Athletic trainer data shows that five percent of football players suffer concussions each year; surveys of athletes show that 50 percent suffer concussions each year, and yet, a 2011 Missouri state athletic association survey showed that less than 1 percent of athletes were actually diagnosed with a concussion. In a military setting, the physician may treat the concussed soldier very differently from a pilot.
These discrepancies lie at the heart of how society approaches traumatic brain injury (TBI), a longstanding health problem that technology is bringing into sharper focus, yet making for tough choices, say experts. In combat for example, said Dr. Teo Dagi, a neurosurgeon and panelist, a physician’s charge is to return the concussed soldier back to duty, but a pilot who suffers a concussion may be grounded for good – why? A soldier is expendable, a fighter jet is not. In sports, the pressure to continue the game and return the player to the field is placing even very young athletes at risk.
Tuesday, a former WWE wrestler turned concussion activist, a neurosurgeon, an engineer and a TBI advocate discussed them at The Safety Institute’s National Conversation on Injury Prevention Tuesday. The day-and-a-half conference in Chicago brought together litigators, physicians, public health officials, engineering experts, and safety advocates to share information on topics ranging from concussions to ATVs, to defects in automotive and children’s consumer products.
Keynote speaker Chris Nowinski, a retired professional wrestler, author of Head Games and founder of the Sports Legacy Institute led off the discussion with a primer on how our increasing ability to identify Chronic Traumatic Encephalopathy (CTE) is challenging a culture that teaches players to “shake it off” after taking a hit to the head, offers coaches few effective tools to make good choices on the sidelines and has developed no standards for concussion recovery.
At the same time, technology can offer solutions. Dr. Ronald Fijalkowsi of ARCCA presented videos of players’ encounters with the new curved flexible glass being installed at the end of players’ benches in U.S. and Canadian hockey rinks and with the hard corners that characterized the old design. Players who struck their heads on the 90-degree angled glass suffered loss of consciousness. The new curved design, with padding, offered a more forgiving surface that allowed a player to get up after hitting it.
But, as Noah Aleshire a policy analyst with the U.S. Centers for Disease Control noted, behavior change is a critical aspect of injury prevention, and the safer change is always the easier change. And technological advances have always given society new tools for injury prevention – even those that were unanticipated. For example, the advent of air-conditioning became a leading cause in the reduction of malaria. Once air-conditioning was installed in a home, people spent their evenings inside, enjoying the cooled air, instead of trying to catch a breeze outside. Fewer exposures to mosquitos meant fewer exposures to the disease. But, Aleshire said, behavior change is hard.
Nowinski noted that doctors first captured the deleterious effects of repeated blows to the head in Punch Drunk, a 1928 Journal of the American Medical Association article on the cognitive degeneration of boxers. In 1905, Edward Nichols, the Harvard football team doctor, advised players:
“In case any man in any game gets hurt by a hit on the head so that he does not realize what he is doing, his teammate should at once insist that time be called and that a doctor come onto the field to see what is the trouble.”
These lessons have long been lost in the pursuit of professional sports, and expanding seasons for even the youngest athletes, Nowinski said. But they are being re-learned, as the cases of dementia, radical behavior change and suicide of former and current athletes underscore the urgency of action. Nowinski, a former college footballer player and pro-wrestler, was moved to establish the Sports Legacy Institute after suffering the lingering effects of repeated blows to the head – headaches, sleep-waking and disorientation and nausea.
TBI is a more common injury mode than many realize. Philicia Deckard, of the Brain Injury Association of Illinois, noted that every 23 seconds someone sustains a brain injury in the U.S. adding up to 1.4 million traumatic brain injuries annually, and 50,00 deaths. The cost is high: at least 235,000 people are hospitalized each year with traumatic brain injuries and 80,000-90,000 Americans experience the onset of a long-term disability following traumatic brain injury each year.
In Nowinski’s case, years of head injuries went unrecognized until 2003, when Nowinski, known to WWE fans as Chris Harvard took a hit that “knocked me silly,” he recalled. “I forgot who I was and what I was doing, and more importantly, who was supposed to win the match, because wrestling is fake.”
He went back stage, and told everyone he was fine, but Nowinski was fighting a throbbing heading, and flu-like symptoms. Every day was a little worse. He developed sleep-walking, and, one night, awoke in one hotel room atop an obliterated night stand. He had apparently tried to climbs the walls and dove headfirst into one. He saw seven doctors in search of relief and, to each, he answered their questions about how many concussions he had suffered: zero.
And, then he met a doctor who changed his thinking. This doctor asked him how many times he had been hit in the head, and had he experienced dizziness and ringing in the ears.
“Oh, that happens all the time,” he said. “‘Well,’ the doctor told me, ‘those are just concussions by other names.’”
Nowinski, began embarking on his own concussion research, tracking cases in which athletes, who, he suspected, had suffered the long term effects of repeated head injuries, met violent ends – such as suicides. Their loved ones described behavior and cognitive changes in these former athletes, such as Andre Waters, the former defensive NFL linebacker who shot himself to death in 2006. Nowinski eventually teamed with doctors and researchers at Boston University School of Medicine, to establish the Center for the Study of Traumatic Encephalopathy in 2008. The center operates a brain bank of tissue samples of former athletes, to study the physical hallmarks of CTE.
But, Nowinski told the crowd, much more could be done to prevent future athletes from leaving a legacy of diseased brain tissue. Better protocols must be developed to sideline players who are hit. He gave the example of baseball, where the number of pitches each pitcher throws a day is strictly monitored to prevent over use. Little League, for example requires a mandatory two-day rest for pitchers ages 7-8, when they throw the 50-pitch limit in a day. There are no such rules for football players who suffer a head blow.
“So, you have limits for the elbow,” Nowinski said. “But not the head.”