Posted tagged ‘football’

Some reassurance about football and your child’s brain

December 4, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Concussions and football have come up before on this blog, and the news so far has been discouraging. We want kids to stay active, and football is one of the most popular boys’ sports out there. But we know that some prominent professional athletes have had serious, cumulative brain damage from years of football – sometimes brain damage that has destroyed their lives. What about high school football, or football starting even earlier? Are we encouraging a sport that’s a cause of serious, lifelong disability?

A recent publication gives at least some reassurance. From the August 2017 issue of JAMA Neurology comes a study titled “Association of Playing High School Football with Cognition and Mental Health Later in Life.” It’s not a perfect, definitive study, but it’s got some solid long term data.

Researchers have been studying a cohort of about 10,000 Wisconsin high school graduates – students who graduated in 1957, so they’re now about 78 years old. Of those, about 2700 have complete data, including formal testing of their mental condition at age 65 and 72. Tests were done of intelligence and brain functioning using several standard assessments, as well as testing for things like depression, anxiety, and alcoholism. They also went through the high school yearbooks to figure out which of these students played football (it turned out to be about 30%. Football was, and still is, big in Wisconsin.)

When the data was analyzed, it looks like football players were no more or less likely to have problems with dementia or mental illness 60+ years later; nor were they more likely to consume too much alcohol. What was different was that they were somewhat more likely to stay physically active (which may have protected them from memory problems as they became older.)

There are some shortcomings of a study like this. We don’t know which if any of the participants played football starting younger than high school, or which positions they played, or whether they had one or more concussions. And, I think even more significantly, it’s apparent that football now is played quite differently than in 1957. Players are bigger and stronger and faster, and collisions are more high-energy. It may be that there are more brain injuries happening now on high school football fields than there were back then.

Still, 60+ years is some great long-term follow-up. It’s good to know that at least one long term study shows that football in high school isn’t associated with later cognitive or mental health problems. We still need to minimize concussion risks and identify and treat them correctly, but this study should provide some reassurance that high school football might not be so bad for high school brains.


Football helmets protect skulls. They don’t protect brains.

March 16, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

A few weeks ago, I wrote about concussions—mild brain injuries caused by trauma. There’s increasing concern that repeated concussions—that is, repeated brain injuries—aren’t good. They can lead to depression, intellectual decline, movement disorders, and other kinds of symptoms that you’d expect from someone whose brain has been injured multiple times.

One tack that athletics departments are taking is to invest in more-expensive helmets. The idea has some appeal—wrap your head in something protective, and then you can bash it into things safely. But there’s a fundamental misunderstanding here. Helmets, the best helmets, can do a really good job at protecting your child’s skull from damage. But no helmet in the world has ever been shown to provide any protection for your child’s brain.

Think about it. The helmet protects the outside of your head, the hair, the skin, the eyes the cheekbones, all of those. People wearing helmets do not get lacerations of the scalp, and they don’t fracture their skulls, because the helmet protects these body parts from damage. But the brain, that is a very different story.

Your brain floats on the inside of your skull, enveloped in fluid. It gets injured not by directly smashing into someone else’s head, or into the ground, or into a windshield. The brain doesn’t strike your steering wheel and it doesn’t get hit by a hockey puck or a boxer’s gloved fist. What strikes your brain, and what causes the damage, is the inside of your own skull.

Picture this: you’re in a speeding car. You, your head, your skull, and your brain are all traveling 60 miles an hour when you swerve off the road into a concrete pole. Very quickly, you and your head stop moving—BAM, you’ve decelerated from 60 mph to zero in just a fraction of a second. If you’re lucky, your head is protected by snapping forward not into the windshield or your steering wheel, but into a relatively-soft air bag. Air bags do a great job to protect skulls and heads. But what happens to your brain? As smart as it might be, brains follow the laws of physics, too. It was just moving at 60 mph, and the thing carrying it, the skull, just stopped. The brain then slams into the front of the skull, from the inside, at 60 mph.

There is no airbag in there to protect the brain. In a car accident, the brain just slams into the inside of the skull. And in a football injury, the same thing happens—the helmet protects the scalp and the head, sure, but the brain still slams into the skull from the inside. Unless they figure out a way to implant a little helmet inside the head, between the brain and the skull, there’s nothing in there protecting the brain.

It’s worse, by the way. The really bad concussions—the most serious brain injuries—come from the brain slamming sideways into the side of the skull, or from rotational forces that shear the cortex, the top thinking part of the brain, away from the base (think of slapping a top from the side and watching it spin. Whee! Brain!) In any scenario, the physics are the same—forces act on the skull to change its motion, and the brain slams into the skull from the inside.

Good sports equipment is still essential for athletes, and I don’t mean to minimize what a good helmet can do. I don’t want poked out eyeballs or broken jaws or caved in skulls, either. But I’d also like to see a more-honest discussion of brain injury in sports, and what we can and cannot do to prevent and mitigate the effects of these injuries. We’re not getting honest info from the helmet manufacturers, that’s for sure.

The best helmet to prevent football concussions is….

November 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Marshall wrote in: “My son has just had his 6th concussion this season in football. What’s the best helmet to use? I want to keep him safe.”

Marshall, football helmets are there to protect the scalp and the cranium—the bones outside of the brain. They prevent scalp lacerations (cuts), and probably prevent skull fractures. But helmets do not protect the actual brain. There is no helmet, and has never been a helmet, and never will be a helmet, that actually prevents brain injury from concussions.

Concussions aren’t caused by the head hitting another head, or a head hitting a wall. They occur inside the skull, when the brain slams into the inside of the cranium during a rapid deceleration. The brain is a soft, squishy, and very important organ suspended in essentially a bowl of water. If you drop that bowl off of your roof, say, the bowl might shatter on the ground (like a skull fracturing). But even if the bowl doesn’t break, the brain suspended in the water will suddenly go from moving very fast to not moving at all as it slams against the side of the bowl. That causes brain damage, and that’s what a concussion is. It’s not a broken bowl. It is a broken brain.

We diagnose a concussion if there’s been a blow to the head immediately followed by a period of altered brain functioning—dizziness, headache, foggy thinking or disrupted memory, or sometimes a loss in consciousness. Most concussion do not knock the athlete out—the immediate symptoms are more subtle. Even without unconsciousness, any concussion means that there has been brain damage. The damage is on the cellular level—you can’t see it on a CT scan or MRI, and those tests are not helpful and not needed after an ordinary concussion unless there’s a suspicion of a skull fracture or other problems.

The brain damage from a concussion will often heal, with appropriate rest and rehab; but repeated concussions or concussions with little time for recovery will lead to permanent brain damage. With more concussions Marshall’s son will develop lifelong problems with depression, fuzzy or easily-distracted thinking, movement disorders, and a genuine, marked drop in IQ. Good sleep and normal mood regulation can become impossible. These symptoms are, by and large, untreatable.

Marshall, your son will probably need his brain to work well as he grows older. If you’re serious about protecting his brain and mental abilities, he doesn’t need a new helmet. He needs to quit football.

Related posts:

Football and your child’s brain

Protecting your child from concussions


Protecting your child from concussions

November 7, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

A concussion is a brain injury resulting from a blow to the head. Not the kind of injury you can see on a CT scan or MRI—there’s no broken bones and no squashed or visibly damaged brain. But nonetheless, the brain is damaged. Symptoms tell you immediately after a concussion that the brain has been affected. Sometimes, a person is knocked out cold, but a concussion can occur without unconsciousness. Milder symptoms can include disorientation, confusion, and problems with memory and balance. With time and rest, these symptoms will usually improve, especially after a first concussion.

But sometimes concussions can cause real, lasting brain damage. After a concussion, athletes (both professional and student) can suffer from poor attention, headaches, memory problems, and depression—symptoms that may or may not get better with time. Unfortunately, young athletes may be more at-risk than the pros. Young brains are still developing, and are more likely to be injured. There’s also some genetic variability—some people are more resilient than others to the effects of concussions. Repeated concussions can be dangerous to anyone, and a “second hit” after a concussion that hasn’t completely healed can be deadly.

As I tell the teenagers: “Protect your brain. You may need to use it later.”

What can parents and coaches do to help keep their kids safe?

  • Provide good training so young athletes know how to play safely. Support coaches who teach student athletes well, and take potential brain injuries seriously.
  • Make sure that athletes have good protective equipment, including helmets and mouth guards. These don’t prevent all (or even most) concussions, but using them consistently and correctly is still important.
  • School systems should have mandatory, science-based concussion management systems, developed in accordance with national guidelines.
  • Officials and referees need to call fouls, and discontinue play when it’s dangerous. Players who put themselves or others at risk should be sent off the field without hesitation.
  • Coaches on the sidelines need to look for even subtle signs of concussion in their players, and pull them out of the game if there are any signs at all. When in doubt, players should sit out.
  • Players themselves need to know that they should never tough it out—any “dinger” needs to be reported, even if that means they’ll be pulled from the game. Brains are far more important than scores.
  • If your child does have a concussion, be sure to follow the guidance of his physician. A gradual return to sports should begin once symptoms have improved. It’s not necessary — and may be a bad idea — to wait until all signs and symptoms of concussion have resolved. If symptoms worsen with activity, back off again.
  • If your child has had more than one concussion, or a concussion with prolonged symptoms, consider working with a neurologist to ensure that there’s no lasting damage.


Updated 2/5/2017