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Are Football Players as “Healthy” as They Seem?

Medically reviewed by Susan Kerrigan, MD and Marianne Madsen on February 8, 2023

When an athlete cuts across the gridiron and scores the game-winning touchdown, he seems super human. Football players are iconic, capable of blazing speed and tremendous power. The most successful recover quickly from brutal collisions while following a playbook more complicated than a billionaire’s taxes. Yet a pair of recent studies on college players adds to the growing body of evidence that the sport may be responsible for hidden brain damage. It can be years, even decades, before the extent becomes apparent as to how much brain damage can shorten a player’s life while doing irreparable harm to their loved ones. So what do these studies reveal? And what do they suggest, not just for fans but for parents whose children are considering playing the sport?


The Delicate Brain


Even the most ardent aficionado of horror movies sometimes cringes or shifts attention from the screen. Certain scenes elicit discomfort. Similarly, even a passionate football fan may be unsettled once they realize what happens when a player gets tackled or even blocked with enough force. That’s because although our jello-like brain is protected by the cerebrospinal fluid, it isn’t tightly affixed inside the skull. When our bodies are hit, the organ can bounce and squish against the bone. Just as you might experience whiplash during a fender bender, the rapid movement from a tackle followed by the sudden stop when the player hits the ground sets the stage for a concussion. Of course, not every tackle results in an injury. But the scary part is how much damage is done to the brain even when there is no apparent pain or trauma


It’s called chronic traumatic encephalopathy or CTE. It’s a degenerative brain disease. For those who follow football, CTE is best known because of the billion-dollar NFL concussion settlement which compensated injured former players. That long-litigated lawsuit was initiated after numerous former players committed suicide, sometimes after killing loved ones first. Although there has been promising research using MRIs and other scans, definitive diagnosis of CTE is only possible from an autopsy. Sadly, several of the players who killed themselves did so with a gunshot to their chests –– hoping to preserve their brains for future study.


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Brachial Plexus Injury - Cause

Brachial Plexus Injury - Cause

When a player sustains a hit that results in a concussion –– no matter how mild –– a protein called tau may be dislodged from his brain. This protein can clump, disrupting the brain’s delivery of information. Over time, a player with serious CTE may have difficulty with comprehension (something that was once called “punch drunk” when it was mainly connected to concussed boxers). People with CTE may also behave more aggressively or violently than they had in the past. While it’s ironic that a game which rewards controlled violence could lead to a condition that accelerates aggressive behavior, there are two important things to remember about CTE. The first is that it’s cumulative. The second is that it can happen even if a player doesn’t show any of the standard concussion symptoms like headaches, ringing in the ears, vomiting, or temporary confusion


As Philip Bayly, an engineering professor at Washington University in Saint Louis, who studied the mechanics of brain movement told Vox in a 2019 interview, “The pain you feel [after a hit] is not necessarily an indicator of the damage that does to your head. The challenge is that nobody sees what happens to the brain when someone gets a concussion.” A pair of recent studies aimed to uncover what happens to the brain and how there may be early indicators that college football players have CTE.


Football and Failing Health


To see what happens to players’ brains, a study from Toronto, Canada’s St. Michael’s Hospital looked at blood flow in the organ’s cingulate cortex. Researchers also examined the white-matter microstructure in the corpus callosum –– the nerve fibers which form a bridge-like connection between the brain’s two hemispheres. The study looked at over 200 athletes who played not just football but soccer, volleyball, or other sports. Over 60 had suffered a recent concussion.


“We know concussions may have long-term effects on the brain that last beyond getting a doctor’s clearance to return to play,” explained study author Tom A. Schweizer, PhD. “It is unclear, however, to what extent the effects of repeated concussion can be detected among young, otherwise healthy adults. We found even though there was no difference in symptoms or the amount of recovery time, athletes with a history of concussion showed subtle and chronic changes in their brains.”


One year after the event, those who’d been concussed showed marked declines within a section of the cingulate. Their cerebral blood flow was also lower than those who hadn’t suffered a concussion at 40 milliliters (mL) per minute per 100 grams (g) of brain tissue versus 53 mL per minute per 100g of brain tissue.


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Concussion - Overview

Concussion - Overview

Yet it may not be necessary to examine a players’ brain. Another new study focused on performance. Coordinating between Northwestern Medicine, Pennsylvania State University, and other universities, some 23 college football players with over a decade of average playing experience were enrolled. Nine had suffered one or two concussions previously. They were tracked during an entire season of play with blood collected and coordination tested before the opener and after playoffs. Sensors embedded in their helmets were also utilized to monitor for any impacts to their skulls. 


Blood tests that revealed abnormalities in how their cells produce energy and regulate inflammation were validated by coordination tests. These showed that players who had suffered prior concussions and had elevated levels of inflammation performed more poorly on tests of coordination than players who hadn’t reported a concussion. These tests utilized virtual-reality-driven examinations where a computer simulation recreates a controlled environment. The VR coordination checked how well players could maintain their balance and correct it when it was disturbed. It also looked at their ability to remember movements. 


As the study’s co-senior author Dr. Hans Breiter, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine explained,“These findings support over a decade of reports about the negative effects of repetitive head impacts along with studies of animal brain injury. At this point, it appears the canary is dead in the coal mine.”


The effects of ongoing brain trauma isn’t limited to pro or college football players. It isn’t even an issue over how well concussions are “policed” on the gridiron. Both studies admit to a singular failing: they had to rely on athletes with diagnosed concussions. While there were clear differentials, the problem is that younger players who do not have a diagnosed concussion may still be at risk. A few years ago, a study concluded that when boys begin playing tackle football before their twelfth birthday, they experience cognitive, behavior, and mood symptoms an average of 13 years earlier than players who waited until they were teens. 


Ongoing research and wider understanding among parents and potential players has had a clear impact. Although the COVID-19 pandemic drastically disrupted youth sports, during the season ending in 2019 the total number of youths aged 6 to 18 playing tackle football fell by more than 620,000, from about 2.5 million to less than 1.9 million. Nothing will alter the fact that football is a compelling, exciting game. Yet it’s important for anyone considering the game to weigh the risks and rewards. 


Written by John Bankston

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