When Sports Take Their Toll
A UNC Researcher Earns a MacArthur for his Work on Traumatic Head Injuries
By Taylor Sisk
Bigger. Stronger. Faster. That’s how we’re building our young athletes today. More durable? Arguably, in some respects. But we haven’t yet figured out how to engineer a more shock-absorbent skull.
These young athletes’ heads invariably collide, on the gridiron, for example, or the ice. When they collide, it can occur at accelerations of upwards of 180 g’s. Drive your car into a wall at 25 miles per hour and when your head hits the windshield, the impact would register at about 100 g’s.
Kevin Guskiewicz knows the cost of such contact. In addition to being a concerned football and hockey fan, with four sons who play organized contact sports, he’s Distinguished Professor and chair of the department of exercise and sport science in UNC’s College of Arts and Sciences, co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center and research director for the Center for the Study of Retired Athletes.
Last September, Guskiewicz was awarded a MacArthur Fellowship from the John D. and Catherine T. MacArthur Foundation, a prize given to groundbreakers in a wide variety of fields. He’ll receive $500,000 over the next five years to spend as he deems appropriate, advancing his work as a researcher and reformer in the field of sport-related concussion.
Guskiewicz’s research has found that each year in this country athletes sustain some 300,000 sport-related head injuries. His work with retired NFL players has underscored the high correlation between multiple concussions and the early onset of neurodegenerative changes, including depression and dementia.
Concussion has been defined as a “traumatically induced alteration of awareness or consciousness,” which may cause a loss of balance, headaches, amnesia, sleep disturbances, vertigo and hearing loss.
Alan Schwartz of the New York Times has written extensively about sport-related concussion for years. Several years ago, he asked a high school football player whether he would tell his coach if he was once again experiencing concussion-like symptoms: “No chance. It’s not dangerous to play with a concussion. You’ve got to sacrifice for the sake of the team. The only way I come out is on a stretcher.”
Bigger. Stronger Faster. But more aware today of the hazards? “Yes,” says Guskiewicz, “but we’ve got to continue to do better.”
Guskiewicz is from Latrobe, Penn., outside Pittsburgh, big-time football country. “Football’s in my blood,” he said. He grew up playing the sport, but realized that a future as a player wasn’t in the cards.
Instead, sports medicine became his passion.
He enrolled in a premier sports-medicine program at West Chester University near Philadelphia, dual majored in sports medicine and journalism, and then moved on to the University of Pittsburgh and a trainer’s gig with the Pittsburgh Steelers for two and a half years. The Steelers paid for his education and he left Pitt with a master’s degree in physics and sports medicine.
“While I was working for the Steelers,” Guskiewicz said, “I was perplexed by the arbitrary way decisions were made about concussion. We had all these special tests and clinical measures to assess ankle injuries and knee injuries and shoulder injuries, but there was so little on head injury.”
He thought to himself, “My goodness; the brain is a pretty important organ, and how in the world do we not have more sophisticated ways of assessing this injury?”
He continued on to doctoral work at the University of Virginia and began studying balance, looking at a variety of injuries using force-plate technology, writing his dissertation on the effects of concussion on balance measures.
One of the first confirmed cases of chronic traumatic encephalopathy (CTE) in a retired professional football player was former Steeler Mike Webster. Webster’s decline, post-NFL, into destitution and severe depression was well documented. He died in 2002, of heart failure, at age 50; his death certificate indicated that he suffered from “chronic concussive brain injury.”
Webster’s autopsy showed tau protein deposits on his brain. These deposits, Guskiewicz said, create tangles similar to those found in Alzheimer’s patients, causing depression, emotional outbursts and issues with executive functioning that can be linked to dementia.
Similar deposits are now being found in the brains of other former athletes who played contact sports in which repetitive impacts to the head occur. Deposits also have been found in younger athletes – as young as 18 years old.
Unfortunately, they can only be identified in vitro, after death.
A different game
Several things have changed about the game of football in the past few decades.
“Equipment is better,” Guskiewicz said, “which is good and bad. It’s good in that we’re doing a better job of protecting against catastrophic injuries, such as skull injuries and drastic acceleration and deceleration of the brain that can cause vessels to rupture.”
But better helmets mean athletes tend to use their heads more – that is, they tend to lead with their heads when tackling.
“It’s a more aggressive game today,” Guskiewicz said. “We do see that blocking and tackling techniques have changed over the years … and so the physics of the collisions are more problematic.”
Advocates have proposed protecting kids from contact sports until, say, 14 years old, restricting organized leagues to flag football, noncontact hockey and soccer that prohibits heading the ball.
Motor-learning studies, he said, show that kids begin to develop skill and coordination and to use their proprioceptive and kinesthetic abilities to protect themselves at 8 years old up through 14 or 15.
“I think that’s when my kids have learned to protect themselves,” he said, “and they’ve done it in an environment – in Pop Warner football or youth hockey – where those leagues control for weight and age…. In middle school or high school football, a kid may strap on pads for the first time and now you could be that 115-pound kid going up against a 180-pound kid, and the hits are more significant at that age.”
“So I think there’s something valuable that takes place during those developmental years, if you have good coaching and good equipment and the proper techniques are being taught.”
According to research released in April by UNC’s National Center for Catastrophic Sports Injury, with which Guskiewicz works closely, the number of high school football-related brain injuries with permanent disability had been in single digits since 1984 but rose to 10 in 2008 and 2009 and to 13 in 2011.
Guskiewicz believes the incident rate of football-related concussions is on the rise across the board.
But, at the youth level, and probably the high school level, he said, “I really think that 85 to 90 percent of the increased rate has to do with reporting. I think that we’re closing the gap on the number of reported concussions and unreported concussions.”
Several states, including North Carolina, Texas and Oregon, have passed legislation that requires coaches and medical staff to be educated in detecting and responding to symptoms of concussion. Some states’ laws require emergency personnel to always be on site during games.
At the pro level, kick-offs – in which 11 members of one team hurtle downfield at full speed in the direction of the other team’s advancing 11 members – have been a primary source of head, and other, injuries, sometimes generating those aforementioned 180-plus g’s. A rule change imposed last season designed to better protect players has resulted in a 42 percent reduction in kick-off concussions, with no dramatic impact on the game, according to Guskiewicz.
The NFL is also more strictly enforcing rules against players leading with their heads, fining and sometimes suspending players for violations.
Guskiewicz sits on the NCAA’s concussion committee and the NFL’s head, neck and spine committee and helped write concussion guidelines that are now recommended by the National Athletic Trainers Association and the American College of Sports Medicine.
At UNC, Guskiewicz does initial neurocognitive and balance tests on about 80 percent of student-athletes – those involved in contact sports – which are used as a baseline to assess damage and track recovery in the event an athlete later sustains a head injury. in 2004, he and his colleagues began equipping the football helmets of all UNC players with sensors that measure the force of every hit, collected during every practice and game, gathering invaluable data.
Most probably, our young athletes will grow bigger, stronger and faster yet – advances in science and technology will see to that, and it’s not likely high schools, colleges or professional leagues will set a limit on how much muscle mass an athlete can nurture.
Guskiewicz will be using his MacArthur money to further advance his research, “to grow that pot of money,” he said, offering a portion of it as matching funds to organizations in a position to help further the study – perhaps the NCAA, the NFL or the National Operating Committee for Standards in Athletic Equipment.
In the early days of his research, Guskiewicz was routinely met with resistance. Today, the data continues to mount. Lives are at stake, and continued education is critical.