Football is unquestionably a contact sport, and repeated “contacts” could be causing brain injuries.
Repeated blows to the head can cause concussion and a syndrome called chronic traumatic encephalopathy (CTE). In a recent editorial, experts called for long-term research on the subject.
This research could help identify how football players are injured and what can be done to protect them. Improving the safety of the athletes should be a top priority, the editorial authors wrote.
The editorial was written by Chad A. Asplund, MD, director of student health and sports medicine at Georgia Regents University, and Thomas M. Best, MD, professor and Pomerene chair of the Department of Family Medicine at Ohio State University.
The good news, Drs. Asplund and Best said, is that although the cases that do surface tend to receive much publicity, the overall incidence seems to be relatively low.
“Despite the seemingly easy to recognize clinical signs and symptoms of CTE, there is currently no imaging or other diagnostic test that can confirm the diagnosis of CTE in living people," Drs. Asplund and Best wrote. "While cases continue to surface and receive tremendous media attention, the fact remains that current evidence suggests the risk is very low when we consider the total number of athletes who have played American football.”
Brain damage from football is a controversial topic. Medical experts point to problems like CTE. The NFL takes the position that there is no tie between football and brain injury.
CTE can only be confirmed with an autopsy when the patient dies. The CTE Center at Boston University notes that it has long been known as a risk for boxers.
Symptoms often include memory problems, depression, poor impulse control, anger and apathy. More recent reports suggest that retired football players and other athletes also show symptoms like confusion, impaired judgment, aggression and dementia.
Repeated brain trauma can cause degeneration of the brain tissue, according to the CTE center website. These changes in the brain may not begin until years after the athlete has retired.
One of the challenges in researching this syndrome is that only 63 cases have been confirmed by autopsy in the last 60 years. However, all of the research so far suggests that CTE occurs after repeated blows to the head.
Past research found that the younger a football player started to play, the more likely he was to develop cognitive impairment as he aged.
Risk-reduction strategies — like assessing a player after a head injury — have been implemented. There is no evidence so far to tell whether these are effective, Drs. Asplund and Best said.
Other strategies include changes in helmet design. Accelerometers on players' helmets can measure the blows a player receives.
The NFL stopped using accelerometers because of questions about their reliability. However, research in high school players found that a player can sustain over 1,000 head impacts per season, Drs. Asplund and Best noted.
“The apparent low incidence of CTE makes it challenging to draw definite conclusions on the condition’s risk factors and natural course and on the tolerance of the human brain to repetitive head trauma," Drs. Asplund and Best wrote. "Improving the safety of American football with regard to head injury will take time and further research. For now, it seems that the more we learn about CTE, the more questions are left unanswered — it still remains unclear if brain damage is an inevitable consequence or an avoidable risk of American football.”
The editorial was published March 24 in The BMJ. Drs. Asplund and Best disclosed no funding sources or conflicts of interest.