At the beginning of the month, the NCAA Injury Surveillance Program published data on sports-related concussions that occurred between the 2009-2010 and 2013-2014 academic years. The data stated that approximately 6.2 percent of all injuries reported to the program were concussions, and while this percentage seems relatively low at first glance, a more recent study indicated that this particular injury may need to be taken more seriously than it has been in the past.
Led by Ann McKee, chief of neuropathology at the VA Boston Healthcare System, researchers from Boston University and the Department of Veterans Affairs recently found that 87 out of 91 former NFL players tested positive for chronic traumatic encephalopathy, a degenerative brain disease commonly known as CTE. The lab also discovered CTE in the brain tissue of 131 out of 165 subjects who had played football at any level, ranging from high school to professional.
This recent discovery expands on research conducted by the same team back in 2008, when CTE was first discovered. The disease, which is believed to develop after repetitive head trauma such as concussions, leads to health issues such as memory loss, dementia and depression, among others.
Though these studies were mainly conducted on professional football players, concussions are relatively prevalent in collegiate-level sports with lower levels of contact as well. The aforementioned NCAA ISP study found that a total of 1670 sports-related concussions were reported during the research period — 888 occurred during competition and 782 during practice.
These numbers refer to concussions of all degrees, which, according to Chad Clements, a professor in the Sargent College of Health and Rehabilitation Sciences, can occur from various kinds of direct blows.
“It doesn’t have to be, necessarily, to the head,” he said. “Any type of collision can cause it, any kind of motion where you have a jarring of the head. The brain is sitting in fluid, so the natural reaction is to bounce off the inside of the skull from the momentum that occurred from the collision.”
Clements added that concussions don’t always occur after high velocity collisions either. CTE has been found in linemen, who only collide after lining up a yard or so away from one another. Athletes of all sports, Clements said, should watch out for symptoms such as headaches, dizziness, coordination challenges, difficulty sleeping and more.
Field hockey senior back Rachel Coll, a student in the Questrom School of Business, once unknowingly sustained a concussion that resulted in her taking a two-week break from practice and sports. While the concussion wasn’t actually a result of a field hockey collision, Coll attended practice soon afterward and noticed that she felt a bit foggy and more aggressive than normal.
“At one point, we were warming up and I just got randomly very aggressive and angry at one of my teammates,” she said. “I passed one of my teammates the ball and kept running into her without any reason to do that. It was very random, and I kind of knew [about the concussion] afterward because I was getting a bad headache and there was this feeling of pressure in my head.”
In order to diagnose a concussion, it is vital for the athletic trainers who work with BU athletes to have a baseline estimate to compare the post-injury test results to. This initial testing falls under the responsibility of Athletic Training Services, a department of Student Health Services which operates separately from BU Athletics and oversees the care of varsity sports, club sports and the ROTC program on campus.
“What we do is collect baseline measures on any patient population that we believe is at risk,” said Senior Athletic Trainer Brian Vesci. “That includes contact as well as collision sports … So for anyone that we think might be at risk, we collect baseline cognitive data as well as balance data so that we have something to compare them to should they get injured.”
In addition to annual medical clearances, these baseline tests occur every two years for average athletes and annually for those who play high contact sports or have had a concussion in the past.
“When you have a concussion, two things — your balance and your memory — kind of get thrown for a loop,” said men’s hockey sophomore defenseman Brandon Hickey, a student in the College of General Studies. “Those are two baseline tests that we do. We’ll do baseline testing at the beginning of every year to make sure that everyone’s up to shape and still doing well.”
Women’s soccer junior forward Erica Kosienski, a student in Sargent College, said that the baseline testing starts with a questionnaire asking athletes to name and describe all the concussions they’ve sustained in the past. From there, the test identifies any remaining symptoms and goes through a sequence of tests that measure the athlete’s brain function.
“It goes through a series of tests, remembering different words, remembering shapes and counting backwards while also remembering a couple letters,” Kosienski said. “Your score is saved so if you ever do get hit in the head, you take that baseline test and based on how you do the second time, it helps determine if you have concussion symptoms.”
Representatives from BU Athletics and Athletic Training Services emphasized the role that this testing plays in clearing athletes after they sustain head injuries. But before the post-injury testing is conducted, athletic trainers monitor the players for the first few hours to rule out any other possible injury diagnoses. Then, they check in with the athletes every 24 hours or so from that point forward.
Bethany Ellis, senior associate athletic director of BU Athletics, also said the separation between the athletics and athletic training departments ensures the athletes’ overall health and safety and eliminates any pressure for them to return.
“Our athletic training has full authority to clear a student to return,” she said. “A coach cannot decide to do that. Again, our coaches are very mindful and receive education every year on the importance of this as well. Either way, they aren’t the ones making the decision about whether a student can return after any sort of head injury, which I think is important.”
T.J. Ryan, a sophomore in the College of Arts and Sciences and former forward/defenseman for men’s hockey, ended his playing career earlier this month due to concussion-related concerns. Ryan only played for three games last season, during which his teammate Hickey said Ryan was heavily monitored.
“Every day, he’d come in and do some testing with our trainer and they’d always be testing him,” Hickey said. “He wasn’t allowed to do any physical activity until his symptoms were completely gone. He did nothing for a week. We do a lot of concussion baseline testing too, so that helped monitor his progress as well.”
With the concussion-related studies and situations like Ryan’s in mind, BU is working to educate athletes and their families on the symptoms and seriousness of head injuries, regardless of the intensity. Ultimately, BU Athletics and Athletic Training Services hope that this encourages the athletes to speak up as soon as they suspect that they might have a concussion.
“Educating them [the athletes] and their parents primarily on the significance of concussions and the challenges that people face later on in life is the most important thing,” Clements said. “To be really honest on what their symptoms are and to never hide anything or play through it if they feel like they may have sustained a concussion.”
However, this may be a difficult goal to achieve. While he does believe that athletes are becoming increasingly aware of the dangers of not reporting a concussion, Hickey said that the overall attitude surrounding sports may hinder BU’s goals.
“Playing sports, you always have kind of this stigma around you that you’re a rough person and have to play through injuries,” he said. “So when people get hit and have a headache, they sort of shake it off because they don’t want to seem weak to their teammates. That goes with football, and it goes with hockey too. When you get injured, you don’t really say much and kind of just want to play through it to help out the team, but you could be doing damage to your body at the same time.”
While the NFL has had a history of ignoring links between its athletes sustaining concussions and developing brain disease, Head Field Hockey Coach Sally Starr said she believes professional leagues have started to take scientific studies more seriously.
“I don’t think anything was done maliciously,” she said. “But I do feel that the statistics are speaking for themselves now, and with the brain scans and modern technology, it allows for doctors and scientists to see. Leagues are now starting to take proactive measures to protect their athletes more than they had in the past.”
Vesci said that these proactive measures have been reflected at the collegiate level as well. The NCAA recently made its rules regarding injuries stricter, possibly in reaction to this CTE study and others like it.
“A number of changes have occurred in the [NCAA] sports medicine handbook that have allowed people like myself, athletic trainers, more access to patients,” Vesci said. “If we were to evaluate someone, that means they’d have to come out of the game. I think those efforts are obviously great to ensure patient safety.”
Though Vesci drew similarities between professional and collegiate sports leagues, Ellis identified a difference between the ways that the two levels operate. While making a point to emphasize her lack of experience at the professional level, she implied that with a moneymaking agenda out of the way, colleges are more concerned with the health of their athletes.
“I think from where we stand institutionally, we’re here to create a good, successful athlete experience for our teams, our student athletes and for the campus and university’s community,” she said. “We’re not trying to make money. That’s not our focus.”
Hickey took this concept to a more personal level, claiming that college athletes may take head injuries more seriously due to their young age and lack of payment.
“I think it [reactions to studies] would differ a little bit with colleges because they’re not professional athletes and they’re still coming to school,” he said. “They have a full life ahead of them and they aren’t getting paid to play the sport, so I think it’s a little bit of a different situation. Obviously, colleges would let the testing happen.”
Regardless of the leagues’ reactions to research, scientific studies similar to McKee’s have affected athletes of all levels and have drawn more attention than ever to the seriousness danger involved in ignoring concussions and related head injuries.
“I think anything involving the head needs to be taken super seriously from the beginning,” Coll said. “Just because you can’t see it doesn’t mean that there’s nothing wrong … You shouldn’t deny things like this [the statistics] that are staring you in the face and affecting someone’s actual life, not just their career.”
