Head Injuries in Sports

“Certainly, we’re disappointed that the concussion numbers are up,” said Dr. Allen Sills, the NFL’s chief medical officer. “It is something which challenges us now to roll up our sleeves and work hard to see that number go down. … We take this is a challenge, because we’re not going to be satisfied until we drive that number much lower.”

In 2017, teams reported a total of 56 concussions during practices; that number was 32 in 2016 and averaged 44 between 2012 and 2015. Of the 56 practice concussions, 45 occurred during the preseason.

According to Sills, the league is analyzing details such as the types of drills that players were participating in when concussed. It will prepare and transmit individualized reports for each team, likely by the beginning of March. It’s possible they could lead to new guidelines and policies for next season, especially during training camp.

“That drove our attention after a couple of years where those preseason practice concussions decreased,” said Jeff Miller, the NFL’s executive vice president of health and safety initiatives. “This is an important aspect of the work we’ll be doing between now and the combine, and not just with the medical experts, but obviously how practices are run at the club level. [That] is something under the control of the coaches, the general managers and others who are on site.”

Concussions during games also rose, from 211 in 2016 to 225 in 2017. Some of that increase could be attributed to a bump in self-reporting by players. According to an analysis by IQVIA, the league’s injury data partner, 28 percent of concussion evaluations during games were prompted by a player reporting his own symptoms. That was up from 18.4 percent in 2016. But Christina DeFilippo Mack, senior director of epidemiology at IQVIA, said she couldn’t yet say how many of the diagnosed concussions — as opposed to the assessments — started with a self-report.

Meanwhile, the league’s data also showed that for the first time since at least 2014, injury rates were higher on Thursday night games than they were during regular-season games. There were an average of 6.9 injuries per game on Thursday nights and 6.3 on other days. IQVIA defined an injury as one that caused a player to miss time, either in that game or subsequent ones.

The league has defended its Thursday night schedule, which puts players back on the field with three days’ less rest than normal, by noting that they produced no difference in injury rates.

Friday, Sills said: “Assessing the overall health and safety impact of the game is a lot more complex than just a simple injury rate.”

IQVIA’s DeFilippo Mack said the one-year flip in injury rates was statistically insignificant, while Sills said there are many other factors involved in evaluating Thursday night games than injury rates.

“It would be somewhat naïve and superficial of us to say that because the number went up or down that Thursday night is safer or more dangerous,” he said.

Also, injuries to the two primary knee ligaments in 2017 were mostly unchanged from 2016. There were 54 torn ACLs in 2017 and 56 in 2016. There were also 147 MCL tears, up slightly from 143 in 2016.

Everyone has had a time in their lives when they first learned how to ride a bike. After hours spent figuring out how to balance on two wheels, we were overcome with joy when we finally pushed off and could continue riding without tipping over. Learning to ride a bike is a pretty exciting milestone in a person’s life, it gives them a sense of pride that they were able to learn how to do something as long as they put their mind to it and practiced. It also made them feel like big boys and big girls who were ready to take on the later stages of childhood. Along with this accomplishment came the constant nagging from our parents that we had to be safe when riding our bikes by wearing a helmet. Even though we all thought it was uncool or lame to wear a helmet, our parents had every right to make us because wearing that helmet could really be the difference between life and death. 

The head injury epidemic has gained more and more attention in the past two decades because people are beginning to become better educated on the topic. People are aware of the risk of head injuries in sports such as boxing, hockey, and football because they are very popular. However, the sport that causes the most head injuries is actually Cycling. 

According to the American Association of Neurological Surgeons, cycling accidents played a role in about 86,000 of the 447,000 sports-related head injuries treated in emergency rooms in 2009. Football accounted for 47,000 of those head injuries, and baseball played a role in 38,394. Cycling was also the leading cause of sports-related head injuries in children under 14, causing 40,272 injuries, roughly double the number related to football (21,878).

Part of the reason is that bicycling is so ubiquitous. But people are also more cavalier about taking precautions, said Dr. Gonzalo Vazquez-Casals, a neuropsychologist at Jamaica Hospital Medical Center in New York.

Bicyclists are also at high risk of colliding with motor vehicles, and when riders are not wearing helmets, such collisions frequently result in serious head injuries. For example, about 90 percent of bicyclists killed in the United States in 2009 were not wearing helmets. A majority were middle-aged men. Going back to what I said earlier, when we are first learning how to ride a bike most boys and girls think that wearing a helmet is lame and does not look very cool.

In New York City, 75 percent of all fatal bike accidents involve a head injury. In addition to wearing a helmet, another helpful precaution is using a marked bike lane: Streets that have them have 40 percent fewer crashes ending in death or serious injury. This strategy of a bike lane is something positive and shows that our community is educated enough to know that something needs to be done to increase the safety of cyclists. 

When we think of sports that are the most dangerous we think of sports like football and hockey because of the amount of body contact that occurs in each game. We also think of those because of they are largely popular among most communities. However, we forget about the sport of boxing. Boxing is solely a sport of hand to hand combat in which opponents take on one another and try to land punches until one of them is knocked to the ground and unable to regain themselves.

A study of 70 boxers found elite-level fighters could punch with an average of 776 pounds of force. Another study of 23 boxers showed elite fighters were able to punch more than twice as hard as novices, the hardest hitter generating almost 1,300 pounds of force. 776 pounds of force, hitting a person over and over again for the duration of a boxing match; additionally, most professional boxers will fight in about thirty matches during their career. Having to endure such harm on their body, a boxer is never really the same person as they were when they first started their career compared to when it is finally over. Now consider a person’s head in a boxing ring and the repeated impacts it takes during a match. Damage comes from three things: (1) the impact itself, which may take place in, a broken jaw; (2) acceleration to the brain leading to abrupt contact with the skull, possibly resulting in concussion; and (3) the rotational force that twists the brain within the skull, increasing the severity of injury and the likelihood of a knockout. One metric for gauging the risk and seriousness of a brain injury is the Wayne State tolerance curve, which looks at both the g-force imparted to the head and the span of time involved. Generally speaking you don’t want to take a shot of more than 50 g, although you can stand more if the impact is really brief — say, a couple thousandths of a second.

Boxer’s careers are usually finished once they have reached a seemingly drunken state in which their motor and mental skills have decreased greatly compared to before their career(it’s characterized by slurred speech and halting step in their walk). Many boxers suffer from dementia pugilistica (about one in five) which is the same thing I mentioned in my blog about the football players who suffered multiple head injuries during their career before killing themselves. Punches to the head can cause detached retinas, brain hemorrhage, fractured bones, and permanent neurological disorder. Worse can happen. According to one estimate, boxing killed at least 650 fighters from 1918 through 1997.

 

Bennet Omalu is a Nigerian physician, forensic pathologist, and neuropathologist who was the first to discover and publish findings of chronic traumatic encephalopathy in American football players while working at the Allegheny County Coroner’s Office in Pittsburgh. Later on, Omalu became the chief medical examiner for San Joaquin County, California, and is a professor at University of California Davis.

After Omalu’s autopsy of former Pittsburgh Steelers player Mike Webster in 2002, there was a re-emergence of awareness of the neurological condition associated with chronic head trauma called CTE which had been previously seen majorly in boxers but in other professional sports athletes also. Webster’s death was extremely sudden and unexpected although it had followed years of struggling with cognitive impairment, mood disorders, depression, drug abuse, and multiple suicide attempts. When Webster’s brain looked normal during Omalu’s autopsy, Omalu conducted further self financed brain tissue analysis. Omalu suspected that Webster had suffered from dementia pugilistica, a form of dementia that is induced from repeated blows to a person’s head. In Webster’s brain, Omalu found large accumulations of the tau protein which affect mood, emotions, and executive functions. Omalu and his fellow colleagues at the University of Pittsburgh published the findings in the journal Neurosurgery in 2005 in a paper titled “Chronic Traumatic Encephalopathy in a National Football League Player.” In the paper, Omalu says that the there needs to be further study on the disease and that the league needs to be giving it much more attention than it had been. He figured that the doctors in the National Football League would be like to read it and furthermore, that his research might be able to possibly fix the problem. Once it was published, the paper did not receive the attention that Omalu had figured and hoped it would. However, once it was seen by members of the NFL’s  Mild Brain Injury Committee they called for the paper’s retraction in May 2006. The committee claimed that Omalu’s description of CTE was “completely wrong” and even called the paper “a failure.”

In November of that year Omalu, who was now partnered Julian Bailes, a neurosurgeon and chairman of the Department of Neurosurgery at the West Virginia School of Medicine, published a second Neurosurgery paper based on his findings in the brain of former NFL player Terry Long, who suffered from depression and committed suicide the year before. Although Long had died at the age of 45, Omalu found tau protein in his brain that was consistent with that of a 90 year old brain with Alzheimer’s. Additionally, Omalu found evidence of CTE in the brains of retired NFL players Justin Strzelczyk (dead at 36), Andre Waters (dead at 44), and Tom McHale (dead at 45).

The NFL did not publicly acknowledge the connection between concussions sustained in football and the long-term neurological effects until December 2009. However, in March of 2016, the NFL’s senior vice president for health and safety testified before congress that the NFL now believed that there was a link between football and CTE.

Doctor Omalu’s research was rejected more than once but that never stopped him to advocate for the health of athletes. Omalu believed that the NFL needed to start taking better care of it’s players so he took a stand through his research and published papers.

      A recent study published in the American Journal of Public Health noted a significant decrease in recurrent concussions among high school athletes following the implementation of laws in many states relating to sports play. As reported by Temple University Center for Public Health Law Research, these laws aim to reduce harm from brain injuries occurring during youth sports activities. They address such factors as removal from play following injury, requirements for return to play clearance after a concussion, and education of coaches, parents, and athletes. According to the Centers for Disease Control and Prevention, up to 300,000 youths suffer traumatic brain injuries (TBIs) or concussions while playing sports each year. TBIs can cause serious health consequences in children, which may be short-term or lifelong. In response to these injuries, all states have passed laws for the purpose of reducing brain injuries during youth sports play. Data is now available to analyze the possible impact of those laws on reducing brain injuries in children.

     Using data from LawAtlas and the High School Report Injury Online between the 2005-2006 and 2015-2016 academic years, the researchers focused on high school boys football, girls and boys basketball, girls and boys soccer, boys baseball, boys wrestling, girls softball, and girls volleyball. During the 11-year study period, the researchers estimated nearly 2.7 million concussions occurred nationwide among high school athletes. Football accounted for approximately half of all reported concussions in the study. In sports that both girls and boys played, the girls had a much higher concussion rate over the study period.

The study examined the statistical association between the implementation of the state laws addressing traumatic brain injuries/concussions and actual concussion rates among the high school athletes. The study found a significant decrease in the number of recurrent concussions, where the athlete had experienced at least one prior concussion. The trend toward decreasing recurrent concussion rates became evident approximately two and a half years after the enactment of the laws. The researchers found that while rates of recurrent concussions decreased, rates of concussions actually went up in the year immediately following a law’s effective date, indicating that more concussions were being reported. This is consistent with the fact that most of the laws require the reporting of all suspected and actual TBIs/concussions. So the increase in concussions was not completely a negative discovery but a positive one in that they were being taken much more seriously.

This research goes off my last post in which I wrote about what the NHL is doing to decrease the suffering from concussions by its players. The theme I was able to deduct from this research done in high school sports is that educating people about the severity of concussions is the best way to help raise awareness and eventually decrease the rate at which kids are suffering from head injuries.

 

My previous blog post was about the infamous NHL enforcer Derek Boogard and his battle with head injuries that eventually led to his early death. Throughout his career as a hockey player, Derek accumulated many head injuries that were left untreated by team doctors His death triggered debate in the hockey community about the struggles players with his role faced during their careers, people felt that not enough attention was given to head injuries. Most of the time team doctors would just prescribe Derek with painkillers, because 1- Derek wanted to continue playing and if they knew how serious his condition was they wouldn’t let him play and 2- the doctors did not know any better.

Derek died at age 28 from an accidental drug overdose while recovering from a concussion. Four months after his death, NHL enforcers Rick Rypien and Wade Belak died as well. Rypien, who was about the same age as Derek, committed suicide. Belak’s death was also concluded to be suicide, both Rypien and Belak suffered from depression like Derek had. These three deaths led other enforcers and sportswriters to ask whether the league was doing enough to treat the effects of the many concussions that enforcers in the NHL suffered and the stress of the role they played. Georges Laraque, a player like those three who had enjoyed a long and successful career in the NHL, spoke up about how he never enjoyed being an enforcer despite the adulation and long career it gave him. Many enforcers would become heavy drinkers in order to deal with the anxiety they would get before a game when they knew they would have to fight. Don Cherry, a popular hockey analyst known for his controversial opinions, responded to Laraque by calling players like him “pukes” and “hypocrites”. As you can see, traditional guys like Cherry were more pro-fighting mainly because of the hockey they grew up watching and the fact that doctors back then were not nearly as intelligent on such issues.

The league has taken steps in recent years to increase the medical attention given to its players and decreasing the amount of head injuries in the sport. The implementation of Rule 48 has helped greatly by prohibiting lateral or blind-side hits where the head is the primary point of impact. Fighting in the NHL has also declined to the point where it is a rarity in games. Now that the hockey community has been witness to the death of enforcers like Derek Boogard and others, players are much more concerned about their health and coaching staffs no longer stress the enforcer role on their teams. Another reason could be the 2005 lockout, during the lockout league commissioners made changes to the rules that would possibly make the game faster and more fun to watch. One of these rules was a new salary cap which left less space on rosters for enforcers. With limited roster spots, general managers wanted guys who could do more than just fight.

All in all, I stand with the NHL in working to decrease the amount of fighting in the NHL. Although it may have been exciting for the fans, the trials that it put many players through is something that should come to an end in hockey.

Growing up in Saskatchewan, Canada, Derek Boogaard was put into ice skates and playing hockey not long after he took his first steps; he continued to play the sport throughout his childhood. Growing up, Derek was always big for his age reaching a size of 6 foot 4 inches and 210 pounds by the time he was only 15 years old. His family encouraged him to continue playing hockey, for they figured a kid of his size could make it to a pretty high level in the sport without really much skill. On every team he played for, his coaches, teammates, and opposing teams saw him as an “enforcer” or a fighter. “Derek would certainly stick up for his team” said one of his youth hockey coaches “but (he) wasn’t mean at all. As Derek continued to grow in size and in his skill, he began moving up to better leagues although because of his size he was always labeled as the “enforcer” rather than a playmaker or goal scorer. Eventually, Derek was drafted into the CHL which is highest amateur level of hockey in Canada. The league is known for being extremely cut and dry, which can be very harsh on the players who are still only teenagers. It was here, while Derek played for three different teams and earned more penalty minutes than the majority of other players in the league, that he realized if he wanted to live his dream as a professional hockey player he would have to fight.

In 2001, Derek was drafted by National Hockey League team the Minnesota Wild. The coaching staff in Minnesota was told to mold him into a fighter, given his obvious size and his renowned fighting career in the CHL. As Derek moved through the farm system of the NHL his reputation as a fighter grew more and more. During the 2005-2006 season, the team he played for ran replays of his fights on their arena’s video board calling it the “Boogeyman Cam”. Despite the fact that he was making millions of dollars doing what he loved, this is not what Derek had in mind when he dreamt of playing professionally as a young boy. Getting in all these fights really took a toll on his body and more importantly, his head. In order to feel better team doctors would prescribe him drug known as a Percocet, which is in short a very strong pain killer and extremely addictive. Due to the fact that Derek was so large, he would have to take eight to ten pills at a time just to feel like himself.   The problem with this is that instead of actually getting his head examined by doctors he would continually pop pills, for he feared that if they examined him that he would never be able to play again.

Derek Boogard died May 13th, 2011 of an oxycodone and alcohol overdose. After six seasons of being an enforcer in the NHL, all the pills he had been taking due to the constant battering his head and brain took had finally gotten to him. After his autopsy had been conducted, the doctors concluded that Derek had been suffering from CTE, a neurodegenerative disease which is found in people who have suffered multiple head injuries.

As this is the first post for my passion blog, I feel as though it is necessary for me to at least introduce the topic of which my blog will be addressing throughout the semester. Because of the fact that I am consider myself a sports fan and I have been playing hockey since the age of five, I wanted to talk about an issue that relates to sports because it is are one of my passions. What I will be addressing is the heavy controversy and presence of head injuries in the world of sports.

Traumatic brain injuries are usually caused by a blow or jolt to the head that creates any kind of disruption to the normal functions of the brain. Symptoms of traumatic brain injuries often vary depending upon the incident. Mild cases of this injury may result in a short change in the mental state of the person. Severe cases can result in extended periods of unconsciousness for the person and even cause permanent damage to the victim’s brain. Sports injuries rarely do contribute to deaths but the most common death from a sports related injury is a concussion. Sports contribute to a large amount of the head injuries, 21 percent, that occur among American children and adolescents.  Many of you may have heard the word “concussion” in reference to these brain injuries. A concussion is actually a subset of traumatic brain injuries but it often is what people refer to brain injuries as these days so that is what I will be calling it in my blog.

When people think of sports related head injuries, they usually think of sports like football or hockey because of the high speed of the game, size of the players, and the large amount of body contact that occurs during these sports. However, the sport with the most recorded and treated concussions is Cycling (over 80,000 in 2009) alone, with Football in second with only half as many. The next three sports in the top five were baseball/softball, basketball, and water related sports such as surfing, swimming, diving, and water polo. According to the US Consumer Product Safety Commission there were 450,000 sports related brain injuries in 2009 and this number has continually gone up in recent years. The CDC (Center for Disease Control and Prevention) reports that about 135,000 children aged from 5-18 are treated annually for concussions which can be seen as a large underestimate due to the fact that concussions are not always considered traumatic brain injuries. The fact of the matter is that brain injuries and head injuries in general are a continuously growing epidemic that is difficult to slow down.

The majority of my blog posts will go in depth on different specific sports to see what in this sport causes the head injuries, what are some ways that we can reduce the risk of head injuries in the sport, and the care that is given to those with head injuries in that sport. Furthermore, some of my blog posts will be about individual athletes that experience brain or head injuries and their journey.

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