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Preventing CTE & Head Trauma

Posted by Rebecca James on Jul 20, 2018 3:21:00 PM

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Football is an iconic American sport, but despite the national interest in watching football, professional athletes experience a lack of protection when it comes to brain injuries. It is not uncommon for football players at any level to experience a traumatic head injury at some point during their career. For some, the injuries come in the form of a concussion, which makes up 7.4% of all head injuries sustained from playing football.

"I want every person who leaves this to be as healthy as possible when they leave. We all give up stiffness in knees, backs, joint pain stuff. You don't want to give up your brain."

- Jeff Saturday, Indianapolis Colts center

The association between concussions—especially repeated concussions—and Chronic Traumatic Encephalopathy is well documented. Referred to by the acronym CTE, this is a neurodegenerative disease that is developed as a direct result of head trauma. While concussions are primarily mentioned as a main cause, any trauma to the brain can lead to developing CTE. This risk is magnified drastically for athletes, who often suffer from head trauma due to rough tackles and other unavoidable physical aspects of sport.  An estimated 20% of athletes who were found to have suffered from CTE had never received a concussion in their career.brain3

CTE is a debilitating condition that mimics Alzheimers closely, causing the person afflicted with the disorder to experience symptoms such as memory loss, unpredictable mood swings, dementia and depression. Mike Webster, an offensive lineman playing at a professional level, was the first NFL athlete to receive a diagnosis of CTE after his death.

Due to the way CTE manifests within the brain, it is almost impossible to diagnose before a patient’s death. Usually the conclusion that someone suffered from CTE during their lifetime is reached only after the brain is removed from the body and an examination is performed. Only one athlete has been diagnosed with CTE while they were alive, due to the difficulty of gathering conclusive evidence prior to death. His diagnosis was reached because of elevated levels of the protein TAU in his brain, and remains controversial because of the lack of a conclusive and standard testing methods. TAU proteins can occur naturally in healthy individuals, but are the main physical symptom of CTE.

CTE is a devastating consequence of trauma, which makes research in this area both timely and critical. While there is currently no way to significantly lower a person’s risk of developing CTE besides avoiding traumatic head injuries, researchers believe the solution may be found by closely observing nature: the woodpecker.  Woodpeckers have developed adaptations that prevent damage, despite a constant and enormous amount of force applied to their heads on a daily basis.

Woodpeckers peck the bark on trees at approximately 15 miles per hour, up to 12,000 times per day. Despite this, they manage to avoid any severe trauma to the brain due to some unique adaptations. In humans, the brain is surrounded primarily by fluid and is likely to suffer damage from hitting the skull when serious force is applied in the head region due to excessive movement inside the skull.  In comparison, woodpeckers have a much smaller amount of unused space inside the skull, and a skull structure more suitable to absorbing impact.

Not only is the brain of a woodpecker surrounded by a thicker, dense bone made from trabeculae, but the hyoid bone has also developed to surround the entire skull. The location of the hyoid bone provides an additional dimension of protection for the birds, whereas the human hyoid bone is located in the center of the neck. A majority of the force that would otherwise potentially damage the brain is absorbed by the skull and beak of the woodpecker, leading researchers to develop similar tactics to insulate the brain.

To protect athletes from potentially brain damaging injuries, something known as the Bauer band was developed. The Bauer band works by squeezing the neck and redirecting blood flow to increase the amount of fluid surrounding the brain to minimize the amount of force absorbed by the brain when it hits the skull. Compelling evidence exists to support the idea that less space inside the skull is directly linked to fewer concussions:  at higher elevations, athletes are 30% less likely to suffer from a concussion due to the corresponding increase in brain volume.

Improving the head protection for athletes is the first step but preventing whiplash could potentially go a long way in minimizing the severity of head injuries. Humans lack the stabilizer muscles that birds have in the neck, meaning that whiplash has the potential to increase the seriousness of any head injury. In fact, whiplash is frequently associated with concussions, meaning that much of the protective gear being developed for athletes today will likely involve not only improved skull protection but neck support as well.

The controversy around violence and unnecessary risk in sports has existed for a long time, but the fear only increased when Dr. Bennet Omalu discovered CTE. He has made controversial public statements, such as saying that allowing children to play football is the same as child abuse, but recently has said the focus on CTE detracts from our ability to focus attention on other forms of head trauma that may be just as important.

“Someday there will be a district attorney who will prosecute for child abuse, and it will succeed. It is the definition of child abuse. If you play football, and if your child plays football, there is a 100 percent risk exposure. There is nothing like making football safer. That’s a misnomer.”

– Dr. Bennet Omalu

One of the reasons that CTE remains in the media and in public attention is the public perception that the NFL mishandled the situation. No stranger to controversy, the NFL has received negative attention for the apparent lack of response to new discoveries about the dangers of football.

When Mike Webster died, he was the first man Dr. Bennet Omalu diagnosed with CTE, a disease that wreaks havoc on patients and their families. A person who suffers from CTE is much more likely to commit suicide or die from reckless actions due to brain damage.  In addition, the level of support for CTE is lacking as well.  Mike Webster is a perfect example of this lack of professional support:  According to multiple sources, he was a seriously ill man in the late stages of his life, yet he was only deemed eligible for partial disability. He received $3,000 a month, the lowest possible amount, from the NFL despite multiple doctors declaring him to have a serious disability that was positively a result of his football career. Had he been eligible for the highest disability payments, he would have received $12,000 monthly. At the time of his death, his symptoms were so reportedly so severe he would slip into a catatonic state for days at a time. In 2016, 14 years after Mike Webster’s death, the NFL committed $100 million to researching head trauma.

"There is no such thing as a safe blow to the head, and then when you have repeated blows to your head, it increases the risk of permanent brain damage. Once you start having hundreds or thousands of blows, there is a 100% risk of exposure to permanent brain damage. The brain does not have a reasonable capacity to regenerate. This is something we have always known."

– Dr. Bennet Omalu

There is an evolving understanding of concussion management and CTE, much of it due to advanced understandings of the biomechanics and damage associated with concussion. This evolution has brought technology and research to the forefront of concussion management. Additionally, greater emphasis on education and awareness has certainly played a major part in helping to recognize and effectively manage these injuries. One of the greatest influences that clinicians can have in preventing sport-related concussion, and catastrophic outcomes, is to educate athletes, coaches, and parents. Education on the dangers of head injury on cognitive health can increase public awareness of the dangers presented in seemingly innocuous activities, and allow for improved prevention of trauma.

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Topics: ethics, social issues, legal, sports