Sports players with at least ten years’ experience of contact sport are experiencing an array of health consequences as a result of repetitive head impacts, a new study has found.
While they may appear healthy, research has established that athletes have problems with inflammation, energy production and coordination.
These are as a direct result of the head impacts they experience, Northwestern Medicine and Pennsylvania State University report.
The head impacts individually may not have been severe enough to cause a clinical concussion, but show the cumulative effect of repeated blows to the head over several seasons.
The issues were found in measures that show abnormal regulation of inflammation, less coordinated movement and abnormalities in how cells produce energy, and add further to existing research showing the long-term impact of head injury in sport.
These three measures are significantly related to each other before the football season and to changes observed across the football season. They were also related to the number of head impacts a player received over the season.
“These findings support over a decade of reports about the negative effects of repetitive head impacts, along with studies of animal brain injury,” said co-senior author Dr Hans Breiter, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
“At this point, it appears the canary is dead in the coal mine.”
“This problem affects much of youth and professional impact sports in the US, along with training of US military personnel,” said co-senior author Dr Semyon Slobounov, professor of neurosurgery at Penn State College of Medicine.
This study – which assessed college American Football players – used measures previously found to be increased in football players before the season began and at a level similar to what is observed in individuals needing hospital treatment for a concussion.
These measures have been associated with inflammation regulation and were increased over the course of the football season. In this study, these regulatory measures of inflammation were linked with measures of energy production and coordination.
The football players’ coordination – measured as accuracy maintaining balance, speed at correcting balance and ability to remember movements – related to measures indicative of energy production issues and inflammation regulation.
Before and during the season, the higher the regulatory measures of inflammation were, the lower the coordination measures.
The study of repetitive head impacts in sport also showed abnormalities in energy production, resulting in decreased energy. These abnormalities linked abnormal inflammation regulation with reduced coordination. They also showed relationships with measured head impacts.
“A lack of energy can have significant consequences, especially in regard to brain function, raising questions of the long-term consequences,” said co-lead author Sumra Bari, a postdoctoral fellow at the department of psychiatry and behavioral sciences at Northwestern.
To perform this study, 23 athletes from a collegiate football team were enrolled who had been playing football for an average of 11 years. The athletes participated in a full season of competitive collegiate play.
Nine of them had experienced one to two concussions in prior seasons. Blood was collected and coordination was tested both before and after the football season.
The coordination tests were designed to assess balance and to test their ability to remember a virtual pathway – collectively referred to as “coordination.”
In addition, head impacts were recorded at all practices across the season using sensors which were attached to the players’ helmets.
Future research should expand to a larger cohort of athletes to confirm the findings, scientists said.
“Ultimately, the goal is to develop preventative interventions that minimise abnormal changes in the brain that have been observed in studies of contact sport athletes time and time again,” said lead author Nicole Vike, a postdoctoral fellow at the department of psychiatry and behavioral sciences at Northwestern.
“Collectively, we need to use interdisciplinary approaches, like those used here, to better quantify the unseen damage of contact sports.”
‘See the hidden me after brain injury’
Action for Brain Injury Week highlights the struggle of survivors to adapt to the ‘invisible’ effects of brain injury
More than three quarters of brain injury survivors experience problems on a daily basis as a result of their hidden disabilities, new research has revealed.
In Action for Brain Injury Week, the reality for survivors is laid bare through new research from Headway, which reveals 76 per cent experience problems every day as a direct consequence of their brain injury being ‘invisible’.
Further findings reveal:
- More than half (55 per cent) of brain injury survivors feel they have been unfairly treated as a direct consequence of their brain injury being hidden
- Two thirds of friendships (67 per cent) and more than half (55 per cent) of relationships with a spouse/ partner have been negatively affected as a direct consequence of the brain injury being hidden
- 86 per cent of people affected by brain injury (survivors and carers) felt that a lack of understanding from society is one of the main challenges to living life with a hidden disability.
To help raise awareness of the hidden, and often misunderstood, consequences of brain injury, Headway has launched its See The Hidden Me campaign, which shows the battle that survivors and their carers, families and loved ones face to adapt to life.
One survivor, Christine Charles, was diagnosed with a brain tumour in 2014 and underwent numerous surgeries and procedures in her eight-year cancer battle that initially left her unable to walk or talk.
“I was alive and I was walking and talking. And whilst it was the end of that chapter, it’s not the end of the story because there are so many side effects,” she says.
It is now the hidden disabilities that Christine, and her wider caring network, struggle with – her memory, her agitation and the assumption that she’s now ‘well’ which she believes negates the long-term damage that’s been caused to her brain.
“Don’t expect me to be better,” she says.
“It took me a long time to realise I will never be better. That’s fine. I’m ok with that.
“But I think some people [struggle], ‘Well when will you be better? Oh, do you still need that [Headway]? But in the politest of ways, I am never going to be better.”
Christine features in this year’s See the Hidden Me campaign film alongside three other survivors John, Iona and Annette.
In the video they share the very real-life ways the hidden effects of their brain injuries, including memory loss, fatigue and difficulties concentrating, may be perceived, and explain their wish to be given a little more time, a little more understanding, and a little less judgement.
Their message: ‘Be kind. Be patient. Don’t misread the signs. See the Hidden Me’
Their sentiments are echoed by some of the 2,682 respondents to the See the Hidden Me study which reflected the emotional toll it can take on the survivor and their wider caring network.
‘People judge you as a normal person with no issues as that is how I look. They literally judge a book by its cover.” – Stephen
“When I tried to return to work folks would just see I looked fine and one even told me I’d “be fine, you look great” like that’s some kind of good thing when there’s a million symptoms kicking that no-one can see.” – Jodie
“Friends have given up on me because I can’t do all the fun stuff they do.” – Rebecca
Peter McCabe, Headway’s chief executive, said: “The results of this study demonstrate the difficult path survivors, and their carers, tread post-brain injury.
“To see the scale of the struggle endured by those with a hidden disability, not just a couple of years after injury, but decades later, makes depressing reading. The results of this survey are a call to action and should make us all more determined to do better.
“Brain injury can happen to anyone at any time, and when it does, Headway is here to help.
“We need to listen to the voices of these survivors and carers to be more patient, to listen, not to judge or undermine, and to educate ourselves about the long-term impact a brain injury can have on every bit of a person’s life.”
Concussion Legacy Foundation tackles media coverage of concussion
CLF worked with BT Sport on a world-first project in training staff in reporting on concussion
The Concussion Legacy Foundation (CLF) is continuing its commitment to changing the way head injury and concussion is viewed in sport by introducing a world-first media training initiative into the UK.
The CLF has worked with BT Sport on its Concussion Reporting Workshop PRO, a first-of-its-kind program to educate its team in how to report on concussion. The broadcaster involved its cricket, boxing, football and rugby reporting and production teams in the initiative.
The workshops, part of the CLF Media Project – the first and only concussion education program designed specifically for sports media members – were presented by CLF co-founders Dr Robert Cantu and Dr Chris Nowinski, and helped to address areas including the basics of concussion, the dos and don’ts of reporting on concussion, and the importance of concussion reporting to educate hard-to-reach coaches, parents, and athletes.
The program has been used successfully by broadcasters and journalists across the United States, and has played a key role in redefining the way concussion is reported and regarded.
Dr Nowinski has previously spoken to NR Times about the importance of challenging the traditional approach of many media outlets in ‘glorifying’ players returning to action after head injury.
Now, through its introduction into the UK, its commitment to changing attitudes, and as a result the future for players of all levels, is increasing further still.
“The UK is many years behind the US in terms of understanding and dealing with concussion in sport,” said Dr Adam J. White, executive director of CLF UK.
“It is great that an organisation as influential as BT Sport is taking this step to educate their team on the proper standards for concussion coverage and shows tremendous leadership on responsible reporting.
“Every concussion on TV is an opportunity to educate, so when a commentator highlights the importance of concussion, it reinforces to every spectator, athlete, kid, and parent why we should be taking concussions seriously.”
“Improving our understanding and research into concussion in sport is a subject that I am hugely passionate about, and whilst it is extremely important that we understand the impact in training, in the game and on our bodies, we the sports media can also play our part in ensuring that we report and describe concussion and head impacts correctly, so that our viewers understand what they are seeing on the field and the correct response,” said Ben Kay, rugby analyst for BT Sport.
“The presentation taught us how to cover the injury while still dealing in facts, something which I would encourage all sports broadcasters to invest their time in learning about.”
CLF launched the Media Project, which includes three parts: a Concussion Reporting Certification for sports media professionals, a Concussion Reporting Workshop for sports journalism students, and the Concussion Reporting Workshop PRO for sports media outlets, in 2018.
Sports media veterans J.A. Adande, Bob Costas, Andrea Kremer, and Olivia Stomski helped CLF create the curriculum for the Media Project and serve as advisors for the program.
More than 140 sports media professionals are now Concussion Reporting Certified, and the Concussion Reporting Workshop has been taught in 54 classes at 24 schools in the US and UK including St. Mary’s University Twickenham and Bournemouth University.
Can concussion clues come from the gut?
Through blood, stool and saliva samples, a new study has examined the diagnostic potential of the gut’s microbiome
Indicators of concussion could be found in the gut, giving new levels of insight into its impact and when it may be safe to return to action, new research has revealed.
By taking blood, stool and saliva samples, a new study was able to examine the diagnostic potential of the gut’s microbiome.
The research, conducted with 33 Rice University footballer players over the course of one season, found a post-concussion drop-off of two bacterial species normally found in abundance in stool samples of healthy individuals.
It also found a correlation between traumatic brain injury linked proteins in the blood and one brain injury linked bacterial species in the stool.
After a concussion, the injuries cause inflammation, sending small proteins and molecules circulating through the blood that breach the intestinal barrier and cause changes in the gut, affecting metabolism.
The Houston Methodist research said these changes in the microbiota can deliver vital clues to help safeguard the person and their recovery.
“Until your gut microbiome has returned to normal, you haven’t recovered,” said Dr Sonia Villapol, assistant professor of neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute.
“This is why studying the gut is so useful. It doesn’t lie. And that is why there is so much interest in using it for diagnostic purposes.”
While brain movement within the skull may cause injury to nerve cells, such microscopic cellular injuries are not visible on imaging tests like X-rays, CT scans and MRIs, which are more capable of finding injuries on the scale of skull fractures, brain bleeding or swelling.
As a result, the most commonly used test for diagnoses of concussions relies on self-reported symptoms like blurry vision, dizziness, nausea and headaches, which can be very vague, subjective and often underreported by athletes who want to continue playing. This can make them notoriously difficult to diagnose.
While there have been dozens of brain injury biomarkers identified, there has been limited success in developing commercial blood tests sensitive enough to detect tiny increases in biomarker concentrations, although a saliva test has been found to be effective.
However, due to the fact the central nervous system is intimately linked to the enteric nervous system, this could provide new insight, Dr Villapol said.
While only four of the players in the study were diagnosed with major concussions, the researchers say the results will need to be confirmed in a larger sample size.
They also plan to conduct a similar study soon among women in sport, who similarly have frequent head trauma.
“Women and men don’t have the same immunities or gut microbiomes, and as a woman and a mother of daughters, I would hate to be that researcher who only looks at men’s issues while overlooking women,” Dr Villapol said.
“Women soccer players have very high rates of concussions, as well, and all the same problems when it comes to existing diagnostic methods.”
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