1. Opinion

Column: Making strides in preventing damaging concussions

Steven T. DeKosky, M.D., has been named interim executive director of the Evelyn F. and William L. McKnight Brain Institute of the University of Florida
Steven T. DeKosky, M.D., has been named interim executive director of the Evelyn F. and William L. McKnight Brain Institute of the University of Florida
Published Feb. 5, 2016

Now that the huge wave of nostalgia preceding tonight's Super Bowl 50 is about to crest, it is the perfect time to reflect on how far sports have come in terms of safety and to gauge how much more needs to be done.

Specifically, I'm talking about concussions.

It's tempting to think of the national conversation on concussions as a recent development, but it's more than a century old. Each time the issue has come up, we have found ways, however imperfect, to address it — without killing the sport in question.

I understand this. I have been studying brain trauma and Alzheimer's disease for decades, and was an author on the first paper describing chronic traumatic encephalopathy, or CTE, in an American football player. That publication, which described the brain changes that had been known to occur in boxers since the 1920s, opened even more widely the discussion of concussions in football at all levels. I even was portrayed in the recent movie Concussion, although regretfully not by Tom Selleck.

The pathological changes in the brain after multiple hits in boxing, football, hockey and likely other sports not yet studied are identical to one of the changes in Alzheimer's disease: alterations in the protein tau, which helps maintain connections between nerve cells and, when altered, will lead to nerve cell death. Our research in Alzheimer's has helped us to understand CTE.

The deaths of multiple college football players in 1905 and earlier seasons (though not predominantly from head injury) led President Theodore Roosevelt to summon several college presidents and require them to reform the sport or it would be banned. In those early days, football was a brutal game with minimal equipment and far fewer protective rules than today.

However, Roosevelt favored continuing the sport because of its benefits of "the exercise of fine moral qualities, such as resolution, courage, endurance." A coalition of college coaches and school administrators changed the rules, saving the sport, leading to the development of the NCAA and, eventually, professional football.

As far back as 1928 it was known that boxers could suffer from a chronic loss of mental functions initially termed "punch drunk," subsequently termed Dementia Pugilistica, and then in the 1970s renamed chronic traumatic encephalopathy, CTE. There is a correlation between the number of rounds boxers box (not their won-loss record) and effects on their cognition.

So we have known for a long time that severe or repeated head trauma is not good for the brain, either in the short or the long term, but the long-term effects are even less understood — especially the frequency with which long-term changes that lead to CTE occur. The focus on avoiding unnecessary head trauma, whether a "subconcussive" blow or a frank concussion, has become an increasing focus of research — and of coaching — in sports in the past decade.

The combination of beautiful skills and coordinated play has advanced college and pro football to a ballet by skilled and gifted athletes, some almost impossibly fast for their size. Of course, children play football, too, and concerns over adequate coaching and proper equipment are as intense as the desire to play (or watch one's children play).

Part of the reason for increased focus on football has been the speed of collisions between superb players, even as mixed martial arts advances to increasing popularity despite rules that appear less constraining than boxing. To address the risks, both short-term (concussions) and the less understood longer-term thinking problems, rule changes (no helmet-to-helmet contact), better coaching ("head up, see what you hit") and technology (improved helmets and gear) all have been advanced.

At the University of Florida and several other universities and colleges, many players have sensors in their helmets to determine the force and direction of hits; this information is transferred wirelessly to a portable receiver on the sideline, and data can be tracked for individual players. Research such as this will enable further advances of techniques, rules and equipment. One intriguing, somewhat counterintuitive example is to have players practice without helmets, to have them concentrate on proper technique and not lead with their heads when making a tackle.

While this may be a good way to learn proper techniques — an unprotected head is a powerful incentive to learn to play while minimizing one's hits to the head — it is noteworthy that in virtually all field sports the use of helmets has expanded, for example, in boxing(!), lacrosse, hockey and other sports. Data indicate that head injuries have decreased as helmets have been added to the sport.

We will never completely eliminate the risks. (In fact, there are head trauma risks in gymnastics, rugby, lacrosse, basketball, swimming and many other sports.) However, we can minimize them. And we must have parents, players and coaches make decisions about playing sports that will extend from children entering their first year of coached sports to professional athletes.

In the movie Concussion, Eddie Marsan (who plays me as a very serious nerd) says, "I'm not interested in common sense, I am interested in science."

We will use both.

Dr. Steven T. DeKosky, a professor of neurology and executive director of the McKnight Brain Institute at the University of Florida, wrote this exclusively for the Tampa Bay Times. He was portrayed by actor Eddie Marsan in the movie "Concussion."