Few were surprised when the analysis of former NHL player Derek Boogaard revealed extensive brain damage and degeneration associated with Chronic Traumatic Encephalopathy.  The brain is not designed to take multiple traumatic hits and be unaffected by the damage.  It doesn’t matter if you’re a 300 pound football player, an elite hockey player, or a housewife.  The brain remains among the most vulnerable areas of the body, and no amount of physical training and conditioning will alter that fact.

Certain occupations in life involve an element of physical risk.  Policemen get shot. Roofers fall off of roofs. Those in the military face risks constantly. Apparently, commercial fishing is  quite dangerous too. The people who do these jobs know what the risk is and they decide to do the job anyway.   It makes no sense to try to cover up the potential risks associated with any occupation, including athletics.   Jobs that have a higher incidence of concussions and blows to the head put an individual at risk for CTE.  CTE is the equivalent of environmentally caused dementia.

Apparently, the NHL is not convinced that there is a link between CTE and hockey. I am not sure what they are looking for as far as proof.  Would they go as far as to agree that concussions happen relatively often in contact sports?  Would they accept the fact that CTE is caused  by repeated blows to the head? Give these athletes the facts and let them decide if they want to take on the risk of playing the sport.   So many times an organization will try to underplay what might damage their immediate interests, and it results in a  worse problem down the line!

It’s never easy to take a proactive stance on anything. This isn’t the first time I have struggled with trying to make peace with the idea that I love to watch hockey and football and yet I know there are very significant  risks to the brain.  Decades of working with brain injured clients has created this dilemma for me.  In some ways, it seems hypocritical to be a fan of these sports and at the same time, point out what I see as a huge risk to people who play these sports. I can only imagine how difficult it would be if my life was and my livelihood was completely tied to these sports or promotion of these sports.  Derek Boogaard’s brother still plays hockey because in his words, “What else would I do?”

It isn’t an easy problem to solve. Still, it would behoove the NHL and NFL to become actively cooperative in trying to discover what risks are involved in playing a sport especially revealing the worst of these consequences. Don’t hold anything back and let the players, their families and their health care providers make informed decisions about what to do.  Also make necessary changes as a league  to improve conditions and have policies in place to minimize risk where possible.   However, the only way to arrive at a solution is to agree that there’s a problem.  How much more evidence will be required before professional sports acknowledge significant link between potentially compromised brain function and contact sports?  As the Minnesota Brain Injury Society stated in their 2010 Walk for Thought campaign: Play hard but play smart.

Another NHL enforcer was found dead in what should be the prime of his life. Wade Belak was found dead in his Toronto apartment today, apparently due to suicide. He joins Derek Boogaard and Rick Rypien in hockey heaven. the causes of death were two suicides and one overdose on alcohol and pain killers.  This is very tragic especially for the families and friends of these players. I believe the culprit here is multiple traumatic brain injuries.  Moreover,  I suspect there are many more of these guys who struggle with pain, irritability, and depression as a result of multiple blows to the head over the course of a hockey career.

In the old days, when someone suffered a concussion on the playing field, court, or rink, it was said that that player, “got his bell rung” .  As soon as he could get back out there, perhaps with the help of some smelling salts, he was encouraged to do so.  However, it is now known that the effects of brain injuries last well beyond the sense of feeling better physically.  Cognitively, they last much longer because the brain has not completely recovered.  The effects of multiple head injuries are cumulative and the effects worsen as the brain ages.

Sports rely heavily on previous motor programming.  In fact, if an athlete is accused of “thinking too much”, it is likely that he is relying too heavily on his prefrontal cortex rather than his finely honed motor skills that are a result of hours of practice. An athlete that is performing in the zone is hardly aware of what he actually did to achieve that level of excellence.  If he thought about it too much, he would lose the flow.  It’s similar to when a golfer suddenly realizes he’s having a personal best round then loses it because he has brought it into awareness.  In my mind, a player could actually appear quite well when his motor functions returned after a concussion, but his executive functions could still be significantly below his pre-injury baseline.

The executive functions are located in the prefrontal cortex of the brain.  They are involved in higher level thinking tasks such as planning, initiating, inhibiting, attention, and decision making. Moreover, the prefrontal cortex is the most vulnerable part of the brain so any concussion would likely involve this area and these functions.  In fact the prefrontal cortex is likely to be the most affected. Is it any wonder why someone who has had repeated blows to the head with little time for full recovery might experience problems in these areas outside of the sports arena?   What happens when they retire and they aren’t earning money using their well-practiced motor skills and having to rely on executive functions?   The worst scenario here is the poor decision to end one’s life.

Now, I am a huge hockey fan.  I love the Detroit Red Wings and have been to 2 Stanley Cup Final games. A close second is football, another head bashing sport. I like these sports very much. However, there are many changes that can happen that will make these sports safer.

1. Enforce the rules that penalize cheap shots that result in head injuries.  No exceptions.

2. Make sure executive functioning of the brain returns to baseline before allowing a return to the game.

3. Provide support and coping skills for individuals who played years before new rules would be in place.  These players are the most vulnerable and need the most help.

Note: Last year’s Minnesota Brain Injury Walk for Thought focused on increasing awareness about sports concussions.  Properly treating traumatic brain injury is important at all levels of competition from youth to professionals.

The Minnesota Brain Injury Association 2010 Walk for Thought occurred on September 25, 2010 at Como Park in St. Paul.  The theme for this year’s walk was “Sports Concussions.”  Sports concussions are not merely “getting your bell rung” as was previously believed.  It is now known that these brain  injuries are a serious matter and the effect of multiple injuries is not only cumulative but sometimes the ramifications of these injuries present later in life.  Our team, “Big on Brains” raised nearly $1600, exceeding our goal by 60%!  Thank you to everyone who donated and participated.  You only have one brain and it has to serve your needs long after you have left the playing field, the rink, or the court.  In the words of  the Minnesota Vikings All-Pro and Hall of Famer Randall Mc Daniel, the honorary ambassador to this year’s event, “Play hard but play smart.”  (Pictured at the right: Big on Brains Team 2010)

“We must educate young athletes, coaches and parents to recognize the warning signs of brain injures and ultimately to find ways to prevent them. I want to educate young athletes to learn to play hard- but play smart.  We all must realize that there is nothing more important than the safety of your brain as brain injury can change your life forever” – Randall Mc Daniel (Former Minnesota Viking/2009 Pro Football Hall of Famer/2010 Honorary Ambassador of the Minnesota Brain Injury Association Walk for Thought 2010).

Sports related concussions occur in over 50,000 high school athletes each year, accounting for 20% of all brain injuries. This figure does not take into account the injures that occur on collegiate fields, courts, and slopes each year nor those that occur in grade school sporting activities .  Even “mild” injuries can affect  an individual’s ability to problem solve, concentrate, and regulate mood and behavior.  The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can slosh around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.  Even “mild” injuries can have devastating repercussions on cognitive function.  Physical symptoms like dizziness and headache often improve before the cognitive symptoms. The effects of multiple concussions are cumulative making it particularly dangerous to return to the sport before full healing has taken place.

I love sports.  I grew up going to football games at University of Michigan. I got excited when Michigan beat Notre Dame last weekend.  However I worried about the ND quarterback who was “having troubles seeing.”  Team officials denied that he had a concussion but I  wondered  why they put him back out there with those symptoms.   It is very exciting to watch a game unfold on a beautiful fall day.  This year, my son who is a senior in high school, decided to play football. There are many benefits from playing on sports teams too numerous to list here.  However,I cringe and I worry about his safety and that of his teammates.  I wonder if this is against my values and my life’s work:  maximizing human potential by challenging and caring for the brain.  I think many of us feel the same way.  We love sports.  We want our teams to win and our young people to excel in these competitions.  Yet, in the back of our minds, we are concerned about the risks.

When my daughter sustained a mild concussion while taking a charge in an AAU National Basketball Tournament in 2004, I really wanted her to get back out there.  There were college scouts present and she had been playing so well. It wasn’t easy to reconcile with the fact that we had traveled all the way to North Carolina and she was going to spend the tournament on the bench.  There was much more at stake though than a basketball tournament.  Another concussion could have had far-reaching implications. The yearning to compete tempered by the real consequences when an individual sustains a brain injury during competition makes this  year’s Walk for Thought  particularly pertinent for parents and youth alike.   The magnetic pull to compete, win, or participate in a sports contest can override our better judgment in the face of a brain injury unless we build an awareness of what’s at stake.  Let them play but let them play smart.

Raising awareness about youth sports concussions is the theme of this year’s Walk for Thought. In the words of Randall Mc Daniel, “We need to change the old-school attitudes about brain injuries in sports.”  Please consider donating to our team “Big on Brains” as we “do the brain walk” on Saturday, September 25th.  Thank you!

**PHOTO:  2009 Big on Brains team (Theme: Brain injuries in U.S. Veterans)  Here we are modeling our “brain tattoos.”

DONATE HERE: http://www.braininjurymn.org/fundraising/event/walkforthoughstpaul2010/big-on-brains-483

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