Football and CTE

[MJWalker45]

They've banned heading of the ball until age 14. Headers played a big role in some players getting concussions as kids. 

[Gothamite]

And even worse, getting the sub-concussive impacts that are the real danger. 

[dfwabel]

https://www.inverse.com/article/37934-nfl-funded-study-brain-injury

 

Excerpt:

Quote

The league has largely avoided the issue, but a study released on Tuesday — paid for by both NFLPA (the player’s union) and the NFL Foundation (which is essentially run by the league) — links specific types of positions to increased brain damage. The findings were published in the journal Radiology.

 

The research, conducted by Kevin Guskiewicz, Ph.D., the research director of the Center for the Study of Retired Athletes at the University of North Carolina at Chapel Hill, didn’t focus directly on the development of CTE through repeated head injuries, but it represents one of the NFL’s first serious endeavors into research into CTE prevention.

 

By analyzing the brain scans of 61 former players — half played only college ball, and the other half went on to play professionally — the researchers concluded that their hypothesis was correct: Certain positions were linked to greater white matter damage due to recurring head impacts. In particular, they looked at the effects of playing speed positions, like running backs and wide receivers, versus non-speed positions, such as offensive and defensive linemen. In general, linemen tend to bear the brunt of brain impacts, especially those to the front of the helmet.

 

They also found, perhaps unsurprisingly, that the duration of a player’s career was linked to the number of concussions they had, which in turn affected how much damage their brains suffered. There was, however, one odd caveat: While ex-college players who had three or more concussions during their careers clearly showed more widespread damage to white matter, the same couldn’t be said for the ex-professionals with the same concussion history, who had higher white matter integrity. It’s possible this was simply an effect of the ex-pros that the researchers sampled — perhaps they were just atypically healthy — though co-author Michael Clark notes in a statement that it’s also possible that the duration of a player’s career is simply not that important when considering the factors leading to serious brain injury.

 

[Gothamite]

That's a great read, thanks.

 

This part is interesting:

 

Quote

In particular, they looked at the effects of playing speed positions, like running backs and wide receivers, versus non-speed positions, such as offensive and defensive linemen. In general, linemen tend to bear the brunt of brain impacts, especially those to the front of the helmet.

 

Really ought to dispel the notion that "concussions" are the issue.  The players who knock helmets together on every play have an outsized incidence of CTE because even small helmet hits are associated with it.

 

You'll know the NFL is actually serious about solving the problem when they make significant rule changes to the line.  No three-point stance, no contact on the snap.

[DnBronc]

New article from USA Today (Interview with Bob Costas):

 

https://www.usatoday.com/story/sports/nfl/2017/11/08/bob-costas-future-football-nfl-this-game-destroys-peoples-brains/842904001/

[dfwabel]

By no means does this excuse his crimes...

https://www.washingtonpost.com/sports/aaron-hernandez-suffered-from-most-severe-cte-ever-found-in-a-person-his-age/2017/11/09/fa7cd204-c57b-11e7-afe9-4f60b5a6c4a0_story.html?utm_term=.14a328be155a

 

Excerpt:

Quote

BOSTON — Aaron Hernandez suffered the most severe case of chronic traumatic encephalopathy ever discovered in a person his age, damage that would have significantly affected his decision-making, judgment and cognition, researchers at Boston University revealed at a medical conference Thursday.

 

Ann McKee, the head of BU’s CTE Center, which has studied the disease caused by repetitive brain trauma for more than a decade, called Hernandez’s brain “one of the most significant contributions to our work” because of the brain’s pristine condition and the rare opportunity to study the disease in a 27-year-old.

 

In a diagnosis that linked one of football’s most notorious figures with the sport’s most significant health risk, doctors found Hernandez had Stage 3 CTE, which researchers had never seen in a brain younger than 46 years old, McKee said. Because the center has received few brains from people Hernandez’s age, McKee could not say whether Hernandez’s brain was representative of a 27-year-old who had played football as much as Hernandez. But she found the advanced stage of CTE alarming.

 

At Thursday’s conference, McKee flipped through slides comparing sections of Hernandez’s brain to a sample without CTE. Hernandez’s brain had dark spots associated with tau protein and shrunken, withered areas, compared to immaculate white of the sample. His brain had significant damage to the frontal lobe, which impacts a person’s ability to make decisions and moderate behavior. As some new slides appeared on the projectors, some physicians and conference attendees gasped.

 

[dfwabel]

http://www.cnn.com/2017/11/16/health/cte-confirmed-in-first-living-person-bn/index.html

 

Quote

Researchers published, what they say is the first case of a living person identified with the degenerative brain disease, chronic traumatic encephalopathy, or CTE.

While unnamed in the study, lead author Dr. Bennet Omalu confirmed to CNN that the subject of the case was former NFL player, Fred McNeill -- who died in 2015.
Omalu is credited with first discovering CTE in professional football players. The only way to definitively diagnose the disease is with a brain exam after death.

The discovery was first made in 2012 using an experimental brain scan that can trace a signature protein of CTE called tau. The case study was published in the journal Neurosurgery this week.

Abstract of study: https://academic.oup.com/neurosurgery/article/doi/10.1093/neuros/nyx536/4616608

[Gold Pinstripes]

1 hour ago, dfwabel said:

http://www.cnn.com/2017/11/16/health/cte-confirmed-in-first-living-person-bn/index.html

 

Abstract of study: https://academic.oup.com/neurosurgery/article/doi/10.1093/neuros/nyx536/4616608

That's good news about the ability to identify living people with CTE, and this goes back to what I said earlier about technology assisting in controlling this problem. Soon, we'll have the ability to give current players information about where they stand, and if early retirement is suggested. Combined with better equipment, coaching, and more player responsibility, football will be just fine. Division 1 football, like the NFL has too many positives to make it a 75% effort game. The Indy 500 won't ever be a 100mph race, and tackle football won't ever be a sport where concussions and violent collisions aren't a reality. Youth football numbers are down, but the foreign players will be here in the future. There is zero factual data on sub-concussive hits on former players, only speculation.

 

The doom and gloom being suggested just isn't going to happen, and all levels of football are partly responsible for not being more proactive and talking about the positives of the sport. One of the many unreported stories is how football is thriving at the D3 level, where academics are king, or even how former pros now dealing with physical problems say they'd do it all over again. I'm on board with the dire predictions if football wasn't a voluntary activity, and we're underselling how much more knowledgeable younger people are today when deciding to play high school and college football.

 

This idea we can legislate the natural violence from the sport, and everything will be fine is a false narrative. Fans will leave the sport so fast, a new pro league will have a great shot at success. The issue is nearly identical to the early years of football, when players died on the field. Logic, and reason carried the day. Just like other issues outside sports, there's been a depressing rush to judgment. And yes, I've spoken to enough former college and NFL players to know precisely what I'm talking about.

[Gothamite]

That is exactly what Goodell and the owners would like us to believe, but  “logic” and “reason” are hardly on their side. 

 

This is indeed momentous, because it has the potential to put the lie to the notion that the game can ever be played safely in its current form.  

[C-Squared]

I am disappointed, but not surprised, to see that manufactured 99% CTE stat used out of context like I predicted over the summer... that being said, once it becomes accessible/affordable, I will definitely get tested for CTE myself.

 

Luckily, there are plenty of nutritional/herbal approaches to minimize damage. In 2017, there is no excuse for a football player to not megadose omega-3 oils.

[Gothamite]

Be careful, somebody might take you seriously without a s/ tag or winky face. 

[BBTV]

So if dudes with bad CTE are killing people, killing themselves, wandering the streets because they can't remember where they live, and having other serious symptoms, at what point does CTE get to be considered like a disease or illness that requires someone to live in a home or at least be monitored?  Seems like once CTE gets to a certain point, you can't make rational decisions, or you could forget serious things (like turning off the stove), or you get depressed and suicidal, etc.

 

Also if it's now possible to test for it (I didn't read the link so forgive me if it's not), at what point do insurance companies get involved and stop covering people for things because CTE is a pre-existing condition or some stupid sh t like that?

 

 

I guess it's great to catch it when it's just a little bit (though by the time an average lineman is in the NFL it's already probably too late) but what exactly do you do with the info?  Does the team doc just let the players know where they stand, and then they decide what to do?  Does the league make a rule forcing retirement if CTE is over a certain point?

 

[Gothamite]

11 hours ago, BringBackTheVet said:

So if dudes with bad CTE are killing people, killing themselves, wandering the streets because they can't remember where they live, and having other serious symptoms, at what point does CTE get to be considered like a disease or illness that requires someone to live in a home or at least be monitored?  Seems like once CTE gets to a certain point, you can't make rational decisions, or you could forget serious things (like turning off the stove), or you get depressed and suicidal, etc.

 

That is an interesting question.  We as a society already have a structure to deal with such a scenario.  I would presume that those players, once so adjudicated, would be treated like we already treat someone suffering from a similar degenerative mental conditions like Alzheimer's.

 

11 hours ago, BringBackTheVet said:

Also if it's now possible to test for it (I didn't read the link so forgive me if it's not), at what point do insurance companies get involved and stop covering people for things because CTE is a pre-existing condition or some stupid sh t like that?

 

At the moment, insurance companies are not allowed to refuse coverage for pre-existing conditions.  Hopefully that will not be changed by this current (or any future) Congress.

 

11 hours ago, BringBackTheVet said:

I guess it's great to catch it when it's just a little bit (though by the time an average lineman is in the NFL it's already probably too late) but what exactly do you do with the info?  Does the team doc just let the players know where they stand, and then they decide what to do?  Does the league make a rule forcing retirement if CTE is over a certain point?

 

 

Again, I think we have a framework in place to deal with this.  Players can already be forced out of the game by injuries - Sterling Sharpe comes to mind.  He was the best receiver in pro football, and looked to be on pace to challenge Rice and Hutson as the greatest of all time, when he suffered a spinal injury and needed surgery.  Sharpe wanted to keep playing but the Packers cut him, not wanting to be responsible for the continued damage.  Sharpe couldn't find another team willing to take him on, and was forced to retire.  I would suspect that players who are found to be a significant risk will find themselves in a similar situation.  Or at least I hope that is the case.

[FiddySicks]

On 9/27/2017 at 8:40 AM, Lenny Dykstra said:

There are literally millions of middle aged men that have played high school football that are perfectly fine.

 

Concussions are serious and should be taken seriously, but there is not an epidemic of CTE from playing high school football. I think it might be getting blown out of proportion.

 

There are also literally millions of middle aged men who smoked a pack a day for years that are perfectly fine. That doesn't mean there isn't a cancer epidemic among those who smoked cigarettes. 

 

"Lung cancer is serious and should be taken seriously, but there is not an epidemic of lung cancer from smoking cigarettes. I think it might be getting blown out of proportion." 

 

Do you see how the logic is flawed? You seriously sound like Nick Naylor with statements like this. 

[dfwabel]

http://www.bu.edu/today/2018/cte-caused-by-head-injuries/

 

Quote

A new BU-led study published Thursday in the journal Brain suggests that chronic traumatic encephalopathy (CTE) is caused by head injuries, not by concussions. The research explains why 20 percent of athletes who exhibited the early stages of the progressive brain illness postmortem never had a diagnosed concussion.

“It’s the hits to the head, not concussion, that trigger CTE,” says study coauthor Lee Goldstein, a School of Medicine associate professor of psychiatry, who also has an appointment at the College of Engineering.

The study suggests that head injuries can cause blood vessels to leak proteins into adjacent brain tissues, inflaming them. CTE is a brain disease characterized by accumulation of tau protein around the brain’s blood vessels. It is found in athletes, soldiers, and others who have suffered repeated concussions and other brain trauma, and is associated with dementia, mood changes, and aggression. Concussions are injuries that impair a person’s functions, such as memory or balance.

 

Study page:https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awx350/4815697?searchresult=1

[Gothamite]

Yes, yes, yes.  

 

Concussions are a red herring.  Of course they’re bad. But they’re not the real existential danger facing football.

 

Anyone who keeps talking about concussions - teams, the league, Goodell, helmet manufacturers, youth football coaches - is either uninformed or deliberately trying to change the subject.

[MJWalker45]

On 1/18/2018 at 1:21 PM, dfwabel said:

http://www.bu.edu/today/2018/cte-caused-by-head-injuries/

 

 

Study page:https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awx350/4815697?searchresult=1

In the Army we treat every hit to the head as a concussion, so this study would be worthless in my line of work. I'm also trying to understand what is the line between head trauma and concussions. 

[dfwabel]

54 minutes ago, MJWalker45 said:

In the Army we treat every hit to the head as a concussion, so this study would be worthless in my line of work. I'm also trying to understand what is the line between head trauma and concussions. 

https://www.psychologytoday.com/blog/the-resilient-brain/201401/the-difference-between-brain-injury-and-head-injury

 

Quote

Head Injury

By definition, a head injury is an injury to the skull. Over the period of evolution, our skulls have been developed and designed to protect our brains. We have a layer of hair, scalp, skull, and several layers inside the skull to safeguard the brain. These protective layers make it possible for a person to run as fast as they can into a tree or door without having any injury to their brain. Yes, if you actually did this you would cause injury to your scalp or skull and may have bruises to either one, but your brain will not be injured

Brain Injury

A brain injury, on the other hand, can be the result of a head injury. Although the skull may not be injured, the brain is jostled back and forth inside the skull in a force strong enough to cause shearing and tearing of the nerves in the brain. Brain Injury (BI) by definition is injury to the brain that causes neurological dysregulation, meaning that the brain is not functioning properly. This can result in ongoing physical, emotional, and thinking problems. With this knowledge, in 1994 the World Health Organization adopted terms more descriptive of actual injuries to the brain. Acquired brain injury (ABI) is used to describe any damage to the brain not present at birth. A type of ABI called traumatic brain injury (TBI) includes any damage to the brain caused by an external force. The following is a list of the various types of brain injury:

• Concussion
• Traumatic Brain Injury
• Stroke
• Aneurysm
• Multiple Sclerosis (MS)
• Parkinson Disease
• Dystonia
• Myoclonic Disorder

 

[dfwabel]

FDA approved blood test for adults which can determine a concussion within four hours of initial impact.

 

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm596531.htm

 

Quote

The U.S. Food and Drug Administration today permitted marketing of the first blood test to evaluate mild traumatic brain injury (mTBI), commonly referred to as concussion, in adults. The FDA reviewed and authorized for marketing the Banyan Brain Trauma Indicator in fewer than 6 months as part of its Breakthrough Devices Program.

 

Most patients with a suspected head injury are examined using a neurological scale, called the 15-point Glasgow Coma Scale, followed by a computed tomography or CT scan of the head to detect brain tissue damage, or intracranial lesions, that may require treatment; however, a majority of patients evaluated for mTBI/concussion do not have detectable intracranial lesions after having a CT scan. Availability of a blood test for concussion will help health care professionals determine the need for a CT scan in patients suspected of having mTBI and help prevent unnecessary neuroimaging and associated radiation exposure to patients.

 

The Brain Trauma Indicator works by measuring levels of proteins, known as UCH-L1 and GFAP, that are released from the brain into blood and measured within 12 hours of head injury. Levels of these blood proteins after mTBI/concussion can help predict which patients may have intracranial lesions visible by CT scan and which won’t. Being able to predict if patients have a low probability of intracranial lesions can help health care professionals in their management of patients and the decision to perform a CT scan. Test results can be available within 3 to 4 hours.

 

[Gothamite]

1 hour ago, dfwabel said:

FDA approved blood test for adults which can determine a concussion within four hours of initial impact.

 

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm596531.htm

 

That’s great. But still, concussions aren’t the real problem.