TIME Sports

Football Head Impacts Can Cause Brain Changes Even Without Concussion

Tetra Images - Erik Isakson—Getty Images/Brand X

New study looks at high school athletes

As the world mourns the loss of Ohio State University football player Kosta Karageorge, who was found dead in an apparent suicide on Nov. 30, concerns about the long term effects of head injuries sustained by footballers continue to mount. A day after Karageorge’s death, a study has been released that suggests sports-related head impacts can cause changes in the brain even when there are no outward signs of a concussion.

In fact, researchers from Wake Forest Baptist Medical Center in Winston-Salem, N.C., say some high school football players in the study exhibited measurable brain changes after a single season of play, even in the absence of concussion.

The Wake Forest team, lead by Dr. Christopher Whitlow, focused on youth players, a group that until now had been widely overlooked in the research into the effects of the repetitive head impacts associated with a typical season of football. “For every one NFL player, there are 2,000 youth players. That’s close to four million youth players and the vast majority of research on impact-related brain injuries has been on the college and professional level,” says Dr. Whitlow, noting that two-thirds of head impacts occur in practice sessions, not games.

Read More: High School Football Player Dies After Injury

In the first-of-its-kind study, the researchers hooked up 24 high school football players between the ages of 16 and 18 with helmet-mounted sensors to assess the frequency and severity of helmet impacts and then sent them out to play ball. As the players hit the field, the sensors allowed the researchers to monitor the severity of players’ head impacts. The team collected data from the helmets before and after every game and the high school students also underwent pre- and post-season diffusion tensor imaging (DTI) of the brain. “We looked at both structural and functional neuro-imaging and evaluated the players’ neuro-cognitive function,” he says.

“We found some changes in the brain that are concerning,” said Dr. Whitlow. “They are concerning because kids with more impacts had more changes and the kids with fewer impacts had fewer changes.”

While none of the football players were concussed during the season, the researchers found that there were microstructural changes in all of the players’ brains, especially in those players who were deemed “heavy hitters.” That direct correlation between game-related hits and changes in the brain is not exactly surprising, but may be unsettling for parents of youth football players.

Read More: The Tragic Risks of American Football

Not that Dr. Whitlow wants people to pull their kids from the peewee leagues or ban high school football just yet. “The high school athletes weren’t experiencing any of the classic symptoms of concussion—dizziness, nausea or double vision,” he says. “While the changes in the brains are concerning, because there were no symptoms of concussions, we don’t yet know how important these changes are.”

Dr. Whitlow sees the results of the study as only the first step in identifying a potential problem with allowing youth players to continue to play ball. He and his team want to determine whether these changes in the brain are permanent or transient and whether they are associated with subtle changes in neuro-cognitive functions. “Once we can identify risks, we can intervene to reduce those risks,” he says. Interventions could include improvements in technology and helmet safety, identifying maneuvers that could be particularly dangerous, making changes in the diagnoses of head injuries and identifying subtle changes that could be harmful.

So what’s a parent to do? Dr. Whitlow suggests they get involved in their kids’ practices. “You have to put these risks in the context of the health-related benefits of playing sports. The take home message is that parents need to use common sense. The best thing for parents to do is know what is going on on the field, know the symptoms of concussions, get to know the coaches, find out if there is a trainer on the field who can diagnose concussions.” He also directed parents to SaveInjuredKids.org for ideas on how to reduce head injuries and to learn to identify the signs of concussion.

“Football is the great American pastime,” said Dr. Whitlow. “I think it’s going to be around for another hundred years and what we’re trying to do is make it safer.”

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TIME Exercise/Fitness

Athletes Should Not Play With Head Injuries, Say Doctors

Christoph Kramer of Germany receives a medical treatment during the 2014 FIFA World Cup Brazil Final match between Germany and Argentina on July 13, 2014 in Rio de Janeiro.
Christoph Kramer of Germany receives a medical treatment during the 2014 FIFA World Cup Brazil Final match between Germany and Argentina on July 13, 2014 in Rio de Janeiro. Shaun Botterill—FIFA/Getty Images

Germany’s decision to let midfield Christof Kramer keep playing in the World Cup final yesterday after being slammed in the head was understandable—if this were 1962, anyway. Back then, a little concussion wasn’t seen as much of a big deal.

That’s not true anymore, and given the fact that everyone from kids’ coaches to the NFL (if grudgingly) recognize that even mild head injuries can have serious consequences, that decision looks close to insane—especially given that Kramer “looked as if he was on another planet and had to be helped off the field,” as TIME’s Bill Saporito observed.

Of course, it’s possible that the German team didn’t realize that this sort of thing can cause permanent brain damage. Or maybe they think that what applies to American football is irrelevant to real football. Except that studies have shown that soccer players are equally at risk.

Clearly, they didn’t read the editorial in The Lancet Neurology published the day before the game reminding coaches and team officials that “cerebral concussion is the most common form of sports-related traumatic brain injury (TBI), and the long-term effects of repeated concussions may include dementia, amyotrophic lateral sclerosis, and other neurological disorders.” The decision to let players continue in a game, wrote these learned medical experts, should be made solely by doctors.

It turns out that FIFA doesn’t have any clear rules about what to do in case a player suffers an apparent concussion. But the fact that Kramer stayed in the game, no matter how important a World Cup final match might be, was at best highly questionable. “I can’t remember very much but it doesn’t matter now,” the dazed player reportedly said after the game was over.

If the medical professionals are right about how serious concussions can be, Kramer and his teammates might well have a different take on things a few years down the road.

TIME brain injury

The Best Concussion-Proof Helmets

Virginia Tech

A new study shows that one helmet may protect against concussions better than others

Concussions are an unfortunate reality in many sports, from football to soccer and boxing. And as studies continue to link concussions to a range of health problems, from depression to Alzheimer’s and other brain changes, sports and health officials have focused their attention on whether protective equipment like helmets can lower the risk of brain injuries.

Most research to date shows that there is no concussion-proof helmet to protect against all concussions and brain injury. In March 2013, a panel of 32 experts updated the Consensus Statement on Concussion in Sport, and concluded that while mouth guards and helmets generally protect the faces and heads of athletes, they don’t do much to protect them from internal brain damage. In fact, they warned, helmets and mouth guards may even give some players a false sense of security and invincibility and may make them act more aggressively on the field.

MORE: A New Blood Test to Diagnose Concussions On The Field

A new study published in the Journal of Neurosurgery confirmed that there’s no helmet that can protect a player from all concussions, but the researchers compared two helmets and found that some can be more protective than others. While previous studies simply looked at rates of concussions across a wide variety of helmet types and among players with varying rates of head impacts, in this study the scientists were able to control for the number of impacts each player had and compare that to his helmet type and risk of concussion. The researchers analyzed six years of head impacts among 1833 college football players from eight schools. The players were either wearing a Riddell VSR4 or Riddell Revolution helmet, which the manufacturers say no longer have screws that are typically found in the forehead area of the helmet. That construction provides “an unparalleled amount of face mask flexion, dispersing impact energies around the helmet instead of onto the player’s head,” the company claims. The two helmets were popular choices at the time of the study.

(MORE: Your Kid Is Probably Wearing the Wrong Helmet to Prevent Concussions)

The research team monitored more than a million head impacts by equipping the helmets with sensors to measure the force, velocity and direction of each impact. They found a 54% lower risk of concussion among players wearing the Riddell Revolution helmet compared to those who wore the VSR4 helmet. That suggests that the Revolution is better at dissipating the energy from an impact on the helmet before it reaches the head, leading to what the researchers call lower head accelerations and a lower concussion risk.

Since rule changes can only go so far in reducing the risk of impacts to the head, the scientists say that improving helmet design to lessen the damage that such trauma can do to the brain is also critical, and their data suggest that may be possible. No helmet can prevent 100% of concussions, but if some can reduce the risk, then they should be studied further, the researchers say.

TIME brain injury

A New Blood Test to Diagnose Concussions On The Field

Debbi Smirnoff / Getty Images

A protein could signal the first signs of brain changes due to a concussion.

With a finger-stick and a drop of blood, researchers from the University of Rochester say it may be possible to tell whether a player experienced a concussion.

Levels of the brain protein S100B start to rise with intense exertion, but also after a major impact such as a blow to the head. So the scientists investigated whether it would be possible to distinguish the two circumstances in hopes of finding a way to detect the first signs of traumatic brain injury.

They tested 46 athletes over age 18 for baseline levels of S100B during their preseason. After physical exertion, the researchers tested them again and found that their S100B levels rose slightly, by an average of 2%. During the season, 22 of the athletes had a clinically diagnosed concussion. Seventeen of the athletes with confirmed concussions had a S100B blood test done within three hours of the injury and their levels were 81% higher than baseline.

Based on their findings, the researchers concluded that a rise in S100B of more than 45% is nearly equivalent to a concussion diagnosis, and easily distinguishable from physical exertion.

In Europe, researchers are using the protein test to study which patients with brain injuries may be at risk for internal bleeding and should have a CT scan. The group hopes to get the blood test approved for concussion diagnosis in the U.S., but acknowledge that more studies will be needed to confirm their results first. They note, for example, that more players from different sports should be tested, and that scientists should investigate how the protein levels may vary among men and women. Still, the findings, published in the journal PLOS ONE, suggest that it may be possible, on the field of play, to identify which players who have experienced head traumas need closer monitoring and treatment for concussion, which could reduce their chances of more permanent and lasting damage.

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