Concussion in Sport

“HEAD THE BALL…THE BALL ISN’T GOING TO HURT YOU” or “SHAKE IT OFF, YOU’LL BE FINE”

concussion-1-300x200

Part #1

Phrases, I and many others, are guilty of validating within our coaching, due to not having the correct amount of knowledge and true understanding of such damage concussion can cause an athlete.  How many times have we heard coaches, parents or spectators yelling towards athletes of all ages to head the ball? As many other coaches and parents around the world, did we really know the full extent and damage heading the ball and/or colliding heads could potentially cause? Did we even know what this kind of injury was called and it’s short and long-term effects on athletes?

As some of you may have guessed, the phenomenon we’re referring to is “Concussions”. Only through personal and real-life experiences of coaching soccer professionally in the US, and discussing such topic with Doctors and Professors and lastly watching a recent movie called “Concussion”. A combination that changed my whole mentality and views towards concussion in sport.

Let’s start from the beginning.

 

The very first publication surrounding “Concussion” was published by Harrison Stanford Martland who wrote “The Journal of the American Medical Association” in 1928, at the time he called such phenomenon “Punch Drunk” as he continually observed boxers receiving repeated punches to the head (Harrison, 1928). The literature and science surrounding concussion have evolved dramatically since 1928. This wasn’t always the case as it hasn’t been for the last 10 years that Dr. Bennet Omalu began to discover athletes suffering from a concussion within multiple and diverse of sports. (McKee et al. 2009; Omalu et al. 2005; Omalu et al. 2006).

 

Concussion has come to be widely recognized within sports including NFL, Ice Hockey, Wrestling and Soccer, whom all fall victim of repetitive blows to the head (Gavett et al. 2011b; Geddes et al. 1999; Hof et al. 1991; McKee et al. 2009; Omalu et al. 2005; Omalu et al. 2006; Omalu et al. 2010; Stern et al. 2011a). Symptoms of concussion include confusion, such as being unaware of your surroundings, a delay in answering questions, or haviconcussion in sportng a blank expression, headache, dizziness, nausea, loss of balance, feeling stunned or dazed, disturbances with vision, such as double vision, blurred vision or “seeing stars” or flashing lights and difficulties with memory (NHS, 2014).

 

Most often or not, we as coaches and parents fail to grasp and identify such conditions and its effect on players, simply because we cannot “SEE” it. If we place the child back into a sporting environment, where the player may experience repetitive blows to the head we risk the condition worsening. What does that mean to us as parents and, more importantly, the athlete? Repetitive brain trauma and concussions as well as hits to the head, will result in athletes potentially suffering with a greater condition and trauma called Chronic Traumatic Encephalopathy (CTE) (McKee, Cantu,, Nowinski, Hedley-Whyte, Gavett, Budson, et al. 2009; (McKee,Cantu,Nowinski, Hedley-Whyte, Gavett,Budson, Santini, Hyo-Soon Le. 2009).

A link between brain trauma and CTE was first discovered by Dr.Bennet Onmalu when the body of NFL star Andre Walters was investigated after he took his own life after suffering from dementia for years. You might be thinking what is CTE?  CTE is a progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.  These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvemenOmalu-biot.  The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

In both sets of photographs, above, the brain tissue has been immunostained for tau protein, which appears as a dark brown color. Tau immunostained sections of medial temporal lobe from 3 individuals

¥        Top left: Whole brain section from a 65-year-old control subject showing no tau protein deposition

¥        Bottom left: Microscopic section from 65-year-old control subject also shows no tau protein deposition

¥        Top middle: Whole brain section from John Grimsley showing abundant tau protein deposition in the amygdala and adjacent temporal cortex

¥        Bottom middle: Microscopic section showing numerous tau-positive neurofibrillary tangles and neurites in the amygdala

¥        Top right: Whole brain section from a 73-year-old world champion boxer with severe dementia showing very severe tau protein deposition in the amygdala and thalamus

¥        Bottom right: Microscopic section from a 73-year-old world champion boxer with severe dementia showing extremely dense tau-positive neurofibrillary tangles and neurites in the amygdala

 

Part 2 of “Concussion in Sport” will discuss how concussion has evolved into the field of soccer and additionally, it’s potential impact on soccer players.

 

Thank you

The Sporting Influencer

The following blog can also be found via the Coach Logic website: Click here to find out more

References:

Ann C. McKee, MD1,2,3,4, Robert C. Cantu, MD3,5,6,7, Christopher J. Nowinski, AB3,5, E. Tessa Hedley-Whyte, MD8, Brandon E. Gavett, PhD1, Andrew E. Budson, MD1,4, Veronica E. Santini, MD1, Hyo-Soon Le. (2009). Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol.. 68 (7), 1-39

Case Study – http://www.awpagesociety.com/wp-content/uploads/2011/09/FinalCaseStudy.pdf

Critchley M (1949) Punch-drunk syndromes: the chronic traumatic encephalopathy of boxers. Hommage a Clovis Vincent (ed) Maloine, Paris

McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., et al. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neu- ecology, 68(7), 709–735.

Omalu, B. I., DeKosky, S. T., Minster, R. L., Kamboh, M. I., Hamilton, R. L., & Wecht, C. H. (2005). Chronic traumatic encephalopathy in a National Football League player. Neurosurgery, 57, 128–134. discussion, 128–134.

Omalu BI, DeKosky ST, Hamilton RL, Minster RL, Kamboh MI, Shakir AM, et al. (2006) Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery;59:1086–1093. [PubMed]

Omalu, B. I., Fitzsimmons, R. P., Hammers, J., & Bailes, J. (2010). Chronic traumatic encephalopathy in a professional American wrestler. Journal of Forensic Nursing, 6, 130–136.

Gavett, B. E., Cantu, R. C., Shenton, M., Lin, A. P., Nowinski, C. J., McKee, A. C., Stern, R. A. (2011b). Clinical appraisal of chronic traumatic encephalopathy: current perspectives and future direct- options. Current Opinion in Neurology, 24(6), 525–531.

Geddes, J. F., Vowles, G. H., Nicoll, J. A., & Revesz, T. (1999). Neuronal cytoskeletal changes are an early consequence of repeat- active head injury. Acta Neuropathologica, 98, 171–178.

HARRISON S. M. (1928). PUNCH DRUNK. MARTLAND, 91 (15), 1103-1107.

Hof, P. R., Knabe, R., Bovier, P., & Bouras, C. (1991). Neuropathy- logical observations in a case of autism presenting with self-injury behavior. Acta Neuropathologica, 82, 321–326.

Millspaugh J. (1937) Dementia pugilistica. US Naval Med Bull. 1937;35:297Y303.

NHS, (2014) – http://www.nhs.uk/conditions/concussion/Pages/Symptoms.aspx

McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., et al. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neu- ecology, 68(7), 709–735.

Stern, R. A., Riley, D. O., Daneshvar, D. H., Nowinski, C. J., Cantu, R. C., McKee, A. C. (2011a). Long-term consequences- cte of repetitive brain trauma: chronic traumatic encephalon- Cathy. PM&R, 10 Suppl 2, S460–467.

Website References:

http://www.bu.edu/cte/files/2012/05/Baugh_Chronic-Traumatic-Encephalopathy_2012.pdf