The Evidence is Adding Up: All Head Impacts Have Consequences for Brain Health

Society has long thought of concussions and general head injuries as an expected hazard of playing sports. Yet, significant steps are not in place to lower instances of or treat them. Instead, players are typically left alone to deal with the consequences, which are often not discovered until symptoms have set in. 

“Even mild head injury can incur neurological damage that may have manifest effects in the intermediate and long-term,” says Dr. James Giordano, a professor of neurology and biochemistry at Georgetown University Medical Center. He explains that the initial symptoms of potential neurological damage include:

• Disorientation
• Varying levels of confusion
• Blurred vision
• Movement and balance problems
• Fatigue
• Nausea 

Giordano says that anyone experiencing these symptoms post-injury, even if they are not struggling with consciousness, should have potential damage assessed as soon as possible. 

Impact of Repeat Head Trauma

A series of recent studies further demonstrate the impact of head trauma in sports.

One preliminary study from Boston University looked at hockey players ranging from youth groups to professionals and how engaging in the sport impacts chronic traumatic encephalopathy (CTE) rates. Researchers found that each additional year of hockey-playing increased a player’s chance of developing CTE by 23%. On top of that, each year playing led to a 15% higher chance of progressing to another CTE stage. 

According to Dr. Joey Gee, a neurologist with Providence Mission Hospital, CTE symptoms include short-term memory loss, mood changes, disorientation, and difficulty thinking or making hard decisions. 

“The high prevalence of CTE in athletes, particularly professional athletes in sports where repeated impacts are routine, has led to the belief that even repeated sub-concussive impacts can contribute to cumulative damage to the brain,” adds Dr. Patric K. Stanton, a professor of cell biology and anatomy and neurology at New York Medical College. 

Another exploratory study from Brain Injury looked at blood samples of professional soccer players taken one and 12 hours after accidentally experiencing a head impact during a game, repeated balls to the head, and intensive exercise. Researchers found that medical professionals could possibly use the first two points as brain injury biomarkers.

This demonstrates a critical point: head injury can occur without a concussion. “Repeat head injuries, including ‘minor’ head injuries, otherwise known as sub-concussive head injuries, have been found to induce microstructural impacts on the brain,” says Dr. Ilan Danan, a sports neurologist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute. 

Further emphasizing this is a study around youth from Brain Communication, which looked at the brain vital signs of football players 14 years or younger in the pre and post-season. There was a link between instances of head impacts and changes in brain vital signs.

Recognizing Signs of Head Trauma

Once you’re aware of the symptoms and potential ramifications, the importance of recognizing head trauma becomes even more apparent. While individuals hold some responsibility for keeping track of injuries and signs of damage, it may be challenging to ascertain depending on the extent of their symptoms.

“This emphasizes the need for responsible individuals, coaches, teammates, and referees to step in and act proactively to remove someone from play if there is even a risk until it can be determined how severe the injury might be,” says Stanton.

In the case of casual sports, he recommends setting rules on how to respond to injuries instead of trusting the player’s call. 

Danan adds that though injuries are almost a guarantee in sports, it’s critical to recognize and address them as soon as possible. 

Necessary Policy Changes 

In line with that, policy changes can help ensure the safety of players. The Centers for Disease Control sets national guidelines at the student level, but they vary between sports. However, schools need to have policies in place to protect students. “It’s important that schools have an emergency action plan that clearly identifies and creates a process for any injury including easy access to an automated external defibrillator if needed, when to use heat acclimatization, how and when to conduct a concussion evaluation, along with a protocol for follow up medical care,” says Gee.

When these policy changes occur in sports, there can be a lower risk of head injury. “We have seen exactly that, at all levels of sport,” says Danan. From reducing the amount of time athletes engage in full-contact practice, to altering the rules on kickoff returns in football. The commitment towards injury prevention can be just as effective off the field as it is on the field.” 

Overall, players and the people surrounding them need to monitor head injuries in sports closely. As Stanton says, “This is an evolving field where regular, more sensitive cognitive monitoring and new biomarkers are needed to strengthen our ability to predict and protect athletes from long-term damage.”