Everyone should avoid concussions, absolutely.
We shouldn’t have defenseless receivers getting, as the phrase went, JACKED UP! At least, if offensive players are going to get…JACKED UP!…we should make rules that incentivize the defense not to aim for their heads.
Unfortunately, what the movie Concussion did, besides making “tell da truut” a catchphrase in my home, was focus everyone’s attention on concussions alone.
And while the movie does a pretty good job of explaining that the risk of playing contact sports is not just concussive collisions, the details, like so many do, got lost in the headline.
This scene emphasizes the nuance behind CTE and it seems to be a detail most have forgotten:
The man in the middle (the Center) is quite deceptively the most violent position on the field.
The slaps, the punches, the forearm…it is an unremitting storm of sub-concussive blows.
The head, as a weapon, on every single play, of every single game, of every single practice, from the time he was a little boy to a college man, culminating in a 18 year professional career…
By my calculations, Mike Webster sustained more than 70,000 blows to his head.
As a title, Concussion works well. It’s (pardon the pun) punchy, it gets to the point.
As far as one word movie titles, it’s at least an interesting word (looking at you Cars franchise).
And what may be lost to time is that “concussion” was actually a somewhat controversial word in 2015. It was like naming your movie Gasoline in 1973 (link for millenials): an otherwise boring name that takes on evocative connotations due to the culture of the moment.
The problem with this title is that “concussion” became a shorthand for the CTE issue, for the head injury issue, and for the risks of playing football in general.
The Forgotten Lineman
We spend so much time talking about, and focusing on, the BIG hits that we tend to forget about the offensive and defensive lineman.
And not just in the normal, casual fan way where you only think about them when they get called for holding or being offsides, but the more important way where their brains start producing a protein that slowly destroys them.
Every play of every practice, every play of every game, these guys are basically getting punched in the head. Yes, the have a helmet on, but that just allows them to take more head punches.
It’s not Concussion’s fault that we think this way. Humanity, or at least modern western society, has a bad habit of reducing a complex issue into an overly-simplistic catchphrases.
It’s pretty commendable that a studio put out a movie about a scientist at all.
While football is arguably safer with this knowledge, it is still not safe, and I’m mentally preparing myself for a future of the NFFL: National Flag Football League.
What The Science Says Today
Below I cite the following leaders of the medical field and their positions on the causes of CTE: Boston University, Mayo Clinic, Cleveland Clinic, Harvard, the CDC, University of San Francisco, and wikipedia’s cited study.
It appears most of these reports mention some type of hit to the head, other than concussions, as possible causes of CTE but they are all quick to point out that the research is speculative at this stage and the cause of CTE is not completely understood yet.
Boston University mentions both concussions and asymptomatic subconcussive hits:
Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma (often athletes), including symptomatic concussions as well as asymptomatic subconcussive hits to the head that do not cause symptoms. CTE has been known to affect boxers since the 1920’s (when it was initially termed punch drunk syndrome or dementia pugilistica).
Mayo Clinic does not mention any type of brain injury except concussions:
There is no treatment for CTE. But CTE may be prevented because it is associated with recurrent concussions. Individuals who have had one concussion are more likely to have another head injury. The current recommendation to prevent CTE is to reduce mild traumatic brain injuries and prevent additional injury after a concussion.
Cleveland Clinic gives near equal weight to each bullet point, from “mild hits” to TBI.:
It is possible that several types of head injuries can lead to tau accumulation in the brain, including:
- A series of mild hits that cause no symptoms
- Mild traumatic brain injuries (concussions)
- More severe damage known as a traumatic brain injury (TBI)
It is not known how many head traumas, or exactly what kinds, it takes for CTE to develop.
Harvard takes time to talk about possible genetic causes or correlations:
At this point the underlying genetics of CTE are unknown. However, not everyone with a history of repetitive brain trauma develops CTE, suggesting that there may be a genetic susceptibility in individuals who go on to develop the disease.
However, there appears to be a build up of something known as hyperphosphylated tau protein that is also observed in Alzheimer’s patients, although some researchers believe that the there is more tau protein in the deep sulci and less amyloid-beta plaques than are observed in Alzheimer’s disease.
…studies are now investigating the possible role of a genetic predisposition based on carrying the apolipoprotein E (APO E) gene, which is carried on chromosome 19 and comes in several forms, one of which is APOE4, where having the double allele is a risk factor for Alzheimer’s disease.
Forty percent of those with Alzheimer’s disease have this type of allele, and thus it may be a risk factor for CTE, although the post-mortem findings suggest that the amyloid beta plaques observed in the deceased brains of those who suffered from Alzheimer’s disease, are not reported to such an extent in the deceased brains of those confirmed cases of CTE at autopsy
The CDC only mentions “repetitive hits to the head” as a cause
Early evidence suggests that individuals may have a higher risk of developing CTE if they engage in activities that increase their chances of sustaining repetitive hits to the head.
This high level article from the University Of California San Francisco only mentions TBI and concussions but doesn’t specify what “repeated head injuries” does and does not include:
Studies have shown that CTE can result from repeated head injuries, including traumatic brain injury (TBI) or concussions from contact sports, accidents or combat. It is still unclear if a single head injury can cause CTE, and not everyone who has a concussion(s) develops CTE.
Wikipedia references this study and only mentions “mild repetitive brain trauma”:
Most documented cases have occurred in athletes with mild repetitive brain trauma (RBT) over an extended period of time. Specifically contact sports such as boxing, American football, wrestling, ice hockey, rugby, and soccer. Other potential risk factors include military personnel (repeated exposure to concussions charges or large caliber ordnance), domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown.