Football season may have ended Sunday but concussion season did not. Other sports and recreational activities continue and, with them, hits to the head.
As for football, the on-field games may have reached their conclusion but the legal contests are only beginning. A federal judge in Philadelphia has scheduled an April hearing regarding the NFL's motion to dismiss the bulk of the lawsuits filed by nearly 4,000 retirees.
Against that backdrop, late last month, the University of Chicago gathered experts on concussion from across the country for a day-long conference. The consensus was that far more is unknown than is known about concussion.
Among the speakers was pediatric neurosurgeon Ann-Christine Duhaime, MD, of Massachusetts General Hospital and Harvard University. She said the concussion laws recently passed in most states, including Illinois and Indiana, were largely an effort to prevent second impact syndrome.
Second impact syndrome (SIS), it is theorized, occurs in the brain of teenagers who, while recovering from a first concussion, suffer a second blow. That triggers uncontrollable swelling in the brain which in turn leads to death in at least 50 percent of cases and permanent disability for survivors.
The description is theory because SIS is so rare.
Given the little which is known about SIS, Duhaime wondered if any law or game rule will prevent it.
She then turned to other apparent manifestations of concussion: post-concussion syndrome, which involves prolonged symptoms in the aftermath of a concussion such as headache, mental fogginess and dizziness; and chronic traumatic encephalopathy (CTE) which may be caused more by thousands of sub-concussive hits than concussions and involves later-in-life effects such as dementia, depression and even suicide.
Given the relatively little research on both conditions, Duhaime said there is no proof yet that one is necessarily related to the other. Furthermore, she wondered if any strategies currently employed are effective at preventing either.
Ultimately, she believes athletes will one day “spit in a cup” for DNA testing which will determine whether or not a child should play a collision sport such as football or hockey.
Meanwhile, neurosurgeon Julian Bales, MD, of NorthShore University HealthSystem in Evanston and the University of Chicago presented evidence that CTE is “dose related.”
For that reason, as national medical director of Pop Warner Football, he has successfully advocated a rule instituted in 2012 that limits full contact to no more than one-third of practice time. Eventually, he sees some kind of “hit count” rule for youth and high school football much like the “pitch count” rule now in effect in Little League Baseball.
A coauthor of the recently released study which was able, for the first time, to detect CTE in living subjects, Bales said the data was “too light” (only five former football players were tested) for firm conclusions. He is hoping the results will be replicated in a much larger sample of former professional athletes.
Given the announcements in the last two weeks that the NFLPA is donating $100M to Harvard for a multi-center study on concussion, and the NFL is partnering with GE for a $50M effort to improve diagnostic and playing equipment, Bales is likely to get his wish.
John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at firstname.lastname@example.org. Follow him on Twitter @JDohertyATCPT.