October 23rd 2011 San Diego Chargers offensive lineman Kris Dielman
suffered a concussion during a football game against the New York Jets with
12:31 left to play. He collided
with a Jets Linebacker and then hit the turf hard. He got up, wobbled and went back to playing the rest of the
game. On the flight home just
before touchdown in San Diego Dielman suffered a "grand mal" seizure. He was out for the rest of the season...
Hype Surrounding the Problem
are getting much press of late, especially as doctors and science help give us
a clearer picture of the short and long-term negative cognitive effects. Lets talk about what really happens
inside the brain when someone suffers a concussion.
the head, moving at a significant speed, comes to an abrupt stop, the brain
cells inside get stretched, squeezed, and twisted. In the cells normal state, they function by transmitting
electric current. A part of the
cell called the axon acts somewhat like a wire, conducting current between the
cells. Ions shift back and forth along the axons in a controlled fashion,
transmitting messages from one part of the brain to the other. When one suffers a concussion, however,
the membranes of brain cells get damaged and the cells become leaky. Ions are able to rush in and out
indiscriminately. Sodium and
calcium rush in and potassium rushes out.
The brain needs to restore balance.
a good analogy that I have found:
a concussion occurring is like a submarine hitting a reef and leaks
start springing everywhere.
Within our cells, there are tiny pumps to help get the ions back in
their proper places during this emergency. However, when a concussion occurs, other havoc is taking
place within the cells scaffolding.
They can't repair the "leaks". It's as if someone is in the cell with a reciprocating saw
and cutting through all the supports and struts of the cells' structure. As calcium rushes in, it can actually
activate enzymes to trigger the cell to destroy itself.
severe cases brain cells simply break apart under the stress. In milder cases, there is an
opportunity to recover. Just how
long this takes is uncertain, most likely 10-14 days and longer for the
adolescent brain. So what happens
if, in the middle of the cellular emergency recovery process, the brain suffers
Concussions to Brain Disease
worst-case scenario after suffering a head injury is suffering another one
while still recovering. This is
called Second-impact syndrome.
This condition can lead to brain swelling and even death. Jake Snakenberg, a Denver-based
freshman (high-school) football player, died in 2004 because of second-impact
syndrome from a hit he took just one week before the second hit that killed
help avoid such an awful situation by avoiding concussions in the first place,
and knowing how to identify a concussed player when it does happen.
and symptoms of a concussion include: thinking deficits, lack of sustained
attention, amnesia, confused mental status, dazed look/vacant stare, slurred
speech, vomiting, nausea, slow motor or verbal response, emotional liability,
memory deficits, poor coordination, dizziness, headache, restlessness, nervous
weakness, exhaustion, and irritability.
long been clear that multiple blows to the head can lead to mental
impairment. Those familiar with
boxing refer to this as punch drunk.
It has been only in the past decade that scientists have identified the
problem in American football players.
They have also been able to identify, on autopsy, pathological markers
for the disease, now called Chronic Traumatic Encephalopathy or (CTE).
NFL players are suffering severe depression, memory loss, erratic or aggressive
behavior, and early dementia because of repeated blows to the head. A disturbing number of former NFL
players have committed suicide or died after suffering mental disturbances, and
many of them worried that they have the disease, have arranged to donate their
brain to science. One of the more
recent players was Dave Duerson, a former all-pro safety with the Chicago
Bears, who shot himself in the chest (not the head) and left instructions to
give his brain to the NFL brain bank for study. A tragic illustration of the
need to raise awareness beyond the rank and file of players and into the hands
of the populace. As in many other
cases, an autopsy determined that Duerson had CTE. A study in 2009 by the NFL found that former players between
the ages of 30 and 49 were being diagnosed with severe memory-related diseases
at approximately nineteen times the rate of the general population.
studies show that around 15% of NFL players suffer a 'diagnosed' concussion
every season. These are staggering
numbers. In the past such head
injuries were often ignored, until recently many players were resuscitated with
smelling salts so they could re-enter the game, its now clear these blows have
a lasting effect and in some tragic cases a deathly effect.
we have this data, it hasn't dissuaded anyone form playing in the NFL. Are the tremendous rewards offered to
these athletes helping to compensate for the potential risk? We understand now why they play on
Sunday, or do we?
friend of mine, and former teammate at the University of Washington Cam
Cleeland had it great, or so he thought.
A second round draft pick of the New Orleans Saints in the 1998 NFL
draft who went on to play 8 seasons in the League and retired in 2006. Shortly after retiring he found himself
in a persistent mental fog with occasional bouts of dizziness. He began gaining weight and lacked
energy. He had bouts of anger and
would fly off the handle at a moments notice. He felt depressed and frustrated.
says, "Fans just see Sundays" they don't see the hits the players take in
practice, during mini-camps, training camps and during practices during the
long NFL regular season. He
suffered from eight diagnosed concussions over his college and NFL career. There is no doubt that these head
injuries and how they were medically handled played a role in the 3 years of
fog Cam found himself in when he was done playing.
been able to find a doctor, Daniel Amen who has been able to help him get his
post football mental health challenges back in order. Dr.
Amen helped Cam by encouraging weight loss, regular exercise, mental exercises
and nutritional supplements. Cam says he has no regrets about
playing football except he wishes his concussions were properly diagnosed and
he was able to give his fragile brain the right amount of time for
the Adolescent Brain More Fragile Than the Adult Brain?
hits seem to be more severe for the adolescent brain. A study in Neurosurgery showed that high school players that
suffered two or more concussions had reported much higher rates of mental
problems including headaches, dizziness and sleeping issues.
concussions are also most likely to affect these developing areas such as the
frontal lobes, responsible for many higher cognitive functions such as
self-control and abstract reasoning.
The still developing adolescent brain requires more time than an adult brain requires to
recover from a brain injury.
interesting piece of data has shown players with a history of concussions have
statistically significantly lower grade point averages than athletes without a
history of concussion. Young
football players are suffering concussions at higher rates than NFL players and
many of these kids will not ever play the sport competitively again after high
school, but are still having lasting consequences.
children have relatively heavier heads and rapidly developing brains, this
makes the frequency and severity of head injuries in children even higher,
making recovery time even more important for them, according to Ann McKee, a
neurologist at Boston University.
Dr. McKee has performed postmortem research on the brains of children,
NFL players and soldiers.
can we do to protect our children from the fate of many retired NFL players
living with mental health issues?
are willing to let your child play football you need to make a checklist. Start by asking these questions to your
son's high school football head coach and/or athletic director.
1. Do you administer a pre-season ImPact
test to all players? The ImPact
test is a twenty-minute neuro-cognitive assessment test. ImPACT (Immediate Post-Concussion
Assessment and Cognitive Testing) is the first, most-widely used, and most
scientifically validated computerized concussion evaluation system. The day following a concussion a player
is run through a posttest. This
helps the medical professional measure the decline in performance triggered by
2. Do you have a certified athletic trainer/medical
personnel on the sideline during games?
Practice? If not at
practice do all the coaches have training on recognizing concussion symptoms
and what to do if a player exhibits these signs?
you have a system in place for educating the players on the risks of head
injuries? Are all the players
aware of what concussion symptoms look like and do they realize they can help
monitor one another? The coaches, players
and parents should all sign a contract that shows they are all-in on concussion
awareness and prevention.
4. Is the equipment fitted properly to the
athlete? Proper sized ear pads,
mouth guards and chinstraps are all a must. The team should have a trainer or coach that fits this
equipment to each athlete individually.
Experts are skeptical of 'anti-concussive' equipment and parents should
5. Does the coaching staff spend ample
time educating players on the technique and mechanics to proper tackling? This is really the only way to help
prevent and limit head injuries.
Avoidance of helmet to helmet hitting is a must and needs to be avoided
at all costs and disciplined if it happens. Is hitting limited throughout the week to help eliminate
unnecessary risk of repeated blows to the head?
checklist is not perfect and you cannot expect it to be a foolproof plan in
avoiding head injuries, yet it does promote awareness and education along with
a proactive approach to the protection of our children as they pursue the
valuable and enjoyable aspects indwelled in the sport of football.
I Let My Son Play Football?
an article in the Los Angeles Times written in October of 2011, which piqued my
interest. I found it interesting
that a young man at Arizona State University, quarterback Steven Threet, was
quitting football at the age of 21.
Steven had noticed his short-term memory escaping him after 4
concussions and feared that another concussion could keep him from sipping
coffee without shaking by the time he was 35 years old.
this story prompted me to ask other former NFL players to air their thoughts
with regard to letting their own children play. Here is what some of them had to say:
Olson was a two-time consensus All-American offensive lineman at the University
of Washington and was drafted in 1998 by the Tennessee Titans. He played guard for the Titans for 10
years and played in a Superbowl in 2000.
He is letting his son play flag football until he gets older and then
that is it. He feels it is a very
touchy subject when it comes to your own children, and being that he realizes
all the risks involved and having experienced many injuries that limit him now
at only 36 he stands firm with his choice.
Homan who played wide receiver in the NFL from 1968 to 1972 played in Super
Bowl V had a great perspective that his college coach at Alabama shared with
him. Dennis was coached by the
great Bear Bryant and asked Coach Bryant his thoughts on when a player should
start playing football and the former coach told him 9th grade. Because a child's brain is still
developing and shouldn't play contact sports until they are a little
older. I really liked this advice
because concussions are now the hype and the buzz. 40 years ago this wasn't the case. Coach Bryant was ahead of his time.
NFL player Chris Coleman, wide receiver for 3 years with the Tennessee Titans
has three boys. He is very aware
of the dangers concussions pose and is very cautious with his children. He has encouraged them to play some of
the less violent sports, but it appears all three are just like their dad and
love the sport. He supports them
but takes an active role in watching them and communicating with their coaches. He trusts their coaches but wouldn't
hesitate to pull the players himself if he felt he had to.
are just a few opinions from former players and all offer great advice and
differing opinions on the challenging decisions parents have to make for their
the reasons I decided to write this article was based on a parent I had in my chiropractic
office and questions she had about her son who recently had a concussion. Interestingly enough this boy didn't
even play football. He was riding
his bike and was hit by a car while crossing the street in a crosswalk. Sure he had a helmet on and he is OK,
but he had a concussion. The
concussion led him to see a neurologist and to have some additional tests,
which showed he was good to go.
But his mom didn't think he was ready to go back to playing hockey just
yet. She noticed him being more
emotional since the accident and that was the biggest difference she
noted. She wasn't sure if it was
because she was not letting him go back to quench his passion for ice hockey or
if it was because a young rapidly developing brain had some very minor damage
in the frontal lobes which houses higher level cognitive thought and
passed and her son recovered and she realizes she made the right choice to rest
her son's adolescent brain for as long as possible. She loves hockey and has been following Sidney Crosby and
his concussion nightmare that just won't go away. She doesn't want that scary reality to be her sons. Despite the flack, this hockey mom
proactively watched over her precious developing adolescent so he has a better
chance at a lifetime of enjoying the things he loves and will grow to
the literature search and publication review has stirred a passion in me to
help educate mothers and fathers, coaches and players to be aware of the
potential for brain injury and just how you might be able to prevent it. The more I dialogue on the topic of
concussions many of my friends and patients alike ask me the question "Well
Tony you played in the NFL and now you are a doctor of chiropractic and you
have a son. Are you going to let
him play?" I find this to be one
of the most difficult questions to answer. I tell them I just don't know.
will tell you this, I was watching a replay of the NFC championship game
between San Francisco and New York just the other day and I was engrossed and
had the chills after a big sack by Justin Smith. Experiencing that moment of chills made me realize just what
I might be taking away from (or benefiting) my son if I don't let him play the
game that I love.