Cobbers on the Brain

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Ask yourself for a moment, is tackle football really something the youth should be involved in? I know I probably sound like an old geezer tweeting vigorously about “the younger generation” when I say that, but seriously think about it for a moment. People talk about how the brain doesn’t stop developing until roughly the age of 25. Concussions are bad at any point in ones life, but before 25 when rapid cognitive development is occurring, large concussive impacts along with that development seem to be a recipe for disaster. Sure tackle football can teach great life lessons and foster lifelong relationships, but it can also leave those that play it in an altered mental state for the remainder of their lives. Ok, watch the video directly below and then we’ll talk again on the other side.

Video 1

So… did your opinion change? What is an age that you would feel comfortable allowing your own children to start tackle football, if at all?

Is flag football a safer alternative?

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Lets take a moment to look at some statistics before you judge flag football too harshly. Tackle football players age 6-14 sustained 15 times more head impacts than their flag football counterparts. Head impacts that were considered to be “hard hitting” occurred 25 times more frequently in tackle football than flag football. Essentially, in tackle football head impacts occurred far more frequently and with far greater force. These factors create more opportunity for concussions to occur in tackle football than in flag football. This inherently makes sense, it is the nature of flag football to mitigate collisions.

Ok, lets continue looking into the differences. Flag football players have a median of 8 head impacts per season while tackle football players experience a staggering 378 head impacts per season. These numbers alone should worry any parent who has a child involved in tackle football, think about that number for a second and consider the last time that you had a head impact let alone 378. I like football a lot, my brother and entire family played it, but I would be hesitant to put my future children in harms way. Even if the 378 head impacts are minor they can still compile on one another to create issues. My brother was a lineman in football, he would usually experience relatively few large hits but he would be hit nearly every play on the line for an entire game. The small hits he took throughout the game were so great in number that he sometimes had concussive like symptoms even though he never took a “big hit.” Look at the hit he delivers to the opponent in this play alone, this is not an anomaly is football, rather it is the norm. For reference he’s the big guy in blue in the middle that levels the orange player. Yes he delivered the hit in this situation to parts of the body other than the head, but there were plenty of times that the hits were in the direction of his head.

Video 2; via me

Youth football players can be as young as 5 years old. Think about that, if these same players get to play college ball they have played 13 years of football already. That means they’ve had 13 years to potentially suffer concussions. If they start at, oh lets say 10, then they have 8 years where they are compiling head impacts. Sure, kids will be kids and they will most likely receive injuries regardless of what we do to protect them, but allowing them to play tackle football is exacerbating the amount of those potential injuries.

The amount of head-to-head contact is directly responsible for the rates of concussions within youth athletes, eliminating that impact would alleviate the risk for concussions. As players get older they exert more force on one another and the subsequent rates of a concussion occurring increases. Because they exert more force on one another upon impact they are able to hurt one another in all new ways, not just via direct head-to-head impact. For example a player gets hit so hard that his head “whiplashes” and he gets a concussion. It is not longer the direct head contact that causes the injury but the force itself. The implementation of flag football as an alternative to highschool JV and Varsity football would help to alleviate the impacts on players brains. Sure, tackle football might be more fun to watch then flag football, that is all subjective and a personal opinion. However, one must ask the following; is risking player safety worth it when there seems to be an alternative. When players have a helmet on they feel invincible, the male football players in my school were completely indifferent to what they were doing to their bodies, in particular their brain. If tackle football removed equipment and still had contact it would essentially be rugby, which also has staggering rates of concussion due to high impact on the head. The implementation of flags allows for the alleviation of detrimental contact while still allowing for the beneficial nature of football (i.e. the life lessons, teamwork, and friendships that a sport creates). 

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Historically speaking, money is football and football is contact. College football makes 4 billion dollars a year on only 65 of its teams, even more if you include the other hundreds of colleges involved in the many leagues. In the NFL, one franchise alone is worth 3.5 billion dollars on average. Tackle football certainly sells, and I’m actually not proposing we stop any of it. In fact I sit down every Sunday to watch the Vikings lose in spectacular fashion while simultaneously wishing I hadn’t. What I am proposing is that perhaps there needs to be some form of intervention that protects players before they join college teams. Players should be able to grasp and understand the negative side of football before their heads are at risk and they lose the capacity to do so. Eliminating years of potential concussion can benefit those that move on to future contact football, allowing them to start at an older age with a cleaner cognitive slate.

“Comparing Head Impacts in Youth Tackle and Flag Football.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, May 19, 2021. https://www.cdc.gov/traumaticbraininjury/pubs/youth_football_head_impacts.html.

Figure 1: A mapping of general symptoms associated with concussions.

What is a concussion?

Put simply, a concussion is the result of a mild traumatic brain injury (mTBI). This is common when the brain bounces off of the inside of the skull because of a great force that is applied to the head in a short amount of time. Common examples come from collisions in sports like football and hockey as well as head injuries resulting from falling or car crashes. The cellular mechanics of these events are pictured below in Figure 2.

Figure 2: A map of what happens on a cellular level when the brain experiences a TBI.

To explain what is happening in Figure 2, it makes to try to follow a chronological timeline after injury. First, because of the injury, holes in the plasma membrane are going to develop. This leads to an ion flux because the axon is no longer to maintain an ion gradient between the inside and outside of the cell. Because of this, an energy crisis is going to occur for 2 main reasons: ion pumps and mitochondria dysfunction. Ion pumps are going to be overworked trying to maintain an ion gradient (which will be nearly impossible because of the holes in the plasma membrane due to the injury), which is important because these are ATP activated channels. So, a lot of energy is going to be used attempting this process. To further propagate this energy crisis, the cell becomes overwhelmed by calcium ions, which it will then deposit in the mitochondria for storage. If there is too much of this calcium deposition, the mitochondria will stop working. This effectively shuts down ATP production by the mitochondria. Instead, the cell must now use glycolysis to produce ATP, which is much less efficient. Overall these events lead to a stressed out cell.

Figure 3: Logo from the ImPACT testing website.

The importance of knowing recovery time

With neural damage as serious as mentioned above, it is very important for people to know when they have a concussion. Subsequent injury during a healing period from an initial mTBI can cause very serious brain damage and an associated longer recovery time. So what is there to test if someone has a concussion? Well one method is ImPACT testing. ImPACT testing is a way to test spatial memory and cognitive speed through a series of tests. It works because the user takes an initial baseline test when they aren’t experiencing a brain injury and then are tested against that baseline when there is a suspected brain injury. However, this method is subject to flawed results as the user could purposefully “tank” their first score so that they pass when they are experiencing a brain injury. The test itself is also subject to flaws. A user taking the test back to back might experience a very different score because of the nature of the test and the time component associate with it.

Figure 4: Picture of an MRI commonly used in fMRI and BOLD signaling analysis.

What to use instead?

Because of the flaws of the ImPACT test, I propose focusing on an emerging practice of using functional nuclear magnetic resonance imaging (fMRI) to analyze blood-oxygen level dependent (BOLD) signaling in the brain. BOLD signaling analysis works because deoxyhemoglobin (deoxygenated blood) is paramagnetic, causing it to appear on fMRI scans. So, these BOLD signaling studies can show where deoxyhemoglobin is present in the brain, which can be reasonably associated with oxyhemoglobin (oxygenated blood) and its deposition of oxygen in certain regions of the brain. Areas of the brain undergoing rapid repair (such as those that have experienced a mTBI) will need this oxygen. So, by using BOLD signal studies, we could determine a general recovery time associated with a certain level of mTBI experienced. This method is still in development because the association between deoxyhemoglobin and oxyhemoglobin isn’t as simple as I described above and this method is quite expensive.

The future of concussion recovery

By showing the severity of concussions to brain health, it is clear that more needs to be known about how concussion recovery occurs. Having a simply way to measure the pace of recovery, such as using ImPACT testing or fMRI BOLD signal studies, would greatly help. Perhaps there are other methods being developed like fMRI BOLD signal studies that give a more molecularly detailed description of recovery.

Figure 5: Artstract by Trenton Vogt. This figure depicts (very rudimentarily) how spatial memory can be impacted by a concussion.

Often when an individual experiences some sort of head trauma and receives a concussion from it they are told not to sleep. However, is this a true thing that we should not do? This idea of not sleeping after a concussion is a myth. In specific occasions this is important though. During a severe concussion that results in medical attention a medical care provider may want you to stay awake so that they can monitor symptoms that may occur after the fact. Symptoms that are not able to be monitored during sleep include dilated pupils to even slipping into a coma and/or death.

What are some symptoms an individual may experience after a concussion?

Individuals who experienced a concussion may have difficulty falling asleep or staying asleep. This results in altered sleep patterns during recovery. Prolonged and/or persistent sleep disturbances can affect the quality of life and result in other symptoms like depression, anxiety, and apathy.

Individuals with a concussion who have indicated difficulty falling asleep or staying asleep take 3-4 times longer to recover from the concussion vs. those who don’t experience these issues falling asleep. This could be a result of the brain not having adequate time to heal while the individual is asleep.

What are the benefits of sleeping after a concussion?

Sleep is beneficial after a concussion (given the individual is not experiencing symptoms that require medical attention). Proper sleep during recovery heals and resorts electrochemical balances in the brain. So, what exactly is it healing?

A team of Switzerland researchers found that restless deep sleep resulted in a visibly reduced learning efficiency. When an individual is awake synapses in the brain facilitate the passing of electrical impulse from one neuron to another. But during sleep, the activity of these synapses goes back to normal. Without this restorative period, they stay excited at their peak activity for too long. This interferes with the brain’s neuroplasticity. Neuroplasticity enables the brain to learn new skills, change and adapt to its environment stimuli, and ultimately learn new things.

Sleep can also alleviate the severity of symptoms like headaches and improves neurocognitive processes. After seeing that sleep aids in neuroplasticity, it makes sense to think that while sleeping different neurotransmitters are moving around the brain working and healing damaged areas that need to be fixed.

Is there a treatment that aids in sleep disturbance?

A treatment that has been shown to help with this is melatonin.
Individuals who experience sleep disturbances experienced greater help falling asleep and staying asleep with the use of melatonin. An individual with a concussion related to non-sport related concussion is more likely to have sleep disturbances compared to individuals with a sport-related concussion. This comes from the idea that a sport-related concussion is more severe and that there may be other factors such as post-traumatic stress.
Sleep is important for recovery of a concussion, but an individual may experience disturbances related to falling asleep and/or staying asleep. Therefore, quality of life regarding mental health is just as important to monitor during recovery time.