These days it’s hard to have a conversation about football without the topic of concussions arising. Which makes sense. Research into chronic traumatic encephalopathy—the degenerative brain disease that seems to be caused by repeated blows to the head—is exploding and explosive. Some of it even suggests that suffering concussions as a kid can cause depression, memory problems, and violent behavior years later. But what if this new conventional wisdom doesn’t get it quite right?
Against this panic, Christopher Giza has been calling for a bit of calm and context. Director of UCLA’s Steve Tisch BrainSport program, Giza is a professor of pediatric neurology and neurosurgery, a heavily published researcher, and has served as an expert on concussions for several contact-heavy sports, including the NFL, Major League Soccer, and the NHL Players’ Association. Before you pull your youngsters from football—or sign them up for it—Giza has some advice.
The first time CTE was found in a pro football player was in 2005, but it wasn’t really until about 2010 that concern about sports concussions was starting to become widespread. When did you become involved?
In the late 1990s, I spent two years with the Yosemite Search and Rescue Team, mostly living in a tent and eating ramen between rescues. Most of the neurotrauma I saw during rescues with the team was serious. Being able to help with those cases was what led me to specialize in traumatic brain injury. By 2001, we were seeing TBI patients in our clinic, and by 2007, we were starting to see more and more sports concussions, many from football. That was before most of the public thought about brain damage outside of car accidents. By 2012, nearly half of our patients were sports concussions. That was also when we started doing neurological assessments for some of the UCLA varsity teams and for some local high schools.
With all the concern about football concussions that came up around that time, how did you come to question the idea that there’s such widespread, severe risk in these sports?
It goes back to 2005, when I joined the California State Athletic Commission that regulates boxing and mixed martial arts, to see how big the problems were with brain injury in the sport. The official position of the American Academy of Neurology was that boxing should be banned, but I wanted to understand for myself what was going on. I met a lot of fighters, and to my surprise most of them seemed fine. Some had signs that could be attributable to brain injury, but if long-term brain damage is just a question of how many impacts you suffer, how do you explain why so many of them do so well?
What kicked concern into overdrive was the 2017 Boston University study. It looked at the brains of 111 deceased NFL players, and saw what seemed to be signs of CTE in all but one player. Isn’t that pretty irrefutable?
Right now the data are actually in the middle. The Boston University researchers included only players who had a history of head impacts, a lot of symptoms of brain degeneration, and then died. So it shouldn’t be surprising that their brains showed signs of degeneration. If you’ve put together a bag of apples, you shouldn’t be surprised when you reach in and pull out an apple. Another autopsy study found CTE in contact-sports players at a rate of only 32 percent. There is also a study that followed 3,000 people for decades, and that didn’t find any difference in brain cognition tests between football players and the rest. But all the public hears about are the 110 people in the Boston University study.
It sounds like you’re saying that the most highly publicized studies, the ones that have really driven public concern, may have been misleading.
The CTE studies of NFL players have really opened awareness about brain injury, and they’ve led to new lines of research. That’s great. The downside is that the results of these few studies have monopolized the discussion, so now anyone who isn’t in favor of really clamping down on football for safety’s sake is labeled a denier of the science. Look, head injury is the most complex injury to the most complex organ. We have to avoid oversimplifying, and take a more nuanced, less black-and-white view of the risks and benefits of playing, especially for kids.
For youth football ages 6 to 12, participation is down nearly 30 percent, in part due to fears over concussions. Nevertheless, millions of younger people are still playing football, as well as skateboarding and playing soccer, and the occasional concussion is inevitable. Is it possible to reduce the risks of damage from a collision?
Animal research has shown that if there’s some time between concussive impacts, brains seem to recover. But repeated concussions at close intervals, before the brain has a chance to recover, tends to lead to more severe symptoms—such as memory impairment. That’s why when there’s any doubt, take the player out. After a concussion is diagnosed, have your child take it very easy for a few days. But keep in mind that prolonged inactivity tends to lengthen recovery time. Light exercise after a few days is good, and then work up to heavier exercise over the next week or two.
The Most Common Causes of Concussions (Beyond the Gridiron)
Football isn’t the only activity in which your noggin gets knocked.
- Women’s Lacrosse: It’s the second-most concussion-prone sport. “Women players have a higher rate of head, face, and eye injuries than men, and 40 percent were concussions,” says Rebecca Acabchuck, a professor at the University of Connecticut. Why? Until spring 2017, U.S. Lacrosse, the sport’s governing body, didn’t let women wear protective headgear, while helmets with face shields are standard for men.
- Horseback Riding: Among adults, equestrians are twice as likely to suffer a traumatic brain injury than contact-sport athletes, data from the National Trauma Databank suggests. Hour-for-hour, being on a horse is more dangerous than riding a motorcycle.
- The Theater: Sixty-seven percent of theater participants have had at least one head injury, research from Ohio University says. Accidents stem from things like stage combat, set-building, and moving props around backstage in the dark.