Daniel Gallucci

Feb 8

Brain Injury In Contact Sports

The “Walk it Off” Mentality in Sports Has Got to Go

Black and white image of hands holding a tablet with a brain scan.

As players or parents, we’re aware of the threat of sports-related concussion, head trauma, and resulting loss of consciousness. Many even consider it the cost of participation in things like ice hockey, tackle football, and other collision sports: accept and mitigate the risk in order to play.

And when it does happen, the prescribed treatment has traditionally been just a few days of rest to help the body heal from common symptoms of a concussion, like fatigue, dizziness, headaches, and nausea.

But that’s changing.

In the past few years, we’ve become more aware of the potential long-term effects of mild traumatic brain injury and brain trauma.

If you, a son, or daughter play a contact sport, you may have noticed more attention to detail, with baseline tests at the start of a season, and multistep protocols for any injury to the head.

The prevailing wisdom told us to stay off our feet for a week, but we now know there’s a lot more that could go wrong weeks, months, or even years after the injury itself.

Of particular concern is CTE, a disease that made headlines following the suicide of many high-profile athletes with brain injuries.

What is CTE?

Chronic Traumatic Encephalopathy (CTE) is a progressive neurodegenerative disease, meaning it gets worse over time.

During the progression of CTE, a brain protein called Tau forms clumps that slowly spread through healthy brain tissue.

These clumps kill brain cells, resulting in symptoms of CTE like memory loss, confusion, impaired judgment, and even dementia.

This is nothing new. Pathologist Dr. Harrison Martland first described a CTE diagnosis in 1928. He performed a number of autopsies on boxers with neurological symptoms before death, and discovered they all had brain haemorrhages in common.

Dr. Martland theorised these haemorrhages could be caused by small and repeated injuries to the blood vessels. These boxers and the subsequent paper were aptly titled “Punch Drunk.”

But we still don’t know everything.

Getting to the Cause of CTE

Concussion and CTE are often used interchangeably, despite the fact there is no evidence suggesting that CTE is caused by a single blow to the head.

But there’s no magic number of concussions that will lead to CTE either according to current research. In fact, there have even been cases of CTE in athletes without a history of concussion at all.

So where is it coming from?

Perhaps counterintuitively, research over the past decade has found that concussions are not the strongest correlator with CTE.

The real culprit? Repetitive subconcussive trauma over time.

A subconcussive hit, as the name implies, is not a concussion. It’s a level below. The brain is shaken, but not so violently as to damage cells and present immediate symptoms.

These “gentler” injuries, if we can call them that, may alter both the structure and function of the brain, resulting in small amounts of trauma that build over time.

In short, the athletes who took more frequent but less severe hits over a longer period of time were at greater risk for neurological problems later in life.

Does that mean contact sport is essentially a ticking time bomb for anyone who wants to play? No.

But it does mean we should be doing everything possible to prevent the accumulation of subconcussive hits when possible.

Here’s how to stay in the game.

1. Introduce Age-Appropriate Rules for Contact

The longer we delay the introduction of contact, the less time an athlete is exposed to potential trauma. Simple.

This is obvious in high-contact sports like football, hockey, and rugby, yet equally important in low-contact sports. U.S. Soccer, for example, is limiting contact not only with players, but prohibiting those 10 and under from heading the ball.

Less contact of any sort means less risk of injury.

2. Eliminate Unnecessary Contact and Exposure

Here we see the intersection of technology and sport. Helmets can be fitted with devices that measure impact, acceleration, and rotation to determine hit and contact profiles for individual players and teams.

Blast sensors are being used in military settings to determine how shock waves alter brain function and cause potential injury. The data collected from these sensors can then be used to determine individual risk profiles as well as provide insight about exposure on a larger scale.

The better we understand where and how these injuries are occurring, the better we can reduce if not eliminate them.

3. Coaching Contact

A good coach is more than just the person with the clipboard.

Do we ensure awareness around brain trauma among the parents, children, high school athletes, coaches, or athletic trainers? Are there enough open discussions about preventing traumatic injuries, structural injury, and long term disease inside of the skull?

It’s important to increase a basic understanding of the research that has been done and what we know so far, especially for the families that have their kids in contact sports.

In modern sports, on-field evaluations by qualified individuals can identify players at greater risk for sustaining trauma, hits, injury, and so forth. It’s a crucial cog in the prevention machine for permanent brain damage.

Proper coaching, conditioning, technical training, and strengthening strategies should be implemented at the appropriate level to help reduce contact and the risk of injury.

4. Strengthening for Stability

Another main focus should be building up the strength in the neck. How can we support the body and be proactive in doing what we can to protect the brain?

A study is taking place right now at The National Center for Biotechnology Information on how neck muscles correlate to brain trauma. They are looking at athletes who have and have not had concussions to see what variables may be present within the neck mobility.

While data isn’t quite showing that stronger neck muscles will completely prevent concussions across all sports, it does show a protective bracing effect during impact, especially in some sports like soccer and lacrosse, and across younger athletes.

Regardless, strengthening the neck can be beneficial to support the body and cervical spine during impact, especially in contact sports, as it works to stabilize one of the most critical regions of the nervous system.

Football Injury Prevention Tips

Let’s discuss some ways we can be proactive in one of the highest-contact sports.

  • Every player should receive physical exams before the season begins. If someone has already had any brain injuries, that needs to be clear and should serve as a disqualifying factor if the past injury was severe enough.
  • Like we mentioned earlier, strengthening of the neck and even the head can assist the body in processing the level of impact that it will endure.
  • Of course, all equipment, especially the helmets, need to fit properly.
  • We now know that there is a proper technique when football players go to tackle. This needs to be enforced during practices and games.

How To Heal the Brain After an Injury

The good news? The brain is capable of creating new cells and pathways when given the opportunity and in the correct environment.

In order to do so, we must create new experiences in life and find new skills to learn. We want to engage all of our senses as much as possible so we can activate multiple areas of the brain.

Here are some other ways we can support the brain in its healing.

Movement is key, and a main pillar in the Nuro app. Exercise helps to strengthen the body as well as our cardiovascular health, which both can ultimately fuel the brain. Even learning a new kind of dance is a great challenge for the brain and also adds to newfound creativity.

Nourishing the brain is the second most important priority. Your brain needs all the energy it can get to heal and work on getting back to where it needs to be. While you can incorporate activities that stimulate synaptogenesis into your everyday brain training routine — like learning a new language or playing an instrument — it’s similar to spending time and effort on restoring a classic car, then trying to drive it with the gas tank on empty. You need to nourish your brain with the nutrients it needs to thrive, or other brain-stimulating activities won’t be helpful.

To Play or Not to Play?

That is the question.

While context is key and the answer is never a simple yes or no, I can confidently say that the goal should be to keep people playing sports. The benefits of sport transcend health and fitness, rewarding us psychologically and sociologically as well.

When it comes to CTE, we need to start looking beyond the careers of professional athletes and beyond sport itself. We need to include a host of biological factors ( inflammation, heart disease etc.) as well as factors from the environment ( social determinants of health) if we are to develop a clearer picture of this neurodegenerative disease.

In the meantime, we simply want to focus on both the enjoyment of sport and player safety.

Game on.