I interviewed Drs. Ann McKee and Robert Stern last summer when I was writing my upcoming book That’s Gotta Hurt: The Injuries That Changed
Sports Forever. I was surprised that neither mentioned concussions that often. Their main concern was the repetitive head impacts that young football players take during each practice and game over the course of the season. When I saw this latest study on specific brain changes from these repetitive blows, I thought I would share it with parents and coaches of young athletes for my latest newspaper column.
Parents concerned about concussions in youth football
For months I have vowed to cut back on the number of columns I write about concussions. Several patients, though, have recently told me that they find this information valuable. Many of them are concerned parents of kids who play football. A new study published this week won’t relieve their fears.
Head impacts in football and brain changes
Researchers at Wake Forest University studied 25 male football players between the ages of 8 and 13. They recorded the number and severity of the head impacts each player received over the course of the season using the Head Impact Telemetry System (HITs). They also performed advanced MRIs on each player at the beginning and end of the season.
The researchers found that the athletes with higher levels of head impacts had more changes in fractional anisotrophy in specific areas of white matters in their brains. This change, involving decreased movement of water molecules within the brain, has been associated with brain changes seen in traumatic brain injuries in previous studies.
Healthy kids showed brain changes after head impacts
One point is key. These brain changes were not observed in kids who suffered concussions. They were found in young football players who had not suffered any injury. These were kids who were completely healthy throughout the season.
Meaning of these brain changes in young football players
To be clear, we don’t know what these changes mean. It is possible these brain abnormalities will have no long-term consequences. They might resolve quickly with six weeks or six months of rest. Or they could represent a precursor to later brain damage, especially with continued head impacts over many seasons.
All we know is that the researchers did not find these changes in young football players among kids who absorbed little to no head impacts.
What is the significance of repetitive blows to the head?
Christopher T. Whitlow, M.D., Ph.D., M.H.A., the chief of neuroradiology at the Wake Forest School of Medicine, served as the lead author the study. “Most investigators believe that concussions are bad for the brain, but what about the hundreds of head impacts during a season of football that don’t lead to a clinically diagnosed concussion? We wanted to see if cumulative sub-concussive head impacts have any effects on the developing brain,” Dr. Whitlow explained in a press release.
The challenge for football
Concussions occur in many sports other than football. What most other sports do not have that football does are the repetitive subconcussive blows. These are head impacts not severe enough to cause a definitive concussion, but they could lead to brain abnormalities over time. Think of the collisions between offensive and defensive linemen at the beginning of every play.
Some experts, including noted researchers Dr. Ann McKee and Dr. Robert Stern at the Center for the Study of Traumatic Encephalopathy in Boston, have expressed to me their belief that these subconcussive blows are the likely cause of CTE. Both experts share serious concerns about letting kids play tackle football at young ages while their brains are still developing.
The challenge for football is eliminating subconcussive blows without fundamentally changing the sport.
More information for parents to consider about football
Should parents be concerned about this latest study? Until we know what these brain changes truly mean, probably not. For parents on the fence 
about letting their children play tackle football before high school, it might push them one step further toward encouraging their kids to play a different sport altogether.
Does this study and the brain changes seen in kids who absorbed head impacts in youth football worry you? Share your thoughts below!
Note: A modified version of this article appears as my sports medicine column in the October 26, 2016 issue of The Post and Courier.
References:
Bahrami N, Sharma D, Rosenthal S, Davenport EM, Urban JE, Wagner B, Jung Y, Vaughan CG, Gioia GA, Stitzel JD, Whitlow CT, Maldjian JA. Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football. Radiology. Published online ahead of print October 24, 2016.
RSNA Press Release: Brain Changes Seen in Youth Football Players without Concussion. October 24, 2016.
