Another Important Study About the Long-term Impact of Football

Monday, April 4, 2016
Another Important Study About the Long-term Impact of Football
By Peter King

(The following is an excerpt from Sports Illustrated’s Monday Morning Quarterback column posted on April 4.)

We’re getting weary, understandably, of the flood of information about the potential dangers of football, particularly at a young age, as it relates to brain maladies later in life. But I want to call your attention to a study published Thursday in the Journal of Neurotrauma that I find particularly important. A group at Boston University, led by MD/PhD candidate Philip Montenigro, studied 93 men who played youth, high school and college football but who did not play pro football. The study found that in the 93 players, the impact of cumulative head trauma led to later-life depression, cognitive impairment and apathy.

Montenigro assigned a value of cumulative head impact for each season each player played, based on the position played and number of games played per season, and totaled up the number. The higher the value, the more likely a player would be to have problems later in life. The “cumulative head impact index” was calculated through a combination of the football history reported by each player, along with the impact frequency recorded by the fairly new study of “accelerometers,” helmet sensors that have recently begun to record the number and intensity of subconcussive hits to players at different levels of football. This study focused more on the subconcussive hits (those that result in significant contact to the helmet but not a concussion-causing blow) than on concussions. Recent accelerometer studies, according to Montenigro’s research, estimated that high school players average 600 subconcussive hits to the head per season, while college players average 1,000. Then, the 93 players were polled to see about their current mental health. The more subconscussive blows, the study found, the higher the chance of a brain-related malady later in life.

That’s not a surprise, and it’s not conclusive, either; 93 players is not an exhaustive study that proves anything beyond a doubt. But it is encouraging that Montenigro and his mentor in the survey, BU’s Robert Stern, were able to quantify that players who took more blows seem more likely to have mental issues down the road.

I spoke with Stern on Saturday, and he left me with the idea that parents and coaches and even the NFL should be using this study as another brick in the wall, and a cautionary look at cumulative head trauma. “We’re learning just enough now that we’re in the toddlerhood of studying the long-term effect of subconcussive blows,” Stern said. “A good analogy is this: I used to be a Little League coach. It’s been mandated for a while now that kids can’t pitch more than a certain number of pitches per game, per week. The goal was to prevent that kid from an overuse injury, and everyone agrees that it’s a good idea to try to prevent these overuse injuries. Yet we don’t do anything about the number of times a head gets hit in football, with the most important part of your body getting jostled or taking a big blow. You drop Johnny off at youth football practice, and you don’t ever think, ‘I want to know how many times he gets hit in the head.’”

“That is absolutely what this study should be doing—getting people to start thinking about the cumulative effect of these repetitive blows to the head,” said Montenigro. “This research can’t say anything definitive, but it should give parents an idea that repeated blows at an early age, and not just concussions, should be monitored. What’s apparent is that concussions suffered did not predict cognitive impairment. But subconcussive hits did predict cognitive impairment, depression and apathy.”

Quotes of the Week

“We will be able to accurately diagnose CTE during a person’s life, perhaps in the next five to 10 years.”

—Dr. Robert Stern, professor of neurology at the Boston University School of Medicine, and the clinical core director of BU’s Alzheimer’s and CTE Center in Boston, to me on Saturday.

This is not just a Quote of the Week. It doubles as Headline of the Week.

Stern has been working diligently on this, and if he does find a way to diagnose CTE in living people, it would be one of the great breakthroughs for former athletes, ever.

“When Robert got hurt against Seattle [in the 2012 playoffs], he lost his LCL and his ACL. None of that had to do with the read-option. I think the read-option is what kept him healthy. He had faked the read-option where people were playing the run, and he was just outstanding with his play-action passes. He got better with the dropback passing game, because the secondary coverages we saw were fairly simple. And everybody said, you know, we can’t run the read-option anymore because they’ve it taken it away. The only guy that’s really run it consistently is Russell Wilson, and he’s had more success the last two years than even the first two years. Wilson doesn’t care how many yards he gets. He gets as many yards as he can, and then he falls to the ground. You will never see him get hit running the read-option, or very seldom, because he knows when to give it, when to keep it, when to slide, and that’s what quarterbacks who run the read-option have to do. He knows there is nothing more important than him staying healthy. For all these analysts that say, ‘Oh, you can’t run it because you take too many hits,’ well, that was true about Robert. Robert did take too many hits. One thing I didn’t do a very good job of is trying to emphasize to him that you can’t take a hit; you’ve got to slide, you are too valuable. He was very competitive, and he didn’t want to do that.”