The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Concussion: Much more serious than once thought

Written by
Karyn Hughes, MEd
Posted in
Live well

Monday, Aug 27, 2012

Sports related concussions especially in football were once trivialized by athletes and coaches whose mentality was to play through pain to prove toughness and “take one for the team”. But now concussions are a hot sports topic and recognized by professionals as an ever increasing concern and public health issue.  The Centers for Disease Control estimates that 3.8 million concussions occur each year in the United States. This number greatly exceeds previous estimates because large numbers off concussions were unrecognized or were not reported.

Research is at an all time high regarding the short and long term results of concussion. Researchers at Boston University said they have found early signs of a disease caused by hard hits in the brain of a University of Pennsylvania football player who killed himself. The New York Times reported that a brain autopsy on Owen Thomas showed he had chronic traumatic encephalopathy (CTE), an affliction primarily connected to NFL players who suffer depression and impulse-control issues. Most recently Junior Seau, a high profile, NFL player, committed suicide at age 43 after 20 years in the NFL. It was speculated that depression and lack of control was possibly at play in Seau’s death so his parents granted permission to autopsy his body to gather information that could possibly confirm this connection. According to USA Today Sports there was no evidence of drug abuse, however, 10 mg of zolpidem, better known as Ambien, a drug for sleep aid and small amounts of naproxen, an anti-inflammatory were found in his blood.  Family and friends disclosed that he had trouble sleeping for years. According to The Food and Drug-Approved Medicine Guide for Ambien, serious side effects can include “worsening of depression, and suicidal thoughts or actions.” Initial autopsy report on Junior Seau’s brain did not reveal CET damage.  His brain has been donated for further studies related to interest in concussions.

NFL agent, Steinberg said the following: “Going back to my earliest players from the '70s, the diagnosis and treatment of concussions was Neanderthal," he added. "A concussion was only when a player was knocked out. The phenomena was largely unrecognized. The injury was subjective; it was not like he was wearing a cast, people would say. We began to raise the issue of how many concussions were too many to risk. What were the long-term issues? Players began to ask themselves, it is one thing at age 40 to feel back or knee pain when picking up my children, but totally another if I won't be able to recognize them. It became an issue with a quantum leap of seriousness. We had three concussion seminars in the '90s where we began to ask for standardized diagnosis, eliminating spearing in football, helmet changes, turf changes and more. The momentum has built. The technology has grown."

Professionals now agree that college and NFL players who suffer concussions should be held out for 24 to 72 hours. In an article from Exercise and Sport Science Reviews, 2012, researchers report immediate deficits seen in concussions are decline in cognitive function and motor control (balance). In the majority of cases these declines return to normal pre-injury levels within 7 to 10 days (1).

This has lead people to ask, just how many people were affected by the poor standard of practice from the past? The following is from Glen M. Wong with Sporting News NFL on August 23, 2012: How many cases—and what kind—have been filed against the NFL, and how many players are we talking about?

As of mid-August, there were 135 cases with 3,402 former players, according to The Washington Times. The plaintiffs range from Hall of Fame running backs Tony Dorsett and Eric Dickerson to former kicker Garo Yepremian. A “master complaint” was filed in federal court in June in Philadelphia, consolidating under U.S. District Judge Anita Brody more than 80 concussion-related suits at the time. The first concussion lawsuit was filed in California state court by 75 former NFL players and 51 spouses on July 19, 2011. This mass action lawsuit was filed against the NFL, NFL Properties and helmet-manufacturing company Riddell. The first federal lawsuit against the NFL was filed on August 17, 2011, in the U.S. District Court by seven players and their families, including Ray Easterling, who later died of a self-inflicted gunshot.

Many of these lawsuits claim that the NFL fraudulently concealed long-term effects of head trauma. The link between concussions and brain diseases is alleged to have been known by the NFL for decades, but that such information was withheld from the players. The lawsuits against Riddell claim strict liability for defective design and manufacturing, alleging that the helmets did not provide adequate protection against foreseeable risk of concussive brain injuries, failure to warn and negligence.

One of the reasons for this being such a hot topic is that the assertion that full recovery after sport concussion is being brought into question. Is there cognitive decline for athletes who have a history of multiple concussions?  How can we know cause and effect? The article Cognitive Decline and Aging:The Role of Concussive and Subconcussive Impacts, by Steven P. Broglio(1) and others, sought to review this issue and search for answers. Their review brings up some key points we should keep in mind such as the following:

  • There are no objective test that can confirm the concussion diagnosis
  • Concussion remains a clinical diagnosis (the athlete presenting signs and symptoms)
  • Some athletes may experience physiological changes in the brain function without the clinical presentation of concussion
  • What is normal aging of the brain compared with concussion related damage?
  • Age related changes in memory, attention, and orientation are well documented
  • Age related decline have great variability between individuals
We know that age-related decline changes progress over time and is not fixed within the individual.  We also know many behavioral and environmental factors such as excessive alcohol intake, smoking, sedentary lifestyle, have been shown to influence brain physiology negatively and negatively affect performance. It can also be said that the converse is also true: a healthy lifestyle can be a possible mechanism for slowing down cognitive decline.

To date the literature reporting the cognitive effects of concussion are mixed.  The American College of Sports Medicine evaluated a large sample of collegiate athletes for chronic cognitive deficits associated with concussion. The Headminder Concussion Resolution Index was administered to 235 individuals and 264 completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Participants were divided into 4 groups based on self reported history of 0,1,2, or 3 concussions.  The data analysis revealed no differences between groups for either test instrument.

The literature also demonstrates other tests and measurements.  One such investigation measured appropriate responses to rapid presentation of stimuli measuring cognitive processing speed. These studies did reveal some decline in concussive individuals. These deficits mimic declines in older adults transitioning from a stage of mild cognitive impairment to Alzheimer’s.

Stay tuned.  There is much more to learn. What will your decision be?  Keep playing impact sports or turn to another career or interest? It is very personal. Even NFL professional athletes have different opinions. Kurt Warner, former NFL and Super Bowl quarterback says he may not want his kids to play football after all his injuries and concussions although the sport broug