Brain Injury Panel Covers Contact Sports

Concussions happen.

They happen on football fields everywhere—in front of tens of thousands of hit-hungry fans around the country, and before dozens of nervous parents outside the local Y.

Whether concussions happen at Abel Stadium, Lambeau Field or the back yard, their effects can be glaring or perniciously hidden.

Take Blake Lawrence. The Husker Blackshirt leapt up after delivering the biggest hit of his football life. He flexed his muscles above the Kansas State ball carrier he’d just flattened. His teammates celebrated the hit by whacking his helmet’s red N.

The excitement was dizzying. So was the concussion. Lawrence lined up for the next play, unable to comprehend the defensive signals coming in from the sideline. Coaches had called for a blitz to the left. Lawrence hollered to his teammates for a blitz to the right. “Half of us went one way,” the linebacker recalled. “Half went the other.”

That’s when it became clear to Lawrence and his teammates that something was wrong. He left the 2008 game and was correctly diagnosed with a concussion.

Coach Pelini told me, "If you were my son, I wouldn't let you play football anymore."

Later in the season, after Lawrence suffered a third concussion in practice, Coach Bo Pelini called him into his office. “I figured he was going to yell at me,” Lawrence remembered. “But Coach Pelini told me, ‘If you were my son, I wouldn’t let you play football anymore.’”

Lawrence wasn’t ready to quit. He took precautions and wore a special helmet with extra protection. Those measures couldn’t stop his fourth concussion in 18 months—this one occurring again in practice with a hit no stronger, he said, than what any player might receive 10 times in a game. Lawrence knew his playing career was unceremoniously finished.

On February 24, Lawrence joined Ann Mc-Kee, a Boston University assistant professor of neurology and pathology, and Dr. Dan Tomes (’93), a Lincoln-based neurological and spinal surgeon, for a Nebraska Wesleyan University forum panel discussion on sports-related brain injuries.

What might have been in Lawrence’s future had he continued to play football? McKee could speak to one grave possibility. She is a leading researcher on chronic traumatic encephalopathy (CTE) and co-directs Boston University’s Center for the Study of Traumatic Encephalopathy. CTE is a progressive degenerative brain disease found in people who have suffered multiple blows to the head. It is most commonly found in professional athletes in contact sports such as boxing, football, hockey and wrestling.

McKee showed her Nebraska Wesleyan audience slides of normal brain tissue and compared them to slides of tissue from former professional football players who displayed CTE symptoms of erratic behavior, mood swings and dementia prior to their deaths.

The differences between the healthy and diseased brains were dramatic. CTE showed itself in clumps and squiggles of tau, “an abnormal protein that forms tangles that strangle and destroy brain cells,” McKee said. The athletes’ brains were atrophied. Small pockets near the center of normal brains became large, misshapen caverns in CTE sufferers. The impact of the slides was redolent of the 1980s public service announcement where a man holds an egg over a hot skillet. This is your brain. This is your brain on football. Any questions?

Still, McKee isn’t inherently anti-football. The lifelong Packers fan was quick to point out CTE’s unpredictability. She’s studied tissue from players who’d suffered more concussions than Lawrence that appeared normal. And she’s seen advanced cases of CTE in players who had reportedly never suffered a concussive hit. She said there is much more to learn about the disease.

But already, awareness about brain injury is changing the way we approach the game. “Walk it off and get back in there,” is no longer an acceptable response to head injuries.

Tomes described factors involved in determining an athlete’s readiness to return to play. He called preseason baseline cognitive testing “one piece of the puzzle.” Players take the test before contact begins. Retaking the test after a head injury can reveal changes in cognitive function. Tomes cautioned against overreliance on results, saying he’s seen obviously symptomatic players score well during retesting.

Make headway. Spot concussions.

Concussions don’t just happen on the gridiron. Husbands fall off ladders. Daughters wreck bikes. Wives get fender benders. Make sure your loved one gets medical attention after a concussive hit. The Centers for Disease Control say a concussion is likely if the person:

•    Appears dazed or stunned
•    Is confused about responsibilities
•    Forgets instructions
•    Moves clumsily
•    Answers questions slowly
•    Loses consciousness (even briefly)
•    Shows behavior or personality
    changes
•    Can’t recall events prior to contact
•    Can’t recall events after contact

The process Tomes described in returning athletes to play exactly mirrored Nebraska Wesleyan’s own “post-concussion exertional testing protocol.” First, student-athletes must remain asymptomatic for 24 hours. The path back to the field of play then involves advancing asymptomatically through work on a stationary bike and treadmill. Then trainers introduce push-ups and sit-ups. Then comes advanced cardiovascular training with sprints, then advanced strength training with weights, followed by sport-specific agility drills. Football players then advance to what Tomes called “dummy contact, where they’re doing the hitting and no one’s hitting them.”

Full contact practice and play resumes only when student-athletes progress through this entire chain of exercises over several days without a return of concussion symptoms.

“I am proud of our concussion management plan,” NWU Head Athletic Trainer Jason Ensrud said. That plan goes so far as to contact the student-athletes’ academic advisors (with student permission) to make them aware of diagnoses so they can watch for any impact on academic work.

Ensrud is equally proud of the culture Head Football Coach Brian Keller has instilled at NWU. “He does a great job of demanding the right form (in tackling).” Proper technique reduces the risk of concussions. That means keeping the head upright and across a ball carrier and making contact with the shoulder as opposed to the crown of the helmet. “They teach it the right way,” Ensrud said.

These emphases on sound technique and concussion awareness are strengths of the university’s football culture. For decades, broader football culture has made the problem of head injuries worse. To suffer a brain injury was to “get your bell rung” or “your clock cleaned.” To sit out was to let your teammates and coaches down. Meanwhile, to suffer mightily was lauded.

“We live in a hero society,” Tomes said. “We applaud players for two things: doing something good, and getting carried off the field.”

If football culture has been part of the problem, Lawrence and Ensrud believe it can also be a part of the solution. Players’ bonds with each other can be as protective as any gear. “It takes teammates looking out for each other,” Lawrence said. When players understand concussions and the long-term stakes, they become advocates for one another. Lawrence put it this way. “No player is going to say, ‘Sure, you’re my best friend. But go ahead and keep hitting. It’s okay if this is the last conversation we ever have.’”

Ensrud said players often see concussion symptoms in one another that coaches and trainers simply can’t detect. “Concussions can have an emotional impact. Players feel sad or just not right.” He said improved education has led to players advocating for each other’s treatment. “They’ll say, ‘Go talk to so-and-so. We know he’s not right.’ We see more reporting every year.”

Locker room education saved Lawrence from further injury, and perhaps staved a future of chronic traumatic encephalopathy. Still, a large part of him wanted to hide that fourth concussion. To keep playing, all Lawrence had to do was walk right on past the training room and keep his mouth shut about his symptoms. But he knew better. “Because I was educated, I took that step.”

Changes in the locker room are welcome. But McKee believes we must also see changes in football’s rulebook. She said reforms to the game are coming. She warned, “It’s not going to be a pleasant experience for millions of football fans.”

If those changes better protect the brains and lives of players at every level of the game, perhaps those disappointed, big-hit-hungry football fans can be asked to suck it up and walk it off.