Concussion concerns have rattled the football industry in recent years, spurring new equipment and practice regulations for NFL pros and peewee punters alike. Now experts at UC Davis are urging the industry to think beyond the blackouts, as even one blow to the head – concussion or not – can have irreparable consequences for an athlete’s brain.
Brain injury was the central focus of a panel of professors who convened this week at UC Davis Medical Center to discuss high-impact sports, particularly football, and how to mitigate risk to young players. Leading the charge was Bennet Omalu, a pathologist and medical examiner who has fought fiercely to get the word out about the long-term effects of a hard hit.
Omalu, an associate clinical professor in the UC Davis Department of Pathology and Laboratory Medicine, spoke to a packed house Wednesday night of researchers, concerned parents and community members. The researcher will be the focus of a feature film, “Concussion,” to be released Christmas Day, in which he’ll be played by actor Will Smith.
“CTE is not caused by concussion,” said Omalu, referencing chronic traumatic encephalopathy, the chronic neurodegenerative illness that has taken the lives of multiple NFL players in recent years. “That is a misappropriation. CTE is caused by blows to the head.”
Omalu was the first to discover CTE in performance athletes, having spotted it in the brain of former Pittsburgh Steelers center Mike Webster in 2002. Webster, like several other NFL players who have died in recent years, suffered dementia and depression in the months leading up to his death – symptoms that the medical field now associates with CTE.
Omalu estimates Webster sustained 200,000 blows to the head during his lifetime.
Just one bad hit, be it a direct impact to the head or a violent jerk of the neck and shoulders, can jostle the brain against the skull, causing tauopathy – the aggregation of tau protein in the human brain.
Over time, that aggregation causes neurons to degenerate. As the disease spreads to different areas of the brain, sufferers can lose everything from memory to motor function, whether concussive symptoms were initially present or not.
“If I had my way, we’d all be walking around with bumpers on our heads,” said Charles DeCarli of the UC Davis Alzheimer’s Disease Center. Tau proteins are also present in Alzheimer’s pathology. “What we have to do is live a healthy life, and try our best to reduce risk. The reduction is not just about concussions. Counting concussions doesn’t work.”
When asked why concerns about CTE hadn’t surfaced earlier, Omalu blamed America’s “intoxication with football culture.” The researcher, born in Nigeria, came to the country not knowing what a quarterback was, or how many points a touchdown was worth. Now, he sees the game as an inherently risky activity in which only informed adults should participate.
“As an adult, I want you to make an informed and educated decision that you want to play,” he said. “But what about our children? Knowing what we know now, we don’t let children smoke until they reach the age of consent. We don’t let children drink alcohol until they reach the age of consent. Why continue to expose them to something we know is inherently dangerous?”
While experts don’t see football stopping anytime soon, they are seeing a trend toward safer play.
Syed Khizer Khaderi of the UC Davis Eye Center presented an innovative gogglelike tool capable of evaluating eye movement, pupil response and even brain waves on the sidelines. Eric Giza, associate professor of orthopedic surgery and team physician for Sacramento Republic FC, discussed the need for coaches to take players out of the game after a hit, even in the face of pressure to win.
Nathan Kuppermann of the UC Davis Department of Emergency Medicine talked about how to assess risk when a player arrives at the emergency room with a head injury. Many clinicians are concerned about exposing players, especially youth players, to unnecessary amounts of radiation with CT scans.
One factor to consider in those situations is the number of blows the player has sustained previously.
“If you’re a secretary and you type every day for five years, you’ll develop injuries with your wrist,” Omalu said. “Same for your brain. If you expose your brain repeatedly to injury, every subsequent injury increases your risk. We need to try to mitigate that risk.”
Like many neurodegenerative disorders, CTE does not have a cure. While researchers nationwide are searching for ways to slow the progression of the debilitating condition, they have not found a way to stop it.
UC Davis Health System has a TBI clinic that offers strategies and medications to help patients cope after traumatic brain injury.
“There’s nothing we have that is currently available that can protect the brain from further injury and allow it to heal and recover,” said Michael Rogawski of the UC Davis Department of Neurology.
Paula Green of Folsom was worried after her son Gavin, 10, sustained his first concussion in 2013. She allowed him to keep playing, keeping a firm eye on team safety. But in 2014, after Gavin spiraled to the ground in a football collision that left him blacked out and post-concussive for weeks, she drew the line.
She and Gavin, who still yearns to play football, attended the panel Wednesday to stay educated about the sport’s risks.
“It’s up to health care advocates and legislation to provide oversight to make sure there’s a safe environment to play,” she said. “It’s up to adults to have a voice for the kids who don’t.”