Jan 29, 2015
Danger Lurks Beyond Symptoms

By Mike Phelps

It’s no secret that suffering a concussion can have long-term effects on an athlete’s brain. But can that damage occur even if no concussion symptoms are present? A new study says yes.

The study, completed by researchers at Purdue University, monitored 21 football players at Jefferson High School in Lafayette, Ind., and found that players may be damaging their brains even if they have not been diagnosed with a concussion. According to the study, four of the players were diagnosed with concussions through traditional methods, but four others who showed no outward symptoms had brain impairment that was worse than their teammates who suffered concussions.

To complete the study, the research team placed monitoring equipment inside the helmets of the players to monitor the number and level of impacts. They did baseline tests on each player before the season, performed subsequent tests on several players each week during the season, and completed a postseason assessment.

“We’ve confirmed what a few other researchers have hinted at: There is something going on and it doesn’t manifest itself with symptoms,” Larry Leverenz, a clinical professor in the department of health and kinesiology and an athletic trainer at Purdue, and a co-author of the study, told the Indianapolis Star. “If there’s a scary part, it might be that we don’t know the long-term effects at this point.”

The study, which was published in the Oct. 2010 issue of the Journal of Neurotrauma, found that some players took more than 1,800 hits to the head during practices and games. But because they didn’t exhibit symptoms of a concussion, the players were allowed to stay on the field and, because of that, risked further injury.

By continuing to play with undiagnosed injuries, the players put themselves at risk for more serious concussions or illnesses such as Alzheimer’s disease, chronic depression, and chronic traumatic encephalopathy (CTE). This is the same disease that afflicted deceased former Cincinnati Bengals wide receiver Chris Henry. Henry, like some players in the study, had never suffered a concussion during his career.

“On a daily basis, there’s no effect these guys are going to observe, really,” Thomas Talavage, an associate professor at the Weldon School of Biomedical Engineering at Purdue and the study’s lead researcher, told the Chicago Tribune. “There’s no immediate deficit. But what we are concerned about is that there have been a number of reports of NFL players and former college players who have shown scarring on their brains even without concussions, and we know that you can develop CTE without having a history of concussions. So the question from our study becomes, ‘Are we seeing a possible explanation?'”

Talavage also added that due to the small sample size, the fact that an equal number of players suffered undiagnosed and diagnosed concussions was of little significance. The key was that the injuries took place on hits between the forehead and the top of the head, reinforcing the importance of players not leading into tackles with their helmets.

One possible solution is to cut down on the number of full-contact practices held by teams.

“We have pitch counts for youth baseball because we understand that a kid throwing a ball 100 times a day for years could wear out his elbow without a single injury,” Chris Nowinski, co-founder of the Sports Legacy Institute in Boston and co-director of Boston University’s Center for the Study of Traumatic Encephalopathy, told the Chicago Tribune. “It’s not crazy to think the brain can operate the same way.”

In other concussion news, in late September, the Pennsylvania House passed the Safety in Youth Sports Act, which calls for high school and junior high athletes in the state who suffer a concussion or brain injury to be cleared by a medical professional trained in concussion management before returning to play. If passed by the Senate and signed into law, the legislation would also require athletes and their parents or guardians to sign a concussion and head injury information sheet before participating in a sport. It also would require coaches to complete a concussion certification course.

So far, the act has drawn mixed reviews.

“To this point, in regard to concussions, there has been a tremendous amount of effort put into education and awareness,” Western Pennsylvania Interscholastic Athletic League Executive Director Tim O’Malley told the Pittsburgh Post-Gazette. “We have provided leadership to not only schools and coaches but parents as well. What the state legislators are choosing to do, we’ll have to wait and see what kind of positive impact that has. But what’s going on right now are positive steps.”

But the Pennsylvania Interscholastic Athletic Association (PIAA) believes the legislation is unnecessary on top of the guidelines that already exist. Under current PIAA rules, an injured athlete must have a licensed physician of medicine or osteopathic medicine examine the athlete and sign a form clearing the student to return to competition.

“It’s a feel-good piece of legislation, which is fine,” PIAA Executive Director Brad Cashman told the Pittsburgh Tribune-Review, “but I think it’s unnecessary. We have more than adequately covered the subject.”

Mike Phelps is an Assistant Editor at Training & Conditioning.

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