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'There is no concussion-proof helmet' 'There is no concussion-proof helmet'
(17 days later)
The NFL and thousands of former players have proposed a $765m deal to settle concussion-related lawsuits, in which the league was accused of hiding the dangers of brain injury while profiting from the sport's violence.The NFL and thousands of former players have proposed a $765m deal to settle concussion-related lawsuits, in which the league was accused of hiding the dangers of brain injury while profiting from the sport's violence.
The Guardian spoke with Barry D. Jordan, M.D., M.P.H. of the Burke Rehabilitation Hospital in White Plains, New York to learn more about the issues those retired NFL players are facing, what is being done to prevent those issues in todays game, and whether or not the sport of football is "safe". Dr Jordan is a board certified neurologist with specialized interests in sports neurology, Alzheimer's disease, and traumatic brain injury. He is the Chief Medical Officer of the New York State Athletic Commission and a team physician for USA Boxing, in addition to serving on the National Football League Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee, the National Collegiate Athletic Association (NCAA) Concussion Task Force and the Pop Warner Medical Advisory Committee.The Guardian spoke with Barry D. Jordan, M.D., M.P.H. of the Burke Rehabilitation Hospital in White Plains, New York to learn more about the issues those retired NFL players are facing, what is being done to prevent those issues in todays game, and whether or not the sport of football is "safe". Dr Jordan is a board certified neurologist with specialized interests in sports neurology, Alzheimer's disease, and traumatic brain injury. He is the Chief Medical Officer of the New York State Athletic Commission and a team physician for USA Boxing, in addition to serving on the National Football League Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee, the National Collegiate Athletic Association (NCAA) Concussion Task Force and the Pop Warner Medical Advisory Committee.
Describe the ailments that the retired players who sued the NFL go through.Describe the ailments that the retired players who sued the NFL go through.
In contact collision sports such as football there's a risk of having chronic neurological injury secondary to repetitive trauma to the brain, either in the form of a concussion, and perhaps even sub-concussive blows. And what I mean by sub-concussive blows are those blows to the head which may affect the brain but doesn't cause any symptoms. Whereas with a concussive blow to the head affecting the brain will cause symptoms such as confusion, headache, dizziness, amnesia, and less than 10 percent of the time, loss of consciousness.In contact collision sports such as football there's a risk of having chronic neurological injury secondary to repetitive trauma to the brain, either in the form of a concussion, and perhaps even sub-concussive blows. And what I mean by sub-concussive blows are those blows to the head which may affect the brain but doesn't cause any symptoms. Whereas with a concussive blow to the head affecting the brain will cause symptoms such as confusion, headache, dizziness, amnesia, and less than 10 percent of the time, loss of consciousness.
Concussions have been around sports for some time, why in your opinion has this topic got so much attention recently? Concussions have been around sports for some time, why in your opinion has this topic got so much attention recently?
It's gotten more attention recently because it's affecting athletes beyond boxers. This has been well described in boxers in the past since the early 1920's. Now that it's becoming recognized in football, ice hockey and even soccer, people are more interested and more concerned about it, because those sports tend to be more mainstream than boxing has been over the years, and in boxing the goal of the sport is to deliver a concussion.It's gotten more attention recently because it's affecting athletes beyond boxers. This has been well described in boxers in the past since the early 1920's. Now that it's becoming recognized in football, ice hockey and even soccer, people are more interested and more concerned about it, because those sports tend to be more mainstream than boxing has been over the years, and in boxing the goal of the sport is to deliver a concussion.
What are your thoughts on how the suicides of former NFL players such as Dave Duerson and Junior Seau have been described by the media from a scientific point of view?What are your thoughts on how the suicides of former NFL players such as Dave Duerson and Junior Seau have been described by the media from a scientific point of view?
Well it seems like the information has gotten to the media before it actually gets to the scientific journals. Sometimes that can be a problem because of over sensationalization.Well it seems like the information has gotten to the media before it actually gets to the scientific journals. Sometimes that can be a problem because of over sensationalization.
How is that?How is that?
Some of these reports come out before they reach medical journals and peer reviews documenting the accuracy of the findings even, and the science.Some of these reports come out before they reach medical journals and peer reviews documenting the accuracy of the findings even, and the science.
What it being done in today's game to help prevent concussions and the longer term ailments that could come along with them?What it being done in today's game to help prevent concussions and the longer term ailments that could come along with them?
I think one of the key issues is, as in most contact collision sports, is limiting the exposure. The increased exposure appears to be a risk factor for this chronic neurological impairment that retired athletes that play in contact collision sports are experiencing.I think one of the key issues is, as in most contact collision sports, is limiting the exposure. The increased exposure appears to be a risk factor for this chronic neurological impairment that retired athletes that play in contact collision sports are experiencing.
Has new equipment helped to improve player safety in any meaningful way?Has new equipment helped to improve player safety in any meaningful way?
Probably not, because there is no concussion proof helmets. The mechanism of a concussion is really rapid acceleration deceleration of the head and the head will accelerate or decelerate regardless if you have a helmet on or not. The helmet is helpful in protecting against more serious brain injuries such as intracranial hemorrhages and skull fractures. There is no concussion proof helmet.Probably not, because there is no concussion proof helmets. The mechanism of a concussion is really rapid acceleration deceleration of the head and the head will accelerate or decelerate regardless if you have a helmet on or not. The helmet is helpful in protecting against more serious brain injuries such as intracranial hemorrhages and skull fractures. There is no concussion proof helmet.
Is there any science forthcoming that may be able to help with that?Is there any science forthcoming that may be able to help with that?
Well people are looking into it but again, theoretically, the only way you could probably prevent a concussion is if you could stop the head from rotating which is literally impossible.Well people are looking into it but again, theoretically, the only way you could probably prevent a concussion is if you could stop the head from rotating which is literally impossible.
Is the sport of football safe? Are parents looking at all of the available information able to make an accurate judgement on whether or not to send their child out to play football?Is the sport of football safe? Are parents looking at all of the available information able to make an accurate judgement on whether or not to send their child out to play football?
I think for the most part it is safe. We don't really know what the frequency of the chronic neurological impairment is amongst these athletes, it's not extremely common but we need to get a better handle on the frequency, of the epidemiology of it. It's only when you have high exposure that you may have an increase risk, that's what the boxing studies have shown. But again, more study needs to be done, more emphasized epidemiological studies need to be done. What's happening now, most of the research that's coming out is on a referred population, they have died, and that may not be representative of the entire football community.I think for the most part it is safe. We don't really know what the frequency of the chronic neurological impairment is amongst these athletes, it's not extremely common but we need to get a better handle on the frequency, of the epidemiology of it. It's only when you have high exposure that you may have an increase risk, that's what the boxing studies have shown. But again, more study needs to be done, more emphasized epidemiological studies need to be done. What's happening now, most of the research that's coming out is on a referred population, they have died, and that may not be representative of the entire football community.
Can one big hit on a player alter their life span or their quality of life down the road? Or does the damage from hits build up over time?Can one big hit on a player alter their life span or their quality of life down the road? Or does the damage from hits build up over time?
I think it's more a build up over time and typically probably one concussion is not going to cause it but I think one bad concussion in the setting of multiple previous concussions does make a difference.I think it's more a build up over time and typically probably one concussion is not going to cause it but I think one bad concussion in the setting of multiple previous concussions does make a difference.
If prolonged exposure to hits is one of the reasons athletes develop symptoms of chronic traumatic encephalopathy (CTE) later in life, should the NFL be exploring career limits for its players? If prolonged exposure to hits is one of the reasons athletes develop symptoms of chronic traumatic encephalopathy (CTE) later in life, should the NFL be exploring career limits for its players?
I don't know. I know people have talked about, they should have a hit count, not the NFL per say, but just, like pitchers [in baseball] have a pitch count limiting the number of pitches, you have a hit count athletes can sustain over a period of time is an interesting concept. However, it would be hard to actually measure the hits. But there's new technology that's available in these football helmets where you can actually count the number of impacts to the head. And some of those studies have shown that over the course of a season a football player may have a thousand impacts.I don't know. I know people have talked about, they should have a hit count, not the NFL per say, but just, like pitchers [in baseball] have a pitch count limiting the number of pitches, you have a hit count athletes can sustain over a period of time is an interesting concept. However, it would be hard to actually measure the hits. But there's new technology that's available in these football helmets where you can actually count the number of impacts to the head. And some of those studies have shown that over the course of a season a football player may have a thousand impacts.
And that would put pressure on the medical community to come up with a magic number?And that would put pressure on the medical community to come up with a magic number?
Yeah, it would. But the problem would be that not all impacts are created equal. So, who knows whether 10 very hard impacts are the same as 100 milder impacts. You know, it's hard to say. All impacts are not created equal, and that's why no one has been able to identify what we call a "concussion threshold" - the amount of force that's necessary to cause a concussion. Some athletes that experience high impacts don't sustain a concussion where some athletes that experience smaller impacts do experience a concussion. So there's multiple variables probably involved, probably also ones susceptibility or predisposition to the effects of concussion or the effects of blows to the head.Yeah, it would. But the problem would be that not all impacts are created equal. So, who knows whether 10 very hard impacts are the same as 100 milder impacts. You know, it's hard to say. All impacts are not created equal, and that's why no one has been able to identify what we call a "concussion threshold" - the amount of force that's necessary to cause a concussion. Some athletes that experience high impacts don't sustain a concussion where some athletes that experience smaller impacts do experience a concussion. So there's multiple variables probably involved, probably also ones susceptibility or predisposition to the effects of concussion or the effects of blows to the head.
So you are saying that in the same way we are all predisposed to all types of medical issues due to our genetics, some players may hold up better under duress than others?So you are saying that in the same way we are all predisposed to all types of medical issues due to our genetics, some players may hold up better under duress than others?
I've seen athletes, in particular boxers, or two boxers that can have identical exposures, one is fine and the other can have neurological problems. And I think a study back in 1997 suggested that there may be a genetic predisposition but that still needs to be worked out more.I've seen athletes, in particular boxers, or two boxers that can have identical exposures, one is fine and the other can have neurological problems. And I think a study back in 1997 suggested that there may be a genetic predisposition but that still needs to be worked out more.
How important is it to be able to diagnose CTE while the athlete is still alive rather than during autopsies which is currently the case?How important is it to be able to diagnose CTE while the athlete is still alive rather than during autopsies which is currently the case?
That's the direction we have to head. The CTE is already diagnosed in post mortem currently, in autopsies, and we need to figure out how to diagnose it while the athlete is alive, and there are technologies being developed to try and identify the abnormal deposition of tau protein in the brain which appears to be the protein that's causing the problems in CTE.That's the direction we have to head. The CTE is already diagnosed in post mortem currently, in autopsies, and we need to figure out how to diagnose it while the athlete is alive, and there are technologies being developed to try and identify the abnormal deposition of tau protein in the brain which appears to be the protein that's causing the problems in CTE.
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