Brain Trauma: The Often-Undetectable, Life Threatening Injury
This is the second in a two-part series examining concussions and their prevalence in collegiate athletics. Today's report examines the science behind brain trauma.
In sports, brain injuries are traumatic and often life changing, and repetitive blows to the skull can have devastating long-term effects.
The norm in sports, though, for years was for an athlete to shake it off – returning to the sidelines only until he or she stopped seeing stars and felt ready to get back in the game.
Now, with intensive research being done at every level, neurologists, ophthalmologists and other specialists have shed light on a often silent but deadly problem.
Most recently, the tragic suicide of former NFL superstar linebacker Junior Seau re-opened the discussion of whether there is a link between multiple concussions and mental illness developing over time.
Dr. Julian Balies is a nationally-recognized neurosurgeon at NorthShore University Health System based in Evanston, IL. He has spent more than three decades taking care of the brain and tending to patients with brain injuries that ranged from minor to severe and life threatening.
First thing first, he said: Neurologists and surgeons no longer use the term "mild" in reference to any kind of brain damage.
"A brain injury is a brain injury no matter if you're an older adult of a kid. The brain is going to react in a standard way no matter what age you are," Bailes said.
"The difference is athletes can have repetitive head injuries. Even though they used to be considered mild or inconsequential, athletes in certain sports think, 'I'm all healed, it's OK for me to go back and hit my brain some more," he said.
The repetitive nature and exposure to more injury is a major part of the issue, Bailes said, because there could be concussions suffered that go undetected. Then, blow after blow continues and brain is forced to suffer more damage, unknown until later in the athlete's life.
In 1988, Bailes was named team physician for the Pittsburgh Steelers, where his interest in concussions and the effects of brain trauma ignited. With the Steelers for 10 years, Bailes later moved on to be a consultant to the NFL Players' Association and in 2001, set up the study or retired athletes based at the University of North Carolina Chapel Hill.
For the past three years, Bailes has also served as the medical director of Pop Warner football.
"In the last decade or so, there has been more interest in our knowledge of how (concussions) occur," he said, reiterating brain injuries can be as damaging in children as they are in adults.
"There are differences in the manifestation in the injuries," Bailes said. "Sometimes, in youth or high school football players, they manifest more in the memory or cause difficulty in school. In an NFL player, there may just be a headache because he's been conditioned that as an athlete at that level, he may play through it more."
Patients suffering one concussion and not returning to a sport with a high risk of another head injury usually get over it, where as athletes feel better and think they've healed and head back on the field to hit their heads some more.
Bailes said there are certain categories sports fall into: contact sports, such as football, ice hockey, some forms of wrestling, boxing and mixed martial arts where contact to the head is "part of ordinary play."
There are also collision sports, such as basketball, lacrosse and baseball where there is less of a chance of head-to-head contact, but an athlete still runs the risk of colliding with another player.
"Collisions are not unusual at all," Bailes said. "In fact, girls' soccer is one of the leading sports of higher and higher levels of increasing concussion."
One of the biggest problems of concussions, Bailes said, is that they can't be detected on an x-ray test yet.
"With a concussion, you don't have a hemorrhage in your brain. It's supposed to be normal," he said. "There are some new kinds of experimental MRI programming that can pick up certain cases of concussion, but it is not able to diagnose."
It can lead to some confusion, Bailes said, because a cat scan or MRI is supposed to be normal with a concussion, so a patient will just assume, "I'm OK."
In recent years, more attention has been paid to the long-term affects of concussions sustained repeatedly by NFL players. According to the New York Times, on October 28, 2009, at a hearing before House Judiciary Committee, the NFL's approach to science was "compared to that of the tobacco industry."
Research methods changed quickly after that.
Bailes said some of the work done at the Center for Retired Athletes points to the long-term damage repeated blows to the head can cause.
"We published that retired NFL players have a higher incidence of having cognitive problems and higher incidents of dementia and depression," he said.
"There's another very important study that was launched," Bailes said.
Reported by the New York Times, the NFL and University of Michigan looked at 1,000 former NFL players.
"They found that retired players who were not even 50 years old – in their 30s or 40s – had a 19 times higher risk (than a non-NFL player) of already having been diagnosed with dementia or Alzheimer's," he said.
"There is evidence that if you play football quite a few years there is a higher incidence of cognitive problems."
Despite trying to minimize the problem or avoid the subject for years, the NFL is finally embracing the research that has been done.
"There's been a lot of interaction with the NFL. The league has a committee and over the last couple years there has been more discussion about this than ever before."