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Expert discusses advances in concussion research

NCAA.org recently spoke with Jason Mihalik, an assistant professor in the department of exercise and sport science at the University of North Carolina, Chapel Hill. The university recently received grants from the National Operating Committee on Standards for Athletic Equipment (NOCSAE) and the NFL to study the causes and consequences of concussions.

The NCAA has an ongoing partnership with Mihalik and his colleagues at the university’s Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center. The group regularly creates educational resources for the NCAA membership and is responsible for two influential studies on concussions (Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study and Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study), which led to the development of the NCAA concussion guidelines.

Marta Lawrence of NCAA.org spoke with Mihalik about what researchers are learning about sports-related concussions.

Question: What impacts do acceleration and location have on the severity of a concussion?

Answer: At this time, researchers do not have a strong understanding of these phenomena. We know that the greater the head acceleration, the greater the likelihood the collision impact has of inducing a sport-related concussion. Our own data are beginning to suggest that top-of-helmet impacts still occur with relative high frequency and a disproportionate number of concussions have resulted in athletes sustaining impacts to the top of the head, or by striking an opponent with the top of the head.

Q: Are there other factors (for example, biological) that can play a role in the severity of a concussion? How do you account for these unique characteristics when developing standards and best practices to avoid Traumatic Brain Injuries (TBIs)?

A: Excellent question. From some of the NCAA Injury Surveillance System data that has been published in the last few years, some reports suggest that females have a higher injury rate in competition than males (for example, women’s ice hockey vs. men’s ice hockey and even football). Could this be a function of cervical muscle strength? Is it a function of hormonal fluctuations experienced by females across the menstrual cycle? Is it a function of training athletes to be more aware of their surroundings? For example, open bodychecking is not permitted in women’s ice hockey. Does this mean that when an incidental body collision occurs it’s more significant because they are not anticipating the collision compared to a male hockey player who expects to be bodychecked when he is in possession of the puck or a running back when he is holding onto the football? We’re still exploring the contributions of these factors on injuries but carrying these findings over to injury prevention interventions seems a logical next step.

Q: There have been several calls recently from New Mexico Sen. Tom Udall and others to create safer testing standards for football helmets. Udall in particular is concerned for youth players. Can age play a factor in the severity and lasting impact of a concussion?

A: Most certainly it can. Research has identified the young student-athlete to be a particularly vulnerable athlete for many reasons. First, their brains continue to develop into their early 20s. Research has supported the notion that younger athletes, all things being equal, typically require more time to recover from concussions than their adult counterparts. If injured in their youth, the window of potential repeat injury is lengthened and, thus, the long-term complications of repeated head trauma (injurious or subconcussive) may have lasting effects on younger athletes into adulthood. We need to remember that children and adolescents are not “little adults” but rather individuals who represent an overwhelming population of football players in the United States.

Q: Will there ever be a safe helmet?

A: This question suggests that today’s helmets are not safe, and that is an incorrect stance to take at this time and, quite frankly, an unfair position to put helmet manufacturers in. We need to understand that the primary purpose of the modern hard-shell helmet is to prevent focal injuries (like cerebral hematomae and skull fractures), and it has done a good job of this. People forget that dozens of football players died each year playing football before the modern-era helmet was instituted in football. In fact, the NCAA was instituted because of such high numbers of deaths in the sport. We’ve come a long way in protecting our athletes with today’s helmets.

Can they be better? Of course. As technological advances continue, it can be expected that helmets would evolve and become more protective. Changes in helmet design have already emerged in the past few years. I think helmet manufacturers get a bad rap for not preventing concussions when, in reality, they very likely prevent a lot of concussions and, more to the immediate purpose of the helmet, prevent catastrophic brain injuries that resulted in many deaths in the past.

Will a helmet ever be able to prevent all concussions? Would a car ever be able to come to a complete stop on a dime without any of the passengers feeling the urge to move forward? In essence, the brain within the skull is the passenger and the head/skull arrives at a full stop very quickly. Can a helmet ever prevent the brain from striking the inside of the skull?    

Q: So, is the real issue the abrupt nature of the stop? Could momentum cause the brain to hit the inside of the skull and cause a TBI even if the hit didn’t occur to the head? 

A: This is certainly a common mechanism of injury. Certainly an impact directly to the head is more likely to stop it suddenly, but impulsive (indirect) blows are also very capable of causing a concussion. In fact, this mechanism of injury has been highlighted in the Concussion in Sport consensus statements. Concussion is a very common and real injury that motor-vehicle accidents victims sustain, often due to the violent whiplash mechanisms they experience during their accident. 

Q: Are football players able to change their behavior to better protect themselves from TBIs? What effect has your research had on North Carolina student-athletes?

A: Players can do a lot of things to protect themselves from TBI while playing. For starters, they can heighten their awareness of where they are on the field and where their opponents are. In so doing, they can better prepare for oncoming body collisions. They can be well-conditioned to withstand the physical rigors of extended athletic participation. They can employ safe tackling techniques and not lead with the head. 

Q: Your lab recently received a grant from the NFL and NOCSAE. How will you use these funds?

A: The NOCSAE funds were awarded to begin exploring the differences between girls and boys hockey players and to begin exploring how aspects of muscle strength and anticipation differ between the sexes. The NFL Charities funding will continue to support the Center for the Study of Retired Athletes and Dr. Kevin Guskiewicz’s ongoing work with retired professional football players.