Football: Heading for trouble?

1. Knockin' heads

2. A player is down!

3. Caution about concussion

4. The macho factor

5. Odd sports injuries

A concussion occurs when a violent impact causes a disturbance of brain function. Most concussions do not cause loss of consciousness. Graphic: National Library of Medicine

 If you've had three concussions in seven years, your risk of another concussion is tripled.

Cussed concussion
Concussed St. Louis Rams quarterback Kurt Warner may have been surprised to get a concussion, but what's the surprise? In terms of attack by a menacing muscular mass, a quarterback is about as vulnerable as a bullfighter -- minus the sword. In reality, concussion is an equal-opportunity mangler in football: Most surveys show that all positions are equally vulnerable. And it's not just football: About 300,000 American athletes suffer a concussion each year.

Diagram shows head hitting wall.

Concussions are caused by blows to the head. Immediate symptoms can include amnesia, memory loss, difficulty concentrating, headache, sensitivity to light and dizziness. Delayed symptoms can include sleep disturbance, fatigue, depression and fogginess. For details, see this NIH Web site.

Does it seem odd that Warner apparently did not know about his concussion during that game in September? Yes, but a one-year study of Canadian athletes found much the same thing (see "Concussions Among..." in the bibliography). Symptoms of concussion appeared among 70 percent of college football players and 63 percent of soccer players. But among the concussed football players, only 23 percent knew they'd had a concussion. Among concussed soccer players, only 20 percent recognized the concussion.

concussion graph shows that less than 20%  of those that had a concussion realized that they'd had one.
A 2002 study looked at concussion among 328 football players and 201 soccer players at Canadian universities for one year. Notice that most concussions were not noticed. Data: "Concussions among ..." (see bibliography).

Here's a good reason to know whether you've had a concussion: They make you more vulnerable to another. "We've done several studies showing that concussions are cumulative," says Joseph Maroon, team physician to the Pittsburgh Steelers and vice chair of the department of neurosurgery at the University of Pittsburgh. "If you return to football while still suffering the effects, the chances of having a more severe concussion, caused by less force, are greater." That's primarily true during recovery, he adds, "but we are finding that individuals who have had one or two concussions are more susceptible beyond the recovery period."

Indeed, in a report published this week in JAMA, Kevin Guskiewicz of the University of North Carolina confirmed that past concussions increase the chances of another. "Based on the study, once you have had a concussion, within a seven-year window, you at a greater risk of sustaining another injury," he said. "Once you have had three or more concussions in seven years, you have at least three times more risk of sustaining another injury."

Bang! More bad news!
The long-term picture of concussion is not pretty, either. "There are many professional, high-school and college athletes who've had concussions, and had prolonged effects," says Maroon, who was an All-American halfback for Indiana University some years ago. While he's not aware that any football player has reached the punch-drunk, brain-damaged condition of former boxer Muhammad Ali, he says mood can get erratic, "they can have a difficult time controlling anger ... have decreased libido, impaired sleep, difficulty in relationships. These are all subtle or not-so-subtle abnormalities that can occur after a significant concussion."

In a recent study of college athletes (see "Epidemiological Considerations..." in the bibliography), Tracey Covassin of Shippensburg University in Pennsylvania found the highest rate of concussions in football. But she confirmed that a rising, and healthy, consciousness about concussion could explain part of the apparent increase. "Trainers are reporting it, coaches are noticing it, or other athletes are reporting that [an athlete] doesn't sound right."

The result, she stresses, is a more cautious approach: "Before, they said 'You got a ding, get out there and play.'"

Graph shows link between concussions and depression.
When 1,742 retired NFL players reported on concussions from pro football, 61 percent suffered at least one concussion, 24 percent had three or more, and 12 percent had at least five. More concussions were strongly associated with depression later in life. Data: "Recurrent Sport-Related Concussions ..."

Not convinced that concussion is a brain injury, not just a "ding"? Then look at some new data associating concussion and depression. Guskiewicz, who heads the Center for the Study of Retired Athletes at the University of North Carolina, studied 1,742 former NFL players. The rate of depression for retired players who'd had five or more concussions was three times higher than for retired players without a history of concussion. (However, the study found no association between concussion and Alzheimer's disease.)

What about the macho factor?


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