Significant Head Trauma Can Occur with Repeated Hits, Not Just Concussions

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

CTE’s connection to football has been in the news for five years now, with a debate centered around whether the number of concussions will affect long-term health and well-being of those playing the sport. Likewise, I’m constantly asked by patients and parents what the future effect of this or future concussions will be on their health. A recent study released by researchers at the Boston University School of Medicine (such as Dr. Robert Cantu, Dr. Ann McKee, Chris Nowinski and others) will probably give moms and dads across America a moment of pause before starting a collision sport like football or hockey.

An answer may lie in a concept developed by these researchers called the Cumulative Head Impact Index (CHII). They found individuals who had more hits to their heads—regardless of whether they had a concussion or not, were significantly (i.e., not even close…a large statistic margin) more likely to experience later-life cognitive problems, apathy and depression. The caution here is that the sample size was only 93 individuals and the exposure was only to football.

Helmet-Warning-Label

A football helmet’s health warning sticker is pictured between a U.S. flag and the number 55, in memory of former NFL player Junior Seau; new research suggests that the accumulation of subconcussive hits may have more significant long-term effects than concussions. (© Mike Blake / Reuters/REUTERS)

The next step is for medical providers and concussion specialists to help families begin to connect the dots throughout the developmental hurdles of a child’s life. For example, the health outcomes for two 7th grade beginning hockey players if they have a different history. One student may have fallen off a changing table as an infant and suffered a skull fracture, have been in a motor vehicle accident, and have fallen multiple times during winter sports, while the other 7th grader may not have suffered any head injuries or significant head trauma. Baseline neurocognitive testing like the ImPACT® test might look different on these two young students, and the outcome and recovery time of any current injuries sustained by each of them could be considerably different.

I’ve often said that kids can’t live in a bubble as much as parents are sometimes inclined to want to wrap their kids in bubble wrap. Young people—really, people of all ages—are going to be in car accidents, bike accidents, and slip and fall just going through life. Parents need to make their own unique, informed decision about how much additional risk of physical injury to which they want to expose their child, given his or her medical history and athletic abilities.

Run, Sam. Run!

This week over 2 million viewers watched Sam’s impressive speed and versatility on YouTube. Sam Gordon is a girl playing in an all-boys tackle football league in Utah.  Sam finished the 2012 season with a stat line that would make any parent and coach proud. According to the video, she scored 35 touchdowns on 232 carries, totaling 1,911 yards and averaging 8.2 yards per carry. And just for the fun of it, she also had 65 tackles.

It is hard not to watch this video and be wowed, but in this era of concerns about concussions, on all levels of football, this video raises some concerns.  The last minute of the video shows clips highlighting the 9 year old girl “taking a hit”.  Some of them are quite jarring. Gordon is not even 60 pounds, and there’s a kid on her team who weighs more than 150 – his nickname is Tank.

In his new book, Concussions and Our Kids: America’s Leading Expert On How To Keep Sports Safe And Protect Young Athletes, Dr. Robert Cantu – a clinical professor of neurosurgery at the Boston University School of Medicine — proposes that children should not play tackle football until they are 14 years old. The better game for children under 14 is flag football — in which kids grab flags rather than each other to stop the ball carrier.

Our message to Sam is simple: run, Sam. Run. Run so you can avoid the hits!