By Connie Wardman
A number of today’s athletes, from pro, college and high school players to enthusiastic weekend warriors, are suffering from the long-term effects of repeated concussions. Based on new ever-growing medical evidence thanks to ever-improving technology, perhaps there was real truth in the childhood rhyme where “All the King’s horses and all the King’s men couldn’t put Humpty Dumpty together again” following his great fall – perhaps it was the first documented case of chronic traumatic encephalopathy (CTE).
There is a growing body of evidence that those who do experience repeated concussions, also known as mild traumatic brain injuries, are often left with cognitive impairment, and a certain number of those impaired athletes will also suffer early onset dementia.
It’s a long-standing tradition that sports teams, players and fans alike have supported and promoted the macho maniac attitude that pushes players to sacrifice their immediate safety for the sake of winning the game. It encourages and compels athletes to get back into the game immediately after being struck on the head, rewarding them with high praise for their gutsy play.
But we now know without any doubt that the physical impact of a concussion can have long-term health consequences for an athlete, consequences that may take years to make themselves known. So it’s now up to individual athletes as well as organized teams and leagues AND the general public to push for safer play – to push for a more enlightened standard of player safety that promotes playing like a brainiac, not a maniac.
Who Gets CTE?
CTE is most commonly found in professional athletes playing contact or collision sports, particularly boxing, football, hockey, rugby, lacrosse, soccer, skiing and wrestling. Statistics on brain trauma within the National Football League (NFL), for example, reveal that one in three retired players will face some type of mental difficulty. The reason for this is brain trauma.
When an athlete takes a hit to the head, the head stops but the brain slams against the skull and bounces back and forth, producing a bruise on the area opposite the impact site. At the same time, different parts of the brain also rub against each other. The brain is soft but the hard skull has ridges on the inside so even when wearing protective headgear, there will still be damage to the brain.
While CTE is most often found in professional athletes in the sports listed above, the fact is that any athlete at any age in any sport who has experienced more than one concussive incident may be at risk for it. That’s a disturbing revelation when you consider the number of families who have steered their young children into playing soccer instead of football because they think it’s safer.
But just think about the number of times a soccer player uses his/her head to hit the ball in just one game. All this prompted Arizona to pass the first-ever state-mandated concussion education program in August 2011. It requires all student-athletes to pass a formal concussion test before being cleared to play interscholastic sports. According to Dr. Javier Cárdenas, a neurologist at Phoenix’s Barrow Neurological Institute, the program is meant not only to help student-athletes recognize the signs and symptoms of a concussion but also to know what to do after suffering one. And one of the most important things is not to return to play until fully healed.
While the length of time a person stays unconscious may be a sign of the severity of a concussion, not all concussions cause a loss of consciousness. Head injuries that cause a concussion often occur with injury to the neck and spine so be certain to take special care when moving people who have had a head injury. A number of those with concussions who don’t pass out may describe seeing all white, black or stars. The fact is that it’s possible to have a concussion and not realize it. At Compete Magazine we encourage all athletes to know the signs and symptoms of a concussion.
Those that range between mild to severe can include:
- Acting spacey or confused, not able to think straight
- Being drowsy, hard to wake up or any other similar changes
- Having a headache
- Losing consciousness
- Losing memory (amnesia) of events either right before or after the blow
- Having nausea and vomiting
- Seeing flashing lights
- Feeling a sense of “lost time”
Emergency symptoms of a concussion shown below indicate a need to seek immediate medical care:
- Changes in alertness and consciousness
- Convulsions (seizures)
- Muscle weakness on one or both sides
- Persistent confusion
- Continued unconsciousness (coma)
- Repeated vomiting
- Unequal pupils
- Unusual eye movements
- Problems walking
While recovering from a concussion, you may:
- Be withdrawn, easily upset or confused
- Have a hard time with tasks that require remembering or concentrating
- Have mild headaches
- Be less tolerant of noise
(Source: The New York Times Health Guide)
What is CTE?
CTE is degenerative, a brain disease that mirrors Alzheimer’s disease behaviors. In addition to deteriorating attention, concentration and memory, symptoms can also include disorientation, poor judgment and confusion, dizziness and headaches, aggression, depression, slowed muscular movements as well as tremors and speech impediments. But it differs from Alzheimer’s disease because CTE has a specific environmental cause. Because it stems from repetitive blows to the brain, it is the only preventable form of dementia.
With CTE now being the preferred medical term for this disease, the first use of this terminology in medical literature occurred in 1996 even though the disorder was first described in 1928. Then it was referred to as “dementia pugilistica” or “punch drunk” because boxers’ movements slowed and they suffered from confusion, tremors and speech problems.
Many sports of that era were brutal, even violent. In 1905 alone, there were 18 football players killed on the field, an occurrence that almost outlawed the game until President Teddy Roosevelt stepped in and rules were set to eliminate the brutality and foul play.
There are a number of very well known former professional athletes in hockey and wrestling as well as football who have been diagnosed post-mortem with CTE, such as “Iron Mike” Webster, the 17-year veteran Hall of Famer who played football for the Pittsburgh Steelers and the Kansas City Chiefs during the 1970s and ‘80s.
Regarded by many as the best center in NFL history, in his post-retirement years he suffered from amnesia, dementia, depression and acute muscle and bone pain. Sadly, he died in 2002 at age 50 after living at times in his pickup truck or in train stations despite offers from friends to rent apartments on his behalf. In his last years he lived with his youngest son, a teenager at the time, who took care of his father. Webster was the first NFL player to be diagnosed with CTE.
A book on football and brain injuries is being written by ESPN reporters Mark Fainaru-Wada and Steve Fainaru for release in 2013, and a documentary based on their research is being produced by a partnership between PBS “Frontline” and ESPN’s “Outside the Lines.” Previously unpublished documents and medical records from the seven-member NFL retirement board were obtained by “Outside the Lines” and “Frontline.”
They reveal that the retirement board’s 1999 conclusion was that Webster’s repeated blows to the head had left him “totally and permanently disabled.” However, members of the NFL’s Mild Traumatic Brain Injury Committee wrote a series of scientific papers between 2003 and 2009 stating that “no NFL player” had experienced any chronic brain damage as a result of repeated concussions. Their contention was that football players didn’t receive the same type of “frequent repetitive blows” suffered by boxers.
A November 16, 2012 article by the Fainaru brothers based on their research, “Mixed messages on brain injuries,” was carried on espn.go.com. The authors reported that Webster’s mental health problems were widely known and that he was in financial ruin. They also said that Webster, who was “in constant pain because of his football injuries … would sometimes jolt himself unconscious with an array of stun guns he picked up in mail-order catalogues.” The NFL retirement board did grant Webster over $8,000 per month in partial retirement and supplemental benefits but denied him full compensation on the grounds that he didn’t become permanently disabled until several years post-retirement.
Although Webster appealed, it wasn’t until after his death when his estate sued the NFL’s retirement plan in federal court that his claim was finally upheld. What a tragic end for one of our collective beloved sports heroes! (For updated information on their research, go to: pbs.org/wgbh/pages/frontline/sports/concussion-watch/researchers-discover-28-new-cases-of-brain-damage-in-deceased-football-players/)
While most athletes suffering from CTE are older, like Webster, hockey enforcer Derek Boogaard, who played for the Minnesota Wild and the New York Rangers, received a post-mortem diagnosis of CTE following an accidental drug and alcohol overdose in 2011 at age 28. A three-part article on Boogaard carried in The New York Times revealed that he already suffered from advanced brain damage and had he lived, he would probably have faced midlife dementia.
Another younger player already facing memory loss is former NFL tight end Ben Utecht who has a Super Bowl ring earned with the Indianapolis Colts before moving to the Cincinnati Bengals. After a hit knocked him out cold, it took him eight months to recover, a fact that influenced his decision to retire in 2009.
All told, he suffered five concussions during his professional football career and he’s now completely terrified that before his children are grown he’ll develop early onset dementia. Only in his early 30s, this father of three couldn’t remember being at his best friend’s wedding even though he was a groomsman – his wife had to show him wedding photos to prove to him that he was there. In a May 24, 2012 update on an Associated Press story carried on espn.com, Utecht, having read about other players who have trouble even remembering the names of loved ones, says that “It makes me sad and it scares me to think I could be someone like that. I could wake up and not remember moments from my children’s past or names – that’s a scary realization to face.”
So while much has been done in terms of rules and equipment over the years to improve player safety, there will always be some potential risk for injury attached to playing contact sports. And for many athletes with a risk-taking personality, that’s what makes sports so exciting. But injuries, whether they’re immediately evident or whether they present later in life, are always fodder for a potential lawsuit. CTE is a good example of an injury that can take years to make itself known.
In early December 2011, three retired NFL players – Harry Jacobs, 74; Jerome Barkum, 61 and Tommy Mason, 72 – sued the league to establish a medical monitoring program for brain injuries that serves all former league players. In addition to the medical monitoring, they are also seeking unspecified personal injury damages. Seeking to represent all former NFL players in the U.S., they have asked the court for a declaration that the NFL knew or should have known that repeated concussions and head strikes put their players at risk of developing degenerative brain diseases as they age.
This case was quickly followed by similar suits in federal court in Philadelphia and state court in Los Angeles. However, according to NFL spokesman Greg Aiello, “The NFL has long made player safety a priority and continues to do so. Any allegation that the NFL intentionally sought to mislead players has no merit.” But all the various legal maneuvering on both sides indicates that expecting a quick, clean resolution to this case probably isn’t realistic.
Looking for a Link
In the meantime, medical researchers are examining the epigenetics of brain injury, the official term for how the body’s internal chemical switching system activates and deactivates genes in the brain. There are thousands of active genes in the brain, each producing one of the many proteins required for memory and learning as well as keeping the brain cells alive, healthy and able to do damage repair. So the newest research is looking for a possible genetic link as to why some people with multiple concussions appear more prone to dementia than others.
One of today’s leaders in brain health is Dr. Daniel G. Amen, a physician, child and adult psychiatrist, brain imaging specialist and bestselling author who serves as medical director of Amen Clinics. According to an interview with Amen in the Spring 2011 edition of Athletes Quarterly, he has amassed the world’s largest database of brain scans in an effort to discover how people with brain trauma can best be treated.
He counts dozens of former athletes with brain trauma among his patients who come to him wanting help in rehabilitating their brains. He believes that equipment changes and upgrades won’t make any difference in preventing brain trauma. In fact, he contends that the addition of helmets made the situation worse rather than better. The reason is because players, thinking they were safe from injury, simply used their helmeted heads as weapons which, of course, only increased the amount of brain trauma.
Dr. Amen doesn’t believe football, for example, can ever be made a safe game but he also recognizes that it’s not going away. So his suggestion is for the NFL to “own it and start taking care of these players.” While Amen was responding to a specific question about football, nevertheless his observation on our inability to make a sport totally safe extends to all sports, contact sports in particular.
The good news, according to Amen, is that there are ways for athletes exposed to brain trauma to keep their brains healthy. He begins with standard good health practices like adequate sleep, good food and exercise, a good multi-vitamin and high doses of fish oil. And then, depending on a patient’s symptoms, Dr. Amen may also include treatments such as nerve feedback, medication for depression and possibly a therapist, even hyperbaric oxygen treatments. He says that athletes need to recognize that if they focus on brain rehab like they would rehab an injured shoulder or knee, they can help themselves, even potentially healing their brains.
Public awareness of CTE’s tragic effects as well as the importance of brain rehabilitation is a critical step forward in giving athletes of all ages and skill levels the ability to make informed decisions about the potential risk level they’re willing to assume. But it is possible to rehabilitate or reframe the macho maniac attitude of players and fans alike that keeps pushing the envelope on risky behavior?
An article on Philadelphia Flyers right wing shot blocker Ian Laperriere on April 23, 2010 by NHL.com staff writer Mike G. Morreale refers to Laperriere as a “hockey warrior,” noting that there is only one thing that motivates him more than wins and that’s sacrifice.
During Game Five of the opening round of the 2009-10 Stanley Cup Playoffs between the Flyers and the New Jersey Devils, Laperriere deliberately stepped in front of a slap shot that hit him on his forehead at full speed. Bleeding profusely and unable to see out of his right eye, this was the second time in six months that Laperriere had taken a shot to the face, the first one costing him 70 stitches and the loss of seven teeth. Yet he later remarked that “it’s all about sacrifice,” declaring that the team would have to sacrifice even more in the next series.
But he does finally seem to have gotten some perspective on his reckless abandon, saying shortly after the latest injury that “It’s just that stupid macho thing in my head, and [the recent slap shot] made me realize I’ve got to smarten up. I have to think about my family more than anything else.”
Laperriere was awarded the Bill Masterton Memorial Trophy for the 2010-11 season, awarded to a player who exhibits exceptional perseverance, sportsmanship and dedication to hockey. It’s named in memory of the late Bill Masterton of the Minnesota North Stars who died in 1968 following an injury sustained during a hockey game. Ironically, the Masterton trophy is often awarded to a player who has come back from career- or even life-threatening illness or injury.
And true to form for the award, following the playoffs, Laperriere was diagnosed with post-concussion syndrome and didn’t play during the 2010-11 season. The Flyers placed him on long-term injured reserve for financial reasons, stating that he “continued to serve the team in several capacities.” Six months post-injury Laperriere said he still didn’t feel any better and doctors advised him to retire or face permanent damage both to his eyes and brain. But he held out until June 2012 after the Stanley Cup to announce his retirement.
No one can deny the importance of an athlete’s personal motivation and dedication to his/her sport, something which is often the difference between a good player and a great one. But how far do we, as their fan base, entice players to push the safety edge? Is it the field of play or the field of battle we expect to see?
Laperriere’s case is a good example of the public’s enthusiasm for high drama on the field of play. Most of the sports press and fan commentary continued to praise him for being fearless, gutsy, gritty … and the string of adjectives goes on, ones that praise his self-confessed sacrifice. Yet at the end of a player’s game, season or career, life goes on as normal for everyone but the player, the one who ultimately has to live with the often-disastrous consequences of his sacrifice.
For many athletes, though, the thrill of competition, the risk involved is what makes playing sports so exciting. Hopefully, the goal is to play what you love without becoming the next Humpty Dumpty who can’t be put back together again.
So if you’re an adrenalin junkie maniac playing a sport (especially a contact or collision sport), whether as a high school or college student-athlete or a weekend warrior, consider what you can and are willing to do to protect your brain and make some intelligent, informed decisions going forward. Certainly following Dr. Amen’s standard healthy regimen of enough sleep, healthy eating, regular exercise and a good multi-vitamin is a solid start on converting your playing attitude and behavior from a maniac to a brainiac. And also be sure you’re in physical condition to play.
For additional tips on good brain health, you can go to Amen’s website, www.amencclinics.com and sign up for a free newsletter.