Brain Game: Using Data To Prevent Concussions in Athletes
There was a time in the early to mid-2000s where ESPN, the worldwide leader in sports, hosted a weekly segment on its Sunday NFL Countdown program under the title ‘Jacked Up!’. The premise for ‘Jacked Up!’ was fairly simple: compile the week’s biggest bone-crushing hits from around the NFL and count them down until reaching the best hit of the week. The talking heads would give a play-by-play of these vicious, jump-out-of-your-TV hits and culminate the clips with a collective cry of “You got jacked up!” before moving on to the next play.
The segment quickly became one of the more must-see clips on the four-letter network, serving both as a way to highlight the defensive aspect of the game and to advertise the intensity in which the game is played.Fast forward to today’s NFL landscape — where you’ll find no such segments on ESPN, or any major sports network, for that matter — and the collective perspective on the very same spine-tingling hits has done a complete turnaround. The Center for Disease Control and Prevention (CDC) identified concussions as a “silent epidemic” and a major public health concern. The heightened awareness of the negative health implications behind concussions has had an inevitable trickle-down effect to the collegiate, amateur, varsity, and youth athletics across the country.
With more awareness comes more testing, recognizing early symptoms, and deployment of preventative measures across all levels of sports. And the numbers bear this out.
In a November 2019 study published in the journal Pediatrics, which looked at 9,542 concussions across 20 high school sports from the 2013-14 school year through 2017-18, the rate of concussions increased during football games from 33.19 to 39.07 per 10,000 athletic exposures (AE). [Athletic exposure is defined as one practice or competition per athlete.] But on an overall basis across the sports landscape, the other notable takeaway from the study was the decrease in recurrent concussions of all student-athletes during the study, dropping from 0.47 to 0.28 per 10,000 AE.
The reason for the dip in recurring concussions? Avinash Chandran, the co-author of the study and a brain injury researcher from the University of North Carolina at Chapel Hill, said, in his opinion, it’s partially related to the heightened awareness.
“This may at least be partially attributable to policies such as the mandatory removal from play following concussions, and strict requirements associated with mandated return-to-play policies,” Chandran said in a story published in Reuters.com.
While football continues to top the charts, in terms of both in-game and practice concussions suffered, it’s far from the only sport where concussions can be an issue. Data from the National High School Sports-Related Injury Surveillance Study (HS RIO) showed that after football’s 10.4 concussions per 10,000 AE, it was girls’ soccer that was the next sport with the highest concussion rate with 8.19 per 10,000 AE. Boys’ ice hockey was the third-highest concussion rate with 7.69 per 10,000 AE.
Football posted a concussion rate of 5.01 per 10,000 during practices with cheerleading surprisingly showing up second with a rate of 3.6, followed by boys’ wrestling’s rate of 3.12.
A growing awareness of concussion risks has prompted more evaluations of athletes on the sidelines as soon as a head injury is suspected, and it has also led many schools to develop protocols to ensure injured students don’t return to sports or academics too soon.
Putting the Numbers To Work
With all this data being recorded that is publicly available for consumption, how do coaches, administrators, and athletic trainers put this to use? That’s precisely the question the University of Michigan is hoping to answer with its newly opened concussion center.
For the last two years, the Michigan Concussion Center has been devoted to maximizing societal and individual health through the relentless pursuit of concussion knowledge. Its staff have focused on neck-strengthening as a preventative strategy and technology that could eventually diagnose concussions in real-time.
Dr. JT Eckner, Michigan Concussion Center’s associate director of research, has spearheaded the preventative strategy — and the results showed that neck strength can reduce head acceleration following impact, suggesting that neck strengthening exercises may be a good strategy for concussion prevention in football players.
“We have seen that our research participants with stronger necks experience smaller head acceleration responses, so we think that if an athlete does exercise to strengthen their neck it should reduce their concussion risk,” Eckner said in an issued press release from Michigan.
The next step is to conduct a larger-scale study involving male and female high school soccer players to better understand how neck strengthening exercises affect an athlete’s risk for concussions.
Forward-thinking is what drives the Michigan Concussion Center. It’s what pushed Dr. Steve Brogiio, Ph.D., professor at the School of Kinesiology at Michigan and the concussion center’s director, to the discovery of blood-based biomarkers of concussions from metabolic profiling of plasma.
What does that mean exactly? Well, while an estimate of 1.8 to 3.6 million people suffer concussions, there are no firm diagnostic tools to evaluate the injury. The current standard for evaluating concussions relies on individual interpretation of clinical examinations, which are subjective in nature. And there are no objective tools for predicting how long it will take for predicting the recovery rate of an athlete.
“There’s no gold standard [diagnosing concussions],” Broglio said. “There’s nothing like an X-Ray where we can see the crack in the bone,”
To solve this gap in healthcare the Michigan Concussion Center developed a device, called functional near-infrared spectroscopy (fNIRS) composed of optical fibers that deliver an infrared light to the forehead in order to measure brain metabolites associated with head injuries. This technology is the first step in the development of a test that may be able to diagnose concussions, instead of relying on a clinical examination and interpretation by a medical provider.
“This is probably still 10-plus years away, on the early side, before public consumption,” Broglio said. “But eventually we hope to be able to use this on the sidelines or in the locker room at halftime that gives us a definitive yes or no.”
In the meantime, Broglio, a former athletic trainer, said it’s important to know your student-athletes — their personalities both on and off the field, their speech cadence, and overall demeanor — in detecting early signs of a concussion.
“The player that’s lying motionless on the ground is easy to detect. But half of the concussions you deal with are ambiguous. Knowing how [the student-athletes] act is the trigger of the full evaluation process.”
He also pointed to sources like Virginia Tech’s five-star helmet rating system that provides unbiased helmet ratings that allow consumers to make informed decisions when purchasing helmets. And it’s not just for football helmets, as they rate helmets ranging from hockey to soccer to bicycle helmets and other sports safety products.
But all of this is fruitless unless leadership buys into the seriousness of concussions and the after-effects. Coaches and administrators must create a culture where taking preventative measures to avoid concussions is a priority and communicate to their teams to look out for one another.
“I think the coach’s attitude is the number predictor of concussions in student-athletes,” Broglio said. “If a coach doesn’t believe in concussions or thinks those who report them are wimps, that’s going to shift how the student-athlete is going to approach the situation.”