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The severity of the damage both acute and chronic is what researchers are now trying to understand and what legislators and the sports-equipment industry are trying to control. Even as scientists look deeper into the physics, neurochemistry and genetics of brain injury, lawmakers are imposing new rules governing how kids should be assessed for concussions and when they should and should not be eligible to play. Equipment manufacturers, particularly those who make football helmets, are being pushed to redesign their product lines and reform the testing standards that essentially allow the industry to police itself. Pro teams too are feeling the heat for selling an elbow-throwing, stick-swinging, head-butting ethos that may be fine for millionaire athletes who know what they're getting into but is hurting, and in some cases killing, the kids who emulate them.
"I keep telling kids, Your brain is not your knee. It's not your shoulder. It's your future," says neuropsychologist Gerard Gioia, chief of pediatric neuropsychology at Children's National Medical Center in Washington. "We have to protect it better than we are."
The Science of a Hit
If it's football that receives most of the attention in conversations about concussions, it's partly because the hits inflicted in the game can be so shocking. In soccer, basketball or even hockey, violence is typically a by-product of aggressive play. In football, it is the play. Guskiewicz conducts his studies by placing accelerometers in players' helmets and recording not just how often they get hit but also how hard. The unit of measure he uses is g-force. Liftoff of a Saturn V moon rocket exposed its crew to a maximum of four g's. A roller coaster may exceed six g's. College football players, by contrast, collide with each other with an impact of nearly 23 g's and that's the average. Higher-end blows range from 85 to 100 g's. "The highest we ever recorded was 180 g's," says Guskiewicz.
Worse, it's not necessary to be hit in the head for that kind of impact to do concussive damage. A player struck in the chest can suffer whiplash just like a passenger in a car accident, and when the head snaps back and forth, the brain sloshes around with it. "One sign," says Gioia, "is when a player complains of neck pain. That's often an indicator that the head has moved around hard."
Many of those blows don't necessarily lead to a concussion, and in a way, that's unfortunate. Only about 10% of concussions lead to loss of consciousness, but the other signs are hard to miss, including headache, vomiting, dizziness, balance problems, sensitivity to light or noise, confusion, irritability and amnesia. A player with any of those symptoms is likely to be sent to the bench at least for a while. A player whose brain has been jolted at a subconcussive level is much likelier to stay on the field and return there week after week with no recuperation time. The damage that does can be deadly.
In April 2010, University of Pennsylvania football star Owen Thomas committed suicide in his off-campus apartment, having never before exhibited any sign of mental illness. When researchers at Boston University examined his brain, they found it flecked with what are called tau proteins, telltale signs of a condition known as chronic traumatic encephalopathy (CTE), which is often seen among dementia patients and NFL players with a lifetime of concussions behind them. Thomas had never sustained a concussion, but that might not have mattered.
"He'd been playing since he was 9," says neuropsychologist Robert Stern, part of the team that conducted the analysis. "That suggests he had a great deal of exposure to repeated subconcussive blows."
The link between tau and brain damage is straightforward. The protein is one of the major structural materials of nerve tissues. When the brain is shaken too hard, nerve fibers are torn and the tau is released. The brain tries to clean up the mess, and given enough time, it could. If the hits keep coming, however, the proteins just accumulate. "I describe [the tau deposits] as a form of sludge," says Bailes.
It's not unusual for players like Thomas suffering from CTE to die in violent or otherwise dramatic ways. Bailes was part of a team that found tau protein in the brain of Chris Henry, a player for the Cincinnati Bengals who was killed in 2009 when he got into an argument with his fiancée and jumped on the back of her pickup truck as she drove away taking a fatal tumble onto the road. In 2007 wrestler Chris Benoit murdered his wife and son and then hanged himself. In 2004 former Pittsburgh Steeler Justin Strzelczyk, who suffered from hallucinations, died when he drove his car into a tractor trailer while fleeing police. Both Benoit and Strzelczyk had CTE. "This disease starts young and progresses through life," says Stern.
Until recently, doctors didn't know just how young, but they're getting an idea. Michael (not his real name) is a ninth-grade football player visiting an outpatient concussion clinic Gioia runs in Rockville, Md. Michael got clobbered in a game in mid-September, suffered many of the immediate concussion symptoms and four months later is still not well. Recovery time varies for all patients, though three months is a good benchmark; four months suggests trouble. Michael's sleep remains disturbed, his temper remains erratic, and his school performance has cratered. An honor-roll student in eighth grade, he has gotten mostly D's and F's this year. "The change," says his mother, "it's shocking."
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