. More and more moms and dads, or players, are deciding against playing football with recent participation numbers revealing a 15 to 20 percent decrease.
Said Nauman, “I think that young athletes are at an increased risk [of brain injuries] because their brains are still developing and it is extremely important to limit the number and severity of head impacts.”
As for the national course of action, U.S. Centers for Disease Control and Prevention (CDC) has charged the panel with developing clinical diagnosis and management guidelines for acute mild traumatic brain injuries (TBI), including concussion, with guidelines expected by spring 2014.
Guidelines for parents of football players
Until then, Benzel said parents must keep a keen eye on their football players and always look for symptoms of possible brain injuries or other related health issues.
“Problems at school, problems with being able to concentrate, most certainly headache and sometimes in more severe cases behavior issues,” Benzel said. “It can manifest itself in many ways and then usually more of it in the acute phase is problems with balance and coordination and focus. In the young child, the parent is usually aware of this because there’s been an incident. The child hits the goal post playing soccer or had a bell ringer, which we hate as a term, playing football.
“There’s a heightened awareness that there could be an injury [but] when the athlete goes to play too soon, what we end up seeing is a situation where there can be second injury before the individual recovers from the first one. When that happens, the recovery is even slower and it can be fatal. That’s an extreme but the lesser injuries can cause kids to perform poorly and sometimes for a long time in school and personal relationships.”
Preventing sports-related mild traumatic brain injuries
Benzel said concussions are becoming an epidemic problem in the states, where the CDC reports each year U.S. emergency departments treat an estimated 173,285 sports-and-recreation-related traumatic brain injuries, including concussions, among children from birth to 19 years old. Furthermore, the number and rates of traumatic brain injuries are highest in football where 0.47 per 1,000 athletes suffer head injuries.
Invariably it appears the game of football will be changing dramatically in generations to come.
“I think every kid doesn’t have to play football but there are a lot of things to be learned from football,” Benzel said. “It’s a team sport and requires incredible cooperation to be successful and those are life lessons that are very valuable. So it could be a significant change to have the sport altered because of our indiscretions regarding management and identification of injured individuals.”
Added Nauman, “There are so many things that could be done to make football safer–limiting contact in practices, better equipment, improved technique, new technologies. It’s really up to the different leagues to determine if they are going to take the necessary steps.”