Are We Failing to Identify 80 Percent of Football Brain Injuries?

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Football leagues from the smallest Pop Warner division to the NFL have developed and implemented traumatic brain injury and concussion protocols to better identify and protect players who may have suffered a serious injury. The education, training and injury protocols that have been implemented are a good starting point to begin the conversation regarding traumatic brain injuries (TBIs) that occur through either a single violent impact to the head or those that build-up with numerous small impacts over time. While we have had some understanding that repeated blows to the head could lead to pugilists developing a condition where they appeared to be punch drunk, we haven’t necessarily understood the length of time or the severity of impacts that were necessary to develop a condition of this type. Furthermore, we have generally lacked a thorough understanding in the differences in outcomes between isolated, severe impacts and repetitive, lower-severity traumas.

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Unfortunately, as research progresses it appears that less trauma to the brain than we initially considered is necessary for the development of degenerative conditions such as chronic traumatic encephalopathy, or CTE. Making this bad news even worse, according to a recent Harvard and Boston University study, we may be missing up to 80-percent of all brain injuries suffered while participating in football and football activities.

The Harvard and Boston University Brain Injury Reporting Study

The study analyzed the outcomes, by position, among football players who suffered head injuries. The cohort included 734 NCAA Division 1 football players who agreed to complete self-reporting questionnaires. The study revealed that, on average, for every one concussion that was reported the player also suffered four suspected concussions that went unreported. Despite initial efforts at identifying and caring for brain injuries, we are still missing 80% of those that occur in football. Perhaps these concussions were unreported due to a desire to compete or because of the pejorative terms, such as dings or bell ringers, that are utilized to minimize injuries of this type. However, regardless of the reason these concussions go unreported, they may still have serious implications and medical consequences.

The study also revealed that while there was not a significant difference by position in the number of reported concussions, the same cannot be said about unreported concussions. The study found that offensive lineman reported a significantly higher amount of undiagnosed concussions and dings. The study also found a significant difference between the positional groupings in the frequency of post-impact and post-concussion symptoms with offensive lineman reporting dizziness, headaches and seeing stars at a higher rate than other positions. Finally, the study also showed that offensive lineman participated in more full-contact practices than other positional groups and they more frequently returned to play or practice despite the presence of brain trauma signs and symptoms. What the study, therefore, seems to suggest is that the frequent, low-magnitude impacts experienced by offensive linemen can be extremely damaging. Based on the fact that offensive lineman appears to develop more post-trauma symptoms than other position groupings, we can draw a few potential conclusions. It is possible that low-grade impacts experienced frequently are equally or more damaging than high-magnitude impacts. Alternatively, it is possible that additional traumas to the head without allowing a brain injury to heal, regardless of magnitude, is extremely damaging to the brain.

Human Brain Anatomy

What Types of Conditions Can Repeated Brain Trauma Result In?

Perhaps the chief condition that researchers have focused on in recent years is Chronic Traumatic Encephalopathy (CTE). CTE is a progressive and degenerative disease that impacts individuals that have been subjected to repeated instances of brain trauma. The trauma to the brain and its surrounding tissue encourages the build-up of abnormal plaques and tau proteins. These changes to the brain do not have to occur contemporaneously to a moderate or severe trauma. Rather, changes can occur weeks, months or even years after the last impact. The signs and symptoms of a CTE condition include problems with memory, confusion, increased aggression, problems with impulse control, and dementia.

Consider former NFL-star Junior Seau. During his 20-year career in the NFL as a linebacker, Seau had no reported history of concussions or brain injuries. However, the autopsy performed after his death would reveal that Seau did, in fact, suffer repeated brain traumas that were never reported or diagnosed. When questioned Seau’s ex-wife stated that he had experienced concussions during his playing career, but, “He always bounced back and kept on playing. He’s a warrior. That didn’t stop him.”

Do These Findings Mean a High School Football Player is at Risk?

The truth is that nobody really knows the extent of the impact high school football will have on the long-term health of the average high school athlete. While some studies have found that the risk of concussion is greater among high school players in comparison to collegiate players, other studies have reached the opposite conclusion. According to one study reported on by Frontline, a total of 128 former football players were studied. This cohort was comprised of professionals, semi-professionals, collegiate players and high school players. From that sample, 101 of the 1128 players tested positive for CTE.

What is interesting to consider is that the Pennsylvania legislature has enacted legislation intended to protect young athletes from brain injuries. The Safety in Youth Sports Act applies to games, matches, club sports, practices, scrimmages, and more. The act sets forth procedures for handling a suspected brain injury. This includes players or participants undergoing baseline testing at the beginning of the season, a removal from play after a suspected head injury, and a protocol that the player must be able to fulfill prior to being permitted to restart play. As an enforcement mechanism, a coach can be suspended or permanently banned from coaching if he or she fails to adhere to the standards and protocols set forth by this act.

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While we do not yet have the data to tell if a program of this type is working in Pennsylvania, the inquiry should be directed at whether concussions are being accurately reported. A system of this type only works if players and coaches put health & safety first and do not engage in the type of underreporting that is apparently occurring in the NCAA. If underreporting similar to the Harvard and Boston University study’s findings are also occurring at the high school level, it is likely that the law is failing to protect student athletes adequately.

It can be difficult to act reasonably and prudently in protecting the health and safety of your child when our understanding of degenerative brain conditions is still developing, but we can take some steps based on what we know. Dr. Ann McKee, a neuropathologist and the director of the NFL brain bank, provides fairly common-sense and measured advice regarding the risk of developing a degenerative condition due to football. She says, “Playing football, and the higher the level you play football [at] and the longer you play [it], the higher your risk.” While we understand that risk is a part of the game, athletes — and especially youth athletes — should not be exposed to unnecessary additional risk following a suspected brain injury. As the tragic stories of former NFL players have shown, the medical consequences are simply too severe to risk further damage to the brain when it is healing and most vulnerable. If you have questions about failure to diagnose lawsuits, contact The Reiff Law Firm today.

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