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Questions linger about long-term impact of hits to the head
May 16th, 2012
04:01 PM ET

Questions linger about long-term impact of hits to the head

During a recent debate addressing whether the United States should ban college football, an argument against the sport was summed up this way: Schools should not be in the business of encouraging young men to hit themselves over the head.

The reasoning behind that argument (by New Yorker magazine staff writer Malcolm Gladwell): Concussions are not what afflicts football, rather it is the cumulative effects of punishing, comparatively subtle, subconcussive hits.

"There isn't a helmet in the world that can be designed to take the sting out of those hits," said Gladwell, at the Intelligence Squared Debate hosted by Slate Magazine in New York last week. "What's the effect of all that neurological trauma? We know it's a condition called CTE."

CTE, or chronic traumatic encephalopathy, is a degenerative brain disease found among contact sport athletes - and associated with repeated head trauma - that can lead to dramatic cognitive, memory and mood problems. What scares some people about CTE is that it resembles dementia, except that it can strike people in their prime.

And considering a football player could suffer around 8,000 subconcussive hits to the head across four years of high school and college games, those hits would seem to be a recipe for neurological disaster for millions of athletes.

Yet so far, studies have not proven CTE to be a compelling issue for more than a fraction of them.

"The question that's being framed is, 'Is hitting your head bad for you? Is it going to lead to all sorts of terrible troubles down the road?'" said Dr. Thomas McAllister, director of neuropsychiatry at the Dartmouth-Hitchcock Medical Center. "That may be wrong question. The better question may be, 'For whom is that exposure bad?'"

In a study of college football players at three Division I universities, McAllister and his colleagues found that subconcussive hits were not causing the dramatic lapses in cognition that might be considered a precursor to CTE. But when they re-examined the data, they found something slightly alarming.

A significant subgroup of the contact sport athletes - 22% - performed worse than expected on tests of verbal learning, compared with only about 4% of the non-contact sport athletes.

The data were gathered by nestling sensors in the helmets of 214 varsity football and hockey players and recording subconcussive hits during one full season. The sensors measured things like the force, location and rotation caused by hits to the head.

The contact sport athletes were compared to a control group of 45 athletes participating in non-contact sports like track, crew and Nordic skiing. Each group took cognitive tests before and shortly after the season.

According to the study, published in the journal Neurology, by the end of the season some contact sport players came up short on those tests.

"It's a good news-bad news thing," said McAllister. "The study suggests that at a group level, a single season of contact sports is not associated with widespread systemic changes in cognition for the majority of people."

"But it has to be qualified that for some, that may not be true," he added.

Other data, including a similar study from researchers at University of North Carolina at Chapel Hill, suggest that subconcussive hits do not cause short-term neurological problems after one season. But there is no verdict - yet - about whether they are causing long-term problems, such as those associated with CTE.

"[The McAllister study] does keep the door cracked for the possibility of season-long effects from head impacts in certain athletes," said Kevin Guskiewicz, co-author of the UNC study and chair of the department of exercise and sport science at UNC Chapel Hill, in an e-mail.

"Let's say there is a subgroup," said McAllister. "What is it about those people that makes them more vulnerable to impact and how can we identify who they are in advance?"

These are questions that cannot be answered by the current crop of scientific studies.

And what about the risk of CTE among college football players?

"It has not been proven, in my view, that everyone who has these repetitive hits to the brain gets CTE," said McAllister. "Sadly, there is a lot that we still don't know."

As for the debate to ban college football - Gladwell's team, arguing in favor of banning the sport, won.


soundoff (4 Responses)
  1. 0rangeW3dge

    Isn't this the same as, what we used to call, being "punch-drunk"?

    May 16, 2012 at 20:32 | Report abuse | Reply
  2. Thermopraxis

    There is something that can be done now and your help is needed to spread the word about it. Thermopraxis has created a revolutionary in-helmet device that can be used to drastically reduce the devastating consequences of concussions using therapeutic hypothermia (cooling). The sooner this product reaches the market, the sooner these types of injuries can be reduced in helmet-wearing athletes. For more information, please see the Concussion Crisis Solution Campaign on YouTube and http://www.thermopraxis.com.

    May 18, 2012 at 14:50 | Report abuse | Reply
  3. cchuck19131

    My thinking is that the brain being banged around inside the skull suffers small fratures that lead to more serious complications.When a man who is suffering from these results decides to take his life, isn't that telling us how the brain injury is that serious that he has to take his life?
    The NFL just brushes the facts aside and acts like it is just the price of playing the game, and do little to nothing to help those who suffer from these injuries. If I remember correctly, the last 3 or 4 quarterbacks for Dallas retired due to concussions.

    June 4, 2012 at 11:30 | Report abuse | Reply
  4. Doungmanee

    Hi guys, I am a 46 year old married faehtr of six, ages 4-19. I have had around 12 concussions playing football. The last and most severe one in 2006 playing AA ball. Since then I have gone downhill. Severe depression, suicidal thoughts, fatigue, sensitivity to light and noise, headaches, memory loss, one time I didn't even recognize my son. I contacted Boston University last week and they are looking for those with multiple concussions and symptoms of CTE to take part in a research study yo start soon. You may want to provide a link for themThanks for creating this site

    September 11, 2012 at 19:26 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.