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Little Blows to Head Add Up to Big Risk

Study Shows Brain Changes In High School Football Players

By Matt McMillen
WebMD Health News

Reviewed by Laura J. Martin, MD

Feb. 3, 2012 -- Small hits to the head may add up to injuries for high school football players, according to a new study by the Purdue Neurotrauma Group at Purdue University in West Lafayette, Ind.

The researchers suggest that the effects of blows to the head while playing football may last longer than previously thought. During this time, players' brains are vulnerable, so the blow that results in a concussion may be the "straw that broke the camel's back," the researchers write.

"Taking a large number of hits to the head is not good for you," says study researcher Evan L. Breedlove, a graduate student in mechanical engineering at Purdue.

And the high school players that Breedlove and his colleagues studied took a lot of such hits. After following about two dozen players over two seasons, they calculated that players received 200 to almost 1,900 head blows each season. They got these numbers from the special helmets that each participating player wore. Sensors inside the helmet cataloged the hits taken, the force of the impact, and the region of the head that was struck.

The players also underwent brain scans so that the researchers could compare the data from the helmets with the effect that each blow had on the players' brains.

"It gave us a sense of how things changed throughout the season," says Breedlove.

Over the course of the two seasons, six of the players suffered concussions, while the scans of 17 of the players showed changes in brain function that the researchers could tie to the hits on their heads.

Questions Raised by Study

It's the first human study looking at the accumulation of sub-concussive blows and their effect on the brain, says Gerard Gioia, PhD, chief of pediatric neuropsychology and director of the Safe Concussion Outcome, Recovery, & Education (SCORE) Program at Children's National Medical Center in Washington, D.C.

"The study raises questions of whether we should be reducing the number of blows an individual takes," says Gioia, who reviewed the study for WebMD.

As the study authors and Gioia point out, changes to the brain are not necessarily indicative of damage. More research will be needed to determine that.

"We are currently in a gray area of research when it comes to concussions," says Gioia. "We're still trying to understand the problem and translate it into education and prevention."

No Clear Cut Answers for Parents

That puts parents in a difficult position, because there are no clear answers about the extent of the risks their child faces when he suits up for a football game.

"I have families who are constantly asking me about these things," Gioia says. "We take the research we have and try to apply it to their kids as best we can, but we can only make educated guesses."

Making matters more complicated is the fact that different kids likely have different injury thresholds. Some may be able to withstand more hits than others.

But, says Gioia, "More hits [are] probably worse."

Michael Bergeron, PhD, says our understanding and appreciation of head injuries is growing rapidly, and he's hopeful that that will lead to safer play for boys and girls in all sports.

"We have better methods, better science to reinforce the new understanding that the single blow idea of concussions is too simple," says Bergeron, a pediatrics professor at the University of South Dakota's Sanford School of Medicine and executive director of the National Youth Sports Health & Safety Institute. "In this study, they are showing that there are neurophysiological changes and suggesting a deficit in neurophysiological health. These changes imply that."

Bergeron describes himself as a big fan of youth sports, but he is concerned that games have evolved in such a way that they no longer promote health and fitness.

"A parent has to carefully consider a sport like football," he says. "The brain is the most important organ, but kids taking 50 to 60 hits to the head per game is typical. But when you talk about changing the way the game is played, people accuse you of trying to 'wussify' the sport. ... The focus should be on the kids and on fun and fitness, not on the violence of the game."

SOURCES: Breedlove, E. Journal of Biomechanics, study received ahead of print.Evan Breedlove, graduate student, Purdue University, West Lafayette, Ind.Gerard Gioia, PhD, chief, pediatric neuropsychology; director, Safe Concussion Outcome, Recovery, & Education (SCORE) Program, Children's National Medical Center, Washington, D.C.Michael Bergeron, PhD, pediatrics professor, Sanford School of Medicine, University of South Dakota; executive director, National Youth Sports Health & Safety Institute.News release, Purdue University.

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