Concussions, CTE, & Football – This Will Make You Rethink Its Safety
I get this question quite often being a Chiropractor and a lover of all things spine and brain related…
“Dr. Kelly, are you going to let your kids play football?”
Ahh, my double edged sword…I was a running back and defensive back in my high school days. I’ll have to show you some film. To say I love football and all the things it taught be is an understatement.
Football taught me valuable life lessons that are not taught in traditional education and kept me out of trouble; at least for the most part. During the season & offseason there were tons of workouts, weightlifting, fellowship, and comradery. I learned how to work with others and challenge myself far beyond my own expectations. All of which built the foundation for my career as a Chiropractor and how to set examples for my children.
There were also the coaches. These individuals can have a tremendous impact on and off the field throughout the entirety of an athlete’s life. I can still call on these coaches at any moment for guidance in life. They are some of the best people I have ever known.
Then there’s the not so glorious part of the game…the violence.
It has been well documented the traumatic effects on the brain sustained by brute force of a concussion. We see it when a player collides helmet to helmet with another player as they stumble off the field and get evaluated by athletic trainers. The concussion may also follow them into the classroom for several days, if not weeks.
The more concerning part is the repetitive sub-concussive forces a football player experiences multiple times per game or practice. These are when two linemen are on opposite sides of the ball. One of which is trying desperately to protect his quarterback. The other is looking to pick up their next sack.
These are the hits that cause a degenerative brain disease called chronic traumatic encephalopathy or CTE. This condition sparked the movie Concussion and the NFL to change policies. It also has youth parents deeply concerned about their children playing football. Signs of CTE include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and, eventually, progressive dementia.
There are other valid reasons for parents to be concerned:
- Young children are skeletally immature
- Muscular strength isn’t sufficient for some football impacts
- Ligamentous structure isn’t sufficient for some football impacts
- Neurological tissue is still developing
- Children’s vertebra are incompletely ossified
- Children have a different fulcrum of rotation in their neck due to a large head
- Older children can take longer to recover from traumatic blows to the head
- Sub-concussive hits can cause permanent brain damage
As children grow, they become bigger, faster, and stronger.
The hits in football also develop more velocity and potential energy which may lead to a higher incidence of injury. This is the difference between a peewee league hit and an NFL league hit. The longer an athlete plays competitive football, the more prevalent CTE seems to become.
When the muscular system isn’t sufficiently stabilizing joints (muscle sprains), more stress gets put onto the ligamentous system (spinal ligaments, torn ACL). If the ligaments fails, the neurological (brain and nerves) system may sustain injury. Muscles sprains may be healed in days to weeks. Most ligamentous strains can be healed in weeks to months. Neurological damage can take weeks, months, or years to heal depending on severity. They may also cause permanent damage.
Bottom line: If your child looks like a bobble head trying to keep their helmet upright, their neck likely isn’t strong enough to safely absorb football hits. If your child plays football, there will likely be damage done to their nervous system. To the extent that it manifests clinically is anyone’s guess.
We must also consider the structure & mechanics of the neck during an impact.
More and more frequently I see school aged children with an alarming amount of structural damage to the neck area. These children come in with a reversed neck curve which compromises the structural integrity of their cervical spine. This would be as if the Golden Gate Bridge loosened its supporting cables or if the Hoover Dam was reverse engineered.
The younger the age, the more flexible their spine is. Hence neural damage occurs in children much earlier than musculoskeletal injury. This is because the fulcrum of cervical mobility moves progressively downward with the child’s increasing chronological age. The upper neck area is a complex web of nerves, receptors, blood vessels, muscles, and ligaments. It is also the “weak spot” of the neck due to its high degree of mobility.
Fulcrum of mobility in the neck:
- < 8 years: C1 and C3
- 8-12 years: C3-C5
- >12 years: C5 and C6
Structural integrity of the neck helps to absorb impact to mitigate damage to the brain.
Remember, your body’s main goal is to protect the brain and spinal cord. This why the brain and spinal cord are completely surrounded and encased in your body’s hardest substance, calcium and phosphorus or otherwise known as bone.
The first line of defense of an impending impact is the anticipatory muscle clenching. This is a contraction of the abdominal muscles before someone punches you in the gut or trying to dodge that soccer ball flying at your head. This happens through the sensory system. One critical sensory concept is proprioception.
This is your body’s ability to sense where your hand or leg is without seeing it, hearing it, smelling it, or touching it. Place your finger behind your back…you can’t see it, smell it, hear it, or touch it but your body knows it’s there. This is why Barry Sanders effortlessly twists and contorts his body in unimaginable ways to avoid tacklers, absorb hits, and stays up without injury.
This system is arguably one of the most important systems to reduce potential injury. It is often under trained in today’s athlete. Today’s training focuses on bigger, faster, stronger, and not so much on stability or structural integrity. This is completely backwards and fosters an environment rampant for injury.
The proprioception system can be trained through intense balance exercises and bombarding the sensory system with information causing the athlete to develop extreme focus. Also, it can also be enhanced by limiting visual cues through stroboscopic therapy.
Common and Uncommon Signs & Symptoms of Upper Neck Injury Include:
- neck pain
- mid back pain
- asymmetric posture
- tilted head
- using one posture for sleeping
- asymmetries of movement patterns
- swelling of the face/head
- asymmetries of the gluteal muscles
- asymmetric development and range of movement of the hips
- deformities of the feet
Here is my professional advice for kids playing football:
- Limit tacking until at least the age of 12 if not 14
- Flag football, skeletal maturity and muscular strength increases
- Teach tackling with the head behind the ball carrier or rugby tackling
- Limits lateral flexion of the cervical spine during impact and less thigh/knee to helmet hits
- Improve the structure of the neck
- Corrective Chiropractic care, Denneroll, Spinal Orthotics
- Strengthen the Cervical Spine and Core
- Devices like the Iron Neck or simple band stability exercises
- Balance and Proprioception Training
- Baseline Testing and monitoring
“Dr. Kelly, are you going to let your kids play football?”
I’m 5’8″ in the morning. The chances of one of my offspring playing in the NFL are slim. Hopefully they pickup punting!
If my child wants to play football, I will support their decision. Following the above guidelines should help reduce the chances of injury and permanent damage.
Also, my clinic is on the way home from the football stadium!
“Great game, now let’s get your adjustment, son.”