Once more, with feeling...it's not just concussions

Well, for whatever amount of time I can retain my sanity and not be overwhelmed by despair, the blog is back. Conveniently, it returns on the day the NFL is staging its conference championship games.

If you want, blame my wife for sharing this article with me.

A study published in the peer-reviewed journal Brain drives home the point that has long been burbling under the surface of the ongoing attempt to sort out the link between brain injury and sport (mostly football, but some others too). This blog has made efforts to drive home this point before.

What is helpful here is a particularly strong effort at distinguishing between three terms that are sometimes thrown about rather loosely in the discussion and drawing a much clearer distinction than is usually the case. Evidently the article's author, Cindy Boren, felt it necessary (and got editorial consent) to draw out that discussion in detail, rather than hoping folks would click on the link in the online post (or go find the journal Brain and read it).

Many studies in the past have suggested that chronic traumatic encephalopathy, hereafter CTE, was not necessarily as connected to concussions as the common wisdom tended to assume, but those studies had not been set up to control for those factors and separate concussive hits from subconcussive hits (which are just what the name suggests, hits not hard or forceful or direct enough to provoke a concussion). This study deliberately set out to control for exactly those conditions.

Note the subject of the study: teenagers, specifically teenagers with head injuries. It shouldn't be a shock by now that early stages of CTE can show up in young athletes, not just grizzled veterans, so the choice of subject isn't out of reason at all.

The key is, not surprisingly, the repetitive nature of such hits. If you play one game of football and get banged up a few times, you could end up with a concussion. You are incredibly unlikely, barring other head injuries off the field, to end up with CTE. Conversely, you can play football through two or three years of middle school, four years of high school, and never get diagnosed with a concussion, and still end up showing signs of CTE. It's not necessarily the most common thing to happen, but it does happen.

The confusion of concussions, traumatic brain injury (TBI), and CTE has tended to hinder the public discussion about all of these subjects. Dr. Lee Goldstein, one of the study's authors, spells out those differences effectively enough that it's best just to let him do it, as quoted in the article:

When it comes to head injuries and CTE, Goldstein spoke of three categories that are being jumbled: concussions, TBI and CTE. Concussion, he says, is a syndrome defined “by consensus really every couple of years, based on the signs and symptoms of neurological syndrome, what happens after you get hit in the head. It’s nothing more than that, a syndrome. You take one [symptom] from column A, one from column B.”

A TBI is different. “it is an injury, an event,” he said. “It’s not a syndrome. It’s an event and it involves damage to tissue. If you don’t have a concussion, you can absolutely have brain injury and the converse is true.”

CTE is “a bona fide neurodegenerative disease. It will progress independently of whether you have future hits and a lot of people think that the injury is the disease and it’s not. There is an injury and then it goes on to spread in the brain, like other neurodegenerative diseases.”

And that being the case, eliminating the concussions (whether by "magic helmet" or some other technological marvel) doesn't necessarily eradicate CTE.

Presumably you can see where the problem lies: it's pretty hard to play football without getting hit, probably getting hit a lot. It's kinda baked into the nature of the game. It's what gets celebrated. It's basic. Other sports also have their issues with violent contact, but few of them (maybe rugby?) are quite so intrinsically based on large and fast men hitting one another as hard as possible as football is. (Soccer fans would probably celebrate enforcing rules enough to cut down on contact if only because it would cut down on the awful injury fakery that plagues that sport.)

But yeah, it's not going to be easy to do much about repetitive hits in a sport that is all about repetitive hits.

So, as the medical evidence continues to escalate, expect more distraction. Quite frankly the NFL and maybe even the NCAA will point to concussions more and more and hope you fall for it. High school athletic associations will frankly just hope you don't notice. After all, there's really not a lot of options otherwise.

Whether such distraction will work is up to you.

One other note: the authors of this study and this article do well to point out that football players are not the only sufferers of CTE affected by this information. Outside of athletics the most commonly afflicted are soldiers, particularly in those combat zones where improvided explosive devices come with the territory. Even beyond those, though, sufferers of repetitive hits include the incarcerated, the homeless, and victims of domestic abuse.

Yes, abused spouses and children can end up with CTE. Let that sink in.

In case you've forgotten...