Football and TBI

Five years ago, I wrote a post on Super Bowl Sunday about Chronic Traumatic Encephalopathy, or CTE. In 2015, a movie called Concussion hit theaters. One of the challenges facing diagnosis was that it was previously only able to be identified with an autopsy. In November 2017, a report was published of the first case of CTE being possibly diagnosed while one former player was still alive. From the Chicago Tribune:

The scans indicated the presence of tau, a protein that builds up over damaged brain cells. But the scientists cautioned that the results needed to be confirmed, because CTE, a dementia-like disease linked to repetitive head trauma, can be definitively diagnosed only by examining brain tissue after a person’s death.

Dr. Julian Bailes, a NorthShore neurosurgeon, said Wednesday that confirmation has arrived.

In a paper published last week in the journal Neurosurgery, Bailes and other researchers reported that one of the former players who underwent a scan had his brain examined after he died — and sure enough, the tissue revealed he had been suffering from CTE.

More study is needed to confirm, but this is a positive first step. That said, chronic repeated brain injury continues to be an enormous issue with the sport (and others).

The NFL started looking at the numbers of what it refers to as concussions (which may be a problematic term, but more on that later) in 2012. According to the NFL’s official injury data, here’s the breakdown of the number of concussions reported, by year:

  • 2012: 261 concussions
  • 2013: 229 concussions
  • 2014: 206 concussions
  • 2015: 275 concussions
  • 2016: 243 concussions
  • 2017: 281 concussions

What’s interesting is that the number of concussions each year is greater than the number of ACL and MCL tears combined. It’s also instructive to look at the number of concussions reported in practice vs the number reported during games. At a roughly 4-6 fold increase, it’s clear that games are much less safe than practice.

Over at the Intercept, Shaun King reports:

The NFL has done a masterful job at mainstreaming the violence of the game, so that fans and spectators don’t feel too bad about what’s actually happening out there. No single word has protected the NFL from the true costs of this violence more than “concussion.” That word puts a protective barrier between us and what’s really going on out on the field.

It’s not a headache. It’s not “getting your bell rung.” You don’t have a bell. It’s a traumatic brain injury. Every single concussion is a new traumatic brain injury. In addition to the torn ACLs and MCLs, in addition to all of the horrible broken bones, the NFL diagnosed at least 281 traumatic brain injuries this season. And no document has ever quite displayed the horror of it all like “Concussion Protocol,” a film by Josh Begley and Field of Vision.

The film shows actions in reverse, which highlights the effect first, and then the cause. It’s powerful:

The issue with the term concussion is that separates itself from, and tries to be a lesser form of, traumatic brain injury. A quick look at the CDC’s page showing the complications of concussion is quite instructive. In my own practice, I’ve been seeing increased post-concussion syndrome, especially among younger individuals with repeated injury. For some, the symptoms persist for months, and sometimes years, post-injury.

There’s much work to be done, and increasing awareness is essential.