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The Cerebral Risks and Damages of Contact Sports

AP Seminar

April 2021

2190 Words
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Introduction

Sports with high physical contact are surprisingly dangerous to an alarmingly large

portion of the population. A high number of youth engage in contact sports, which means

properly knowing the dangers of these activities is highly important. Due to the global scale of

contact sports, the risks and effects of these sports can be considered a major health issue. Most

cerebral risks of contact sports are due to impacts during participation. These impacts can be

categorized into concussive and subconcussive. An impact is considered concussive when it

causes symptoms of concussion (eg, headache, nausea, fatigue, blurred vision); if no symptoms

are present, a bump, blow, or jolt to the head is a subconcussive impact. Studies have found that

the risks of subconcussive and concussive impacts are high when participating in contact sports.

They have also found that subconcussive and concussive impacts, although different, both cause

a number of negative effects on the individual.

Subconcussive Risks

With the National Center for Biotechnology Information estimating 45 million children

and adolescents participate in organized sports, the risk of subconcussive impact is high for our

nation’s youth. One study found that “athletes playing contact sports can experience hundreds of

unrecognized subconcussive impacts in a single season, through which they continue to play,

seemingly unharmed.” (McKee 1). The popularity of youth sports nationwide causes these

unrecognized subconcussive impacts to be a major health crisis, one which is worthy of

recognition. Multiple studies show the many risks related to subconcussive impacts in contact

sports. One study found participants have “changes to their brain structure and function, with

sports that have greater risk of body contact showing greater effects on the brain” (St. Michael’s
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Hospital 1). The risk of cerebral changes is major for contact sports participants. The more

contact heavy a sport is, the higher this risk. Another study showed that “Compared with control

athletes, amateur soccer players exhibited impaired performance on tests of planning (39% vs

13%; P=.001) and memory (27% vs 7%; P=.004). Among soccer players, 9 (27%) had incurred 1

soccer-related concussion and 7 (23%) had had 2 to 5 concussions during their career. The

number of concussions incurred in soccer was inversely related to the neuropsychological

performance on 6 of the neuropsychological tests.” (Matser 5). Impairment of memory and

planning functions in soccer players compared to non-contact sport athletes is a surprising risk.

Yet another study found impairment in athletes from subconcussive impacts. They took near

point of convergence (NPC) measurements and found that “NPC values were impaired beyond

baseline. The impairment was associated with cumulative subconcussive head impacts” (Zonner

2). Multiple sources show the risks of sustained subconcussive head impacts, and how these

impacts can cause major neurological impairment in the brain. Although subconcussive impacts

may be a natural occurrence, participation in contact sports causes them to happen far too often.

One study found that “college football players in the United States endure over 1000 head hits

every season.” (Smith 1). They studied the risks of these impacts, and like other studies

concluded that “these “clinically silent” hits are associated with the same type of brain damage

as concussion” (Smith 1). Due to the frequency of subconcussive impacts in contact sports,

players are at a high risk of serious brain damage. This brain damage, related to impairment from

concussions, comes in different forms and has a number of impacts on the individual.

Effect of Subconcussive Impacts on the Individual

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Subconcussive impacts cause many negative effects on the individual. With risk of

repetitive subconcussive impact being so high, it is vital to recognize how these impact athletes.

One of these effects is that athletes who play contact sports have noticeably different brain

structure than athletes who play non contact sports. The study found that “athletes in collision

and contact sports had differences in brain structure, function and chemical markers typically

associated with brain injury, compared to athletes in non-contact sports.” (St. Michael’s Hospital

3). The alarming brain injury caused by contact sports comes down to damage in the neurons

themselves. The study goes on to pinpoint the damage to “differences in the structure of the

brain's white matter -- the fibre tracts that connect different parts of the brain and allow them to

communicate with one another.” (St. Michael’s Hospital 8). Comparing the brains of contact

sports athletes with non-contact sports athletes shows surprising cerebral damage. Yet another

source points out the changes subconcussive impacts can have on the brain. They say that

“subconcussive head impacts are a substantial source of acute and chronic structural and

functional changes in the brains of contact sport athletes” (McKee 1). These structural and

functional changes in the brain caused a number of impacts on the individual athlete. The study

found “impairments on neuropsychological testing in various samples of athletes playing contact

sports, including football, soccer, and ice hockey. Growing evidence, primarily in former football

players, further suggests that repetitive exposure to subconcussive impacts can lead to long-term

neurobehavioral disturbances, including those from the neurodegenerative disease chronic

traumatic encephalopathy (CTE).”(McKee 1). The high levels of severity in the effects of

subconcussive impacts is alarming, as subconcussive impacts have the ability to produce effects

similar to chronic traumatic encephalopathy, a deadly brain condition. With multiple sources
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finding that subconcussive impacts have serious negative consequences, any jolt to the head

(even if asymptomatic) should be considered a more serious danger.

Concussion MTBI Risks

Contact sport athletes are at an extremely high risk for concussion impacts. An estimated

3.8 million concussions occur in just the United States every year (Harmon 5). These

concussions, sometimes referred to as mild traumatic brain injury (MTBI), place contact sports

athletes at risk. One study aimed at documenting the frequency of concussions looked at 1,219

MTBIs, and recorded which sport each concussion occurred in. “Of the MTBIs, football

accounted for 773 (63.4%) of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys'

soccer, 69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball, 25 (2.1%);

baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6 (0.5%)” (Powell 6). Football is

the most popular sport in the United States. With it accounting for 63% of all concussions, the

frequency of mild traumatic brain injury is a major risk to contact sports participants. Another

study uses neuropsychological assessment to determine the risks associated with multiple

concussions. This study documented 393 athletes, and found that “129 (34%) had experienced 1

previous concussion and 79 (20%) had experienced 2 or more concussions” (Collins 5). This

study shows that the risk of concussion is extremely high for contact sport athletes. They then

found that these concussions brought risks of learning disability (LD) on multiple performance

tests, and poorer psychological performance (Collins 5). They also found a strong correlation

between “LD and history of multiple concussions” (Collins 5). This same study strongly

concluded that “despite the high prevalence and potentially serious outcomes associated with

concussion, systematic research on this topic is lacking. Many sports medicine practitioners are
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not satisfied with current return-to-play and treatment options, which do not appear to be

evidence based.” (Collins 7). With concussions being linked to learning disabilities and poor

cognitive performance, concussions should certainly be regarded with more concern. Another

report finds similar cognitive risks in soccer concussions. They say “long-term exposure to ball

heading in soccer, the most popular sport in the world, confers risk for adverse cognitive

outcomes” (Hunter 4). They found that athletes who experienced concussions had “worse verbal

memory than players with low exposure to ball heading” (Hunter 2). With multiple studies

finding concussions to be a source of poor cognitive performance in athletes, contact sport

athletes are at extremely high risk for a plethora of negative effects. Another looking at young

athletes found concussions to be common in adolescents (Yeates 9). They estimated that over

“500 000 youth younger than 15 years sustain TBIs that require hospital-based medical care,

most of which are mild in severity” (Yeates 9). They conclude that “even if only a small

proportion of children with mild TBI have persistent negative outcomes, then mild TBI is a

serious public health problem” (Yeates 9). It is evident from multiple studies that mild traumatic

brain injury, or concussion, is a serious public health problem. Risk of concussion is extremely

high for contact sport athletes, causing them to experience a number negative effects.

Effect of Concussive Impacts on the Individual

Concussive impacts have many negative effects on athletes. These negative effects were

documented for adolescence in the study above. Youth who experienced a concussion showed

“reliable increases in both cognitive (eg, headache and fatigue) and somatic (eg, inattention,

forgetfulness, and slowing) symptoms” (Yeates 7, 10). These symptoms were “associated with

significant declines in health-related quality of life and an increased likelihood of educational

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intervention” and “functional impairment in their daily lives.” (Yeates 7-8). The negative effects

of concussions on youth are very severe, and can interfere with their lives. With concussions

having been established as affecting so many youth, concussions in youth sports is a serious

public health problem. Another study looked at the effect concussions have on youth as they

grew older. This study researched youth that had experienced concussion as a child, and

documented them as they developed. They found that “at age 14 to 16 years, children who had

been hospitalized for MTBI during preschool years were significantly more likely to show

symptoms of attention deficit/hyperactivity disorder (odds ratio = 4.2), conduct

disorder/oppositional defiant disorder (odds ratio = 6.2), substance abuse (odds ratio = 3.6), and

mood disorder (odds ratio = 3.1)” (McKinlay 4). These studies prove the many life-impacting

problems and conditions that can develop due to concussions, all of which affect youth. Another

study looked at how the negative effects from concussion cause an increase in suicide among

athletes. This study was at a large-scale, and took data from “10 cohort studies (n = 713 706

individuals diagnosed and 6 236 010 individuals not diagnosed with concussion), 5

cross-sectional studies (n = 4420 individuals diagnosed and 11 275 individuals not diagnosed),

and 2 case-control studies (n = 446 individuals diagnosed and 8267 individuals not diagnosedI)”

(Fralick 10). With a study of over 700,000 patients diagnosed with MTBI, the results were very

accurate, and very alarming. They found that “experiencing concussion and/or mild TBI was

associated with a 2-fold higher risk of suicide (relative risk, 2.03 [95% CI, 1.47-2.80]; I2 = 96%;

P < .001). In 2 studies that provided estimates with a median follow-up of approximately 4 years,

1664 of 333 118 individuals (0.50%) and 750 of 126 114 individuals (0.59%) diagnosed with

concussion and/or mild TBI died by suicide. Concussion was also associated with a higher risk

of suicide attempt and suicide ideation.” (Fralick 10) The cerebral damages caused by
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concussions produced a plethora of negative effects on individuals, which in turn impacted

individuals so much they had a two times higher risk of suicide. This finding is alarming and

shows the damaging impact concussions have on individuals, especially to contact sport athletes

at a high risk of repeated concussion.

Chronic Traumatic Encephalopathy

When athletes are subject to repeated concussion over the course of multiple years, they

can develop a type of brain damage called Chronic Traumatic Encephalopathy, or CTE. This

severe condition is a “degenerative disease of the brain found in people with a history of

repetitive brain trauma (often athletes), including symptomatic concussions as well as

asymptomatic subconcussive hits to the head” (Boston University’s CTE Center 1). CTE

develops after a long history of repeated concussion, which “triggers progressive degeneration of

the brain tissue” (Boston University’s CTE Center 3). This condition causes “memory loss,

confusion, impaired judgment, impulse control problems, aggression, depression, suicidality,

parkinsonism, and eventually progressive dementia” in the individual (Boston University’s CTE

Center 3). A study researching the frequency of CTE in athletes sheds light on how repeated

concussions reliably cause drastic cerebral damage. They documented 202 former football

players of various play levels. They found that “CTE was neuropathologically diagnosed in 177

players … including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%),

9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111

National Football League (99%) players” (Mez 9). This data clearly shows the dangers of contact

sport participation. As the level of play increases, so does the likeliness of CTE. This scales from
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21% in high school, to the surprising 99% in the NFL. This data is astounding, and reaffirms the

danger of repeated concussion, subconcussive impact, and overall participation in contact sports.

Conclusion

In conclusion, both concussive and subconcussive impacts cause a variety of negative

effects on the individual. These effects range from poor psychological performance to CTE to

hightened risk of suicide. Contact sport athletes are at a major risk for concussive and

subconcussive impacts, as these athletes experience them frequently throughout the season.

These impacts should be regarded with the utmost importance, as multiple studies have shown

that they can have life-altering negative effects and encumbrances. Parents should consider the

dangers of contact sports when deciding whether to let their children participate. Former

president Theodore Roosevelt voiced his concern in a similar fashion over 100 years ago, in

reference to football. In 1903, he said to his son “the very things that make it a good game make

it a rough game, and there is always the chance of your being laid up” (Roosevelt 1). All parents

should follow the former president’s lead, and take the time to consider potential risks. Knowing

the dangers of contact sports is vital, as concussive and subconcussive impacts have been proven

to cause a range of debilitating negative effects.

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Works Cited

Collins, Michael, et all. “Relationship Between Concussion and Neuropsychological

Performance in College Football Players.” JAMA, JAMA Network, 8 Sept. 1999,

jamanetwork.com/journals/jama/fullarticle/191533.

Fralick, Michael. “Association of Concussion With the Risk of Suicide.” JAMA Neurology,

JAMA Network, 1 Feb. 2019,

jamanetwork.com/journals/jamaneurology/fullarticle/2712851?resultClick=1.

Harmon, Kimberly. “American Medical Society for Sports Medicine Position Statement:

Concussion in Sport.” National Center for Biotechnology Information, U.S. National

Library of Medicine, Feb. 2013, pubmed.ncbi.nlm.nih.gov/23243113/.

Hunter, Liane. “Associations of APOE ε4 Genotype and Ball Heading With Verbal Memory in

Amateur Soccer Players.” JAMA Neurology, JAMA Network, 1 Apr. 2020,

jamanetwork.com/journals/jamaneurology/fullarticle/2758831?resultClick=1.

Matser, Erik, et all. “Neuropsychological Impairment in Amateur Soccer Players.” JAMA,

JAMA Network, 8 Sept. 1999, jamanetwork.com/journals/jama/fullarticle/191458.

McKee, Ann. “Assessing Subconcussive Head Impacts in Athletes Playing Contact Sports-The

Eyes Have It.” JAMA Ophthalmology, JAMA Network, 1 Mar. 2019,

jamanetwork.com/journals/jamaophthalmology/article-abstract/2718520?resultClick=1.

McKinlay, Audrey. “Adolescent Psychiatric Symptoms Following Preschool Childhood Mild

Traumatic Brain Injury.” LWW, Journal of Head Trauma Rehabilitation, May 2009,
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journals.lww.com/headtraumarehab/Abstract/2009/05000/Adolescent_Psychiatric_Sympt

oms_Following.8.aspx.

Mez, Jesse. “Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of

American Football.” JAMA, JAMA Network, 25 July 2017,

jamanetwork.com/journals/jama/fullarticle/2645104.

Powell, John. “Traumatic Brain Injury in High School Athletes.” JAMA, JAMA Network, 8 Sept.

1999, jamanetwork.com/journals/jama/fullarticle/191539?resultClick=1.

Roosevelt, Theodore. “Proper Place for Sports.” Bartleby, 4 Oct. 1903,

www.bartleby.com/53/29.html.

St. Michael's Hospital. "Contact in sports may lead to differences in the brains of young, healthy

athletes." ScienceDaily. ScienceDaily, 22 August 2017.

<www.sciencedaily.com/releases/2017/08/170822092215.htm>.

N.a. “What Is CTE? | Frequently Asked Questions about CTE.” Boston University’s CTE Center,

Boston University, N.d. www.bu.edu/cte/about/frequently-asked-questions/.

Yeates, Keith. “Reliable Change in Postconcussive Symptoms and Its Functional Consequences

Among Children With Mild Traumatic Brain Injury.” Archives of Pediatrics &

Adolescent Medicine, JAMA Network, 1 July 2012,

jamanetwork.com/journals/jamapediatrics/fullarticle/1149498?resultClick=1.
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Zonner, Steven. “Oculomotor Response to Cumulative Subconcussive Head Impacts in US High

School Football Players.” JAMA Ophthalmology, JAMA Network, 1 Mar. 2019,

jamanetwork.com/journals/jamaophthalmology/fullarticle/2718524.

(v. 2020-21)