The Boys of Fall

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This could be a bitter pill to swallow, so buckle up.

I want to shake you, I want you to think -- just give me two minutes of your time after this video. This video is going to stir up some tremendously deep and fond memories for many, some old emotions, feelings and memories of youth, yearning of days gone by -- herein lies part of the problem, we want those same things for our kids. We have made this game part of the American way, part of our families and lives --but, is it worth it ? Only you can decide, but, should it really be your decision?

When I feel that chill, smell that fresh cut grass
I'm back in my helmet, cleats, and shoulder pads
Standing in the huddle, listening to the call
Fans going crazy for the boys of fall.
They didn't let just anybody in that club
Took every ounce of heart and sweat and blood
To get to wear those game-day jerseys down the hall
The kings of the school, man, we're the boys of fall.    -Kenny Chesney

Do you like to take risks ? How about high percentage risks ?  What about high percentage risks with a part of your body that you cannot fix ? No, I am not talking about taking up juggling chainsaws or free soloing the 2500 foot shear cliff face of El Sendero Luminoso.  What if I asked you if you are willing to take on those high percentage risks, with a part of the body that one cannot fix, and put that part on your child? 

Here is the problem -- I see things.  On a weekly basis I would bet, I see people come in with actual physical problems that strongly appear to be related to a minimal traumatic brain injury weeks, months, years and sometimes decades ago. This sadly sometimes includes poor kids who clearly had a minor head injury in the past few weeks.  I see things, I see sad things, preventable things.  Mind you, not all things are preventable, we must move on through life and things happen in life that are out of our control, but we can at the very least control these higher percentage risks in our children.  However, the question that haunts me, the one I do not understand is, why are some taking on these known higher percentage risks -- with their kids.  I am not judging, I just do not understand. 

I think some of this story is about denial, a sort of cognitive dissonance. Let me share a story from Jared Diamond's book "Collapse" to explain this phenomenon a bit clearer.

"consider a narrow river valley below a high dam, such that if the dam burst, the resulting flood of water would drown people for a considerable distance downstream. When attitude pollsters ask people downstream of the dam how concerned they are about the dam's bursting, it's not surprising that fear of a dam burst is lowest far downstream, and increases among residents increasingly close to the dam. Surprisingly, though, after you get just a few miles below the dam, where fear of the dam's breaking is found to be highest, concern then falls off to zero as you approach closer to the dam! That is, the people living immediately under the dam, the ones most certain to be drowned in a dam burst, profess unconcern. That's because of psychological denial: the only way of preserving one's sanity while looking up every day at the dam is to deny the possibility that it could burst."

I believe this denial is a little of what is going on today when it comes to head injuries in our children, in a day and age where we know more, we know better, we understand the tremendous risks. This is hard stuff to take in, it somehow rattles and challenges us because it puts cracks in the foundations of our life, in our memories, in our feelings and emotions of our youth -- the same good stuff we want for our children.  Humans make excuses for the choices that serve us best. It's human nature to dodge the hard painful things that once defined us

So lets get down to some facts.

From the Nauman Purdue football study:
“The worst hit we’ve seen was almost 300 Gs,” Nauman said in reference to the G- forces of a football tackle. A soccer player “heading” a ball experiences an impact of about 20 Gs.“  So, how many Gs would 20 headers create ? How about 30 sub-maximal football tackles, in a week of game and practice? You can do the math, the numbers are there.  How large do these numbers get through a week of games and practice?  What are they over a whole season? The latest facts of the matter are that it is no longer about a single event, it is about the constantly rising odometer of impacts such as the Purdue Football Study found. And, I will show you information in a moment that reveals that it doesn't even need to be head impacts to up the odometer.

Concussions have been now shown to cause abnormalities in brain and motor functioning. These issues can last long after perceived clinical recovery. "Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion.”  This is just the tip of the iceberg. How about the more serious stuff, the seizures, inability to sleep, memory loss, difficulty thinking, dizziness, vision problems, vomiting, depression, headaches, anxiety, speech problems, coordination problems, and then what about the big one, CTE.  CTE stands for Chronic Traumatic Encephalopathy, a progressive degenerative disease that some studies suggest begins ramping up about 10 years down the road if enough cumulative trauma has occurred. The problem lies with our inability to know how much, or how little, one needs to sustain to begin this terrifying brain degenerative disease. 

Some of our current society continues to ignore the immense long lasting effects of head injuries, even minimal ones. We continue to allow young developing brains to partake in football, soccer, and other jarring sports. Yes, we cannot live in a vacuum, but we can live in awareness and wise choices.

The 2 year Purdue Study of high school football players suggested that concussions are likely caused by many hits over time and not from a single blow to the head, as previously believed. “Over the two seasons we had six concussed players, but 17 of the players showed brain changes even though they did not have concussions,” Talavage said. “The most important implication of the new findings is the suggestion that a concussion is not just the result of a single blow, but it’s really the totality of blows that took place over the season,” said Eric Nauman. “Most clinicians would say that if you don’t have any concussion symptoms you have no problems,” said Larry Leverenz, an expert in athletic training and a clinical professor of health and kinesiology. “However, we are finding that there is actually a lot of change, even when you don’t have symptoms.”

“New research into the effects of repeated head impacts on high school football players has shown changes in brain chemistry and metabolism even in players who have not been diagnosed with concussions and suggest the brain may not fully heal during the offseason.” stated Emil Venere.  “We are finding that the more hits you take the more you change your brain chemistry, the more you change your brain’s ability to move blood to the right locations,” Nauman said.

By now there are those of you reading this with heavily sweating palms. You played football or hockey, soccer or lacrosse, or had a sport-unrelated concussion, maybe several. You remember it, kind of, or the many -- sort of.   You sweat now, wondering what your future will hold for you. Will you be as statistic ? How many more years do you have before that first "apparent senior moment"?  Will everything be alright ? Is it CTE or am I just getting older? One has to wonder, and that is no way to go through life. This is the chainsaw juggling act again, do we need to take on such risks ?   Why do we knowingly welcome our children into this potentially life changing brethren?  Why must we offer them that same wonderment and worry as their years go by ? No longer can we remain in denial and lean on cognitive dissonance as acceptable reasons for our avoidance to act and protect our children.  Our answer to our children cannot be, " sorry son, we didn't know any better" -- because now, we do.

- Shawn

These head injuries are complicated cases which I cannot take on yet, I am not smart enough yet, this is too complicated a problem.  I refer these cases out to my tribe of neuro specialists from The Carrick Institute who specialize in putting these brains back together. Watch this video, my mentors, my teachers. As a parent or patient, you do have options.

Biomechanical Correlates of Symptomatic and Asymptomatic Neurophysiological Impairment in High School Football
Evan L. Breedlove, BS1,Thomas M. Talavage, PhD2,3,Meghan Robinson, BS2, Katherine E. Morigaki, MS ATC4,Umit Yoruk, BS3, Larry J. Leverenz, PhD ATC4 , Jeffrey W. Gilger, PhD5, Eric A. Nauman, PhD1,2,6

'Deviant brain metabolism' found in high school football players

Frequent soccer ball 'heading' may lead to brain injury. Albert Einstein College of Medicine of Yeshiva University