JOHN DOHERTY: The serious business of 'mild' head injuries

2013-09-17T17:00:00Z 2013-09-18T03:04:05Z JOHN DOHERTY: The serious business of 'mild' head injuriesJohn Doherty Times Columnist
September 17, 2013 5:00 pm  • 

Ten days ago in Munster, neurosurgeon Julian Bales, MD, one of the top concussion experts in the nation, appeared at Community Healthcare System's annual neurosurgery symposium.

His speech was entitled “Mild Traumatic Brain Injury in Sports: Are They Really Mild?”

The short answer?

If they are mismanaged and allowed to add up, they are not mild at all.

Bailes, who is the Chairman of the Department of Neurosurgery and Co-Director of the NorthShore Neurological Institute in Evanston, spent the better part of an hour explaining why to the physicians and nurses in attendance.

He first talked about what happens at the cellular level in the brain in the immediate aftermath of a concussion. While a concussion does not cause an injury that is visible on an MRI or CT scan, it does cause injury to individual cells.

Mitochondria are the power plants of a cell. Damaged, they impair the cell's ability to use oxygen. Electrolytes that belong inside the cell go rushing out while those that belong outside go rushing in. The cell membrane itself becomes more porous and the connections between cells are stretched and twisted.

In a precarious state, the injured brain cells will start to die if they are stressed further.

Given an opportunity via physical and cognitive rest over the course of several days, the brain will attempt to “self-heal” the damage which has occurred.

Too many hits, even those that do not cause a concussion, over the course of years will cause permanent damage.

Incomplete attempts at healing within the brain leave tangles of protein behind which impair communication between cells and ultimately lead to cell death and brain atrophy. Symptoms similar to those found in Alzheimer's disease result.

That condition, known as Chronic Traumatic Encephalopathy, was first discovered in a deceased NFL football player by Bailes and his research partner, pathologist Bennet Omalu, MD.

Hearing all that, at the conclusion of Bailes' presentation, one physician asked if it was time to ban football.

“Football has never been safer,” replied the Medical Director for Pop Warner Football, the largest youth sports association in the U.S. “What are you going to have (children) do? There have been no deaths in 40 years of youth football but there are 30-plus skateboard-related deaths, 300-plus bicycle-related deaths and (150-plus) ATV-related deaths per year (in the same age group).

"Do you want to raise a generation of video-game players?''

Bailes believes football could be made safer.

He is responsible for Pop Warner instituting rules a year ago which drastically reduce the amount of contact allowed in practices. At higher levels, Bailes cited Nick Saban who allows full contact in practices at Alabama only five times per year.

In general, Bailes believes the three-point stance by offensive linemen should be eliminated and a hit-count limit – similar to the pitch-count limit in youth baseball – should be instituted.

Football organizers who take this advice seriously will find the current objections to their game become more and more mild.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

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