The League

Dr. A. Brion Gardner
Orthopedic Surgeon

Dr. A. Brion Gardner

Staff Orthopedic Surgeon at Camp LeJeune

Don't Need Concussions

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Anyone who watched the Monday Night Football game between the Washington Redskins and Philadelphia Eagles should be concerned about head injuries in football after watching Brian Westbrook lay motionless on the field for minutes after being struck in the head by a defender's knee. Recently, there has been a lot of attention focused on concussions and the residual effects of multiple concussions in the National Football League. Despite many previous studies that suggested multiple concussions in NFL players had long term and potentially permanent cognitive and behavioral effects, the NFL was reluctant to acknowledge this phenomenon until their own study produced similar findings.

The report of this study conducted at the University of Michigan suggested that retired NFL players may have an increased incidence (up to six times the normal population) of Alzheimer's and other forms of dementia. Based upon this study, the House Judiciary Committee has convened a hearing to examine the lasting impact of head injuries, how to limit them and how to compensate the players and their families. Reportedly, the committee chairman is also interested in determining the role that head injuries play in collegiate and high school football competition as well.

The true incidence of concussions in the NFL is somewhat unknown and definitely under reported. The short and long term affects are now being better recognized, understood, and appropriately treated earlier. A concussion is a mild traumatic brain injury that is caused by a direct blow to the head and causes transient impairment of neurological function that resolves itself. Neuroimaging of the brain usually shows no structural changes as a result of the injury. The temporary symptoms that may be present include physical (headache, nausea/vomiting, tinnitus, balance disturbance, visual disturbance), cognitive (confusion, amnesia, loss of consciousness, attention deficit), and emotional (crankiness, irritability, loss of interest, lethargy). The development of these symptoms is known to be the result of a cumulative effect of concussions. There is an increase in the number and severity of symptoms with each concussion, especially if occurring in the same season. The duration of the symptoms tends to last longer as well with each subsequent episode.

Post concussive syndrome (PCS) develops when the initial symptoms of the concussion are still present three months after the injury. According to some criteria, this can actually develop within weeks after the injury. The symptoms of post concussive syndrome can resolve, although it may be more than a year until they are completely gone. Persistent PCS has been associated with depression, anxiety, and dementia. The controversy begins at this point. There is no way to determine which players are going to develop PCS and more specifically which players are going to have lasting neurological and cognitive deficits.

There have been multiple studies that have tried to determine the causal relationship between the head injury and permanent damage. No study has been successful as of yet. The reason for this is that these studies had a significant number of individuals that showed cognitive deficits on neuropsychiatric testing that NEVER had a history of head trauma. The latest NFL study has similar shortcomings to this. The one common conclusion is that more scientifically valid studies are warranted. Hopefully, the Congressional Hearing will call for this and provide for funding and support.

The NFL has done a respectable job in trying to reduce the incidence and severity of head injuries. In the 1970s helmets were improved and they continue to improve. The design of each helmet is such to provide for maximum shock absorption and dissipation of force to the head. Despite these efforts, even in the most ideal situation, head injuries will persist. The league has also implemented rules to prohibit head to head contact and other head first plays that may lead to injury. Again, I think it will be impossible to completely eliminate head injuries in this a contact sport.

Professional football has become our national pastime. The passion with which we follow our favorite teams and favorite players is almost unrivaled. I don't believe that the rule modifications and equipment modifications will rob us of our affinity for this sport. I do believe that the heightened interest in head injuries will lead to a better product on the field. Many former players have testified to the horrible plight that they face in the ignored world of the retiree. For too long, the NFL has denied the possibility of the existence of permanent brain damage as a result of cumulative head injuries. To protect the quality of the sport we love and the sports heroes we love even more, this congressional hearing should be the first step in a long journey to determine the answers to the questions that have not been addressed previously.

The NFL is tremendously exciting without concussions. With more scares witnessed on a national stage such as the one we watched with Brian Westbrook, the thrillers that we long for will more and more become horrors.

By Dr. A. Brion Gardner  |  October 28, 2009; 9:38 AM ET  | Category:  Concussions , Medical , NFL , Roger Goodell Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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I totally agree with this post by Dr. Gardner. My only dissapointment has been about why the league has not been far more aggressive about implementing improved equipment for NFL players. Perhaps NFL owners beleive that the costs of such new equipment -- and the standard of safety it provides -- will be something unmatchable by high-school football programs, if not some college programs. So, perhaps the fear is that expensive new, but safer equipment will effectively destroy highschool/college football programs in regions where such safer gear is unaffordable? So safer gear is seen as ultimately detrimental to the business of the NFL, since it may cut the NFL's potential recruiting pool? Could be one of the thought's running around in the owners' boxes

Posted by: chris3 | October 28, 2009 4:26 PM

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