With more attention given to concussions and possible long-term brain damage from football and other sports, more athletes and parents are asking questions about these injuries and how to prevent them than ever.Head injury in soccer

Based on a recent article by Leah G. Concannon and others in the journal Sports Health, I answer some of the common questions regarding these difficult and dangerous injuries.

What is CTE?
Chronic traumatic encephalopathy (CTE) is a progressive neurologic disorder thought to be associated with repetitive mild traumatic brain injuries.

Also read:
The hidden dangers of concussions
New sideline tests could improve concussion assessments
Can an athlete’s genes influence recovery from concussion

Is it only seen in football players?
While it has gained most attention recently in former football players, a similar neurologic deterioration had been seen decades earlier in boxing. CTE has also been reported in soccer, wrestling and hockey athletes. Outside of sports, CTE has been seen after abuse and in former members of the military.

How do doctors diagnose CTE?
It is important to note that CTE can only be diagnosed by autopsy after death. There are no physical exam findings or neurological tests that definitively diagnose CTE. CT scans and MRI have not been conclusively shown to demonstrate brain changes associated with CTE as of yet.

Also read:
Player-to-player contact and concussions in high school football
Suicide and mental health concerns exist after concussions in young athletes
Concussions are increasing in high school sports
Troubling trends about concussions in high school athletes

What are the symptoms of CTE?
A patient affected with CTE might exhibit memory loss and attention deficits. He might demonstrate lack of inhibition, impulsiveness, violence, and drug and alcohol abuse. He could also appear irritable, depressed, apathetic and even suicidal.

Do concussions cause CTE?
While concussions, especially a history of multiple concussions, are associated with CTE, it is difficult to assert that concussions cause CT. Soccer concussionDespite the high number of athletes who have suffered concussions in sports, only a small percentage of them appear to develop CTE. Repetitive subconcussive blows might be the culprits, but it is equally difficult to determine if this cumulative trauma causes CTE.

Also read:
New study suggests concussions in college football increasing
How can we encourage athletes to report concussions?
8 facts about concussion risks and longer recoveries

What other factors could predispose certain athletes to develop CTE?
More time and research are needed to assess which risk factors could be most associated with CTE. Some of the proposed factors, outside of a history of multiple concussions and repetitive subconcussive blows, include drug and alcohol abuse, chronic inflammation from medical conditions like diabetes, hypertension and obesity, and genetic associations.

Can helmets decrease the number of concussions and prevent CTE?
Theoretically, new helmet technology can decrease impacts to the brain, but no helmet has been conclusively shown to prevent concussions. Since it is hard to know what effect, if any, helmets have on repetitive subconcussive blows, it is hard to say that better or newer helmets would decrease the chance of developing CTE. Some experts believe that newer helmets give players a sense of security that leads to more dangerous tackling and could actually increase the risk for concussions.

Also read:
Does fear of getting benched keep players from reporting concussions?
Ensure proper helmet fit to minimize concussion severity
Baseline concussion testing critical for later management

How do doctors determine an athlete’s return to play after concussion?
Any player with symptoms consistent with concussion should be removed from play and not allowed to return the same day. The athlete rests from physical and mental activity until he is asymptomatic. If baseline neurocognitive tests were administered, doctors can use them as Football concussioncomparisons to determine when an athlete’s neurocognitive function has returned to normal. Doctors specializing in concussions can guide the athlete through a process to increase activity and determine when he can safely return to sports, assuming he remains asymptomatic throughout the more strenuous activity.

Also read:
Don’t allow players to return to the game after any concussion
Undergo baseline concussion testing before the season
Recognize that concussions occur in sports other than football

Should a player who has had multiple concussions consider retiring from sports?
Many factors play a role in this decision, and it should be based on the individual athlete. A history of multiple concussions, history of severe concussions, concussions occurring with less trauma and prolonged recovery from them are all important factors. Any athlete with persistent symptoms, like headaches and memory loss, or permanent neurologic impairment should also consider retiring from sports.

Also listen to these podcast discussions from The Dr. David Geier Show:
Episode 93: Can new football helmet designs decrease the risk of concussions? (starts at 3:30)
Episode 90: Will young athletes deny concussions symptoms in order to play sports? (starts at 3:18)
Episode 37: Can concussions cause personality changes? (starts at 2:45)
Episode 27: Are concussions prevalent among young athletes? (starts at 4:24)

Concannon LG, Kaufman MS, Herring SA. Counseling Athletes on the Risk of Chronic Traumatic Encephalopathy. Sports Health: A Multidisciplinary Approach. Published online April 17,2014.