Football Concussions Serious But Not Always Debilitating, Says Neurologist

Taking one for the team has a far different meaning in the 21st century than it has in decades past.

In fact, the “Friday Night Lights” of high school football is considered a religion in some parts of the United States, and when that ball is kicked high, someone has to catch it and dodge 11 opposing players without suffering a serious injury or concussion.

And then, it happens.

One jarring body blow sends that ball carrier into the turf, slamming the back of his head against the field, and the lights go out.

The player might get up and walk off the field on his own, show no symptoms of injury, or he may be dazed and need to be helped off the field.

Either way, the player may have a concussion.

The narrative on concussions has been part of the national discussion for more than 10 years, resulting in terms such as CTE seeping into the American sports vernacular. CTE — chronic traumatic encephalopathy — is a progressive degenerative disease found in people who have had a severe blow or repeated blows to the head.

It can lead to any number of neurological conditions, such as memory loss, personality changes and depression.

In the most extreme cases, and usually many years later, CTE may result in symptoms that include a decline of recent memory, mood and behavioral disturbances demonstrated through depression, impulsivity, aggressiveness, anger, irritability, suicidal behavior and eventual progression to dementia.

Thus, parents fear their child could suffer irreparable brain injury, coaches and school administrators fear the potential lawsuits, and that poor student athlete fears that he or she could be throwing away an athletic dream.

While the human brain — a 3-pound organ capable of innumerable things — can suffer significant injury, it is also resilient and can heal when it receives the right treatment.

Dr. Jeffrey Kutcher, a board-certified sports neurologist specializing in sports- related concussion and neurological disorders in athletes, leads the recently opened Sports Neurology Clinic at the CORE Institute in Brighton.

The Dearborn native, a nationally recognized sports neurologist who is considered an expert in total athlete brain health, said the goal is to consider the whole patient and take a whole new approach to total brain health.

“Our mission is to get people active, playing sports, and to be able to get through their playing career…and ready to go on for the rest of their life,” he said.

Flurry of Legislation

In May 2014, a WebMD article reported the statistics on concussions had risen significantly between 2005 and 2012.

Much of that was due to increased awareness of concussions, Kutcher suggested.

“When I started doing this no one cared about the issue, now everyone seems to care,” Kutcher said.

With medical practitioners and athletes bringing greater awareness to the issue of brain health and concussions, state lawmakers also began to take notice and enact legislation.

In 2009, the state of Washington enacted the Zackery Lystedt Law, and shortly after that Oregon legislators passed Max’s Law.

Since 2013, state legislatures have taken action and enacted new laws in all 50 states that protect high school athletes who’ve suffered concussion injuries.

Most of the state laws regarding concussion injuries have three action steps such as educating coaches, parents and athletes about concussions; removing the athlete who is believed to have suffered a concussion from the field of play; and requiring the athlete to obtain permission to play or practice no less than 24 hours after being removed from play or practice.

According to the U.S. Centers for Disease Control, these laws, referred to as return-to-play laws, can vary from state to state and include different components, such as removal from play, collection of concussion histories, or mandated training.

Some return-to-play laws are vague and may not clearly define or provide specific guidance on how each of the components of the laws should be carried out, which forces those implementing the policy to make decisions that may negate successful implementation.

While programs and laws are effective tools, new equipment may also play a role in reducing the likelihood of a concussion.

Alberto Garcia, a 19-year old sophomore at Texas Tech University, is working on a patent for a combined helmet-and-shoulder-pad system with a microcontroller that helps stabilize the head after impact.

Garcia, who designed the project several year ago for his high school science fair project, caught the attention of the Defense Department and a number of national engineering organizations when it was presented at the Intel International Science and Engineering Fair.

Turn Out the Lights?

Still, some school districts have considered abandoning the gridiron, at least for a little while, for the sake of student health.

In 2014, a Michigan high school football program ended the season early after several players suffered injuries, including concussions and others left the team.

While it’s good that the issue of concussions and brain health are being openly discussed, the same attention has created a culture of hyper-awareness. In fact, Kutcher said the national conversation on concussions and brain health has been “overly simplistic.”

“People stopped thinking critically,” he said. “They just made these assumptions that playing a sport equals concussions.”

Kutcher has co-authored a book, “Back in the Game: Why Concussion Doesn’t Have to End Your Athletic Career,” with former Detroit News and USA Today sports writer Joanne Gerstner, who now teaches at the Michigan State University.

Gerstner said hyper-awareness on the issue of concussions is a double-edged sword, where some fear a single concussion can result in CTE, and others who are in denial about concussions and just want to walk off that bump on the head.

“No one was articulating this in a mainstream fashion, and that is what we’ve done,” Gerstner said. “This whole hyper-awareness has come from a place to us not doing anything 10 years ago, to now us taking kids out of sports because of concussions, or people wanting to proactively sue the school districts because they worry (school districts) aren’t doing enough … It’s really fascinating to see how this has grown so quickly, in only a decade.”

Through her association with Kutcher, Gerstner said she learned that concussions are not instantaneous and in many cases can take hours to develop.

“People present (symptoms) differently,” she said. “It’s something that is very complex…”

The complexity of the issue, and how the public views the issue as a whole, is why the book needed to be written, Gerstner said.

“There are a lot of books out there that talk about concussions being scary, and trust me, it’s a brain injury and has to be taken seriously, but most people who have concussions return to play if they are properly managed,” she said.

Kutcher agrees, and he advocates seeing athletes involved in contact or collision sports once their sports season ends and speaking with the athlete one-on-one to talk about the season, how often they played, how they are doing in school and, overall, how they are feeling.

This, Kutcher said, really helps determine how they are functioning.

“Concussions themselves are important, but it’s only the beginning,” he said. “It’s the long-term brain health I am concerned about.”

About Dr. Jeffrey Kutcher:

Dr Jeffrey Kutcher is also a team physician for the U.S. Ski and Snowboard Association, and served as the team neurologist for the United States at the 2014 Olympic Winter Games in Sochi, Russia. Kutcher serves as the director of the NBA’s concussion program and as an adviser to the NFL and NHL Players’ Associations. He helped develop the concussion policies of the NCAA, as well as several college athletic programs and conferences. Kutcher and his team of neurologists also provide direct clinical support to several intercollegiate athletic programs across the country.

Image by John Martinez Pavliga via Flickr Commons