Brain experts develop game plan for football concussions
Saturday, March 13, 2010
By Chuck Finder, Pittsburgh Post-Gazette

If international expert Robert Cantu had his druthers, football teams would practice without helmets.

That would be the best way to teach players to avoid head-to-head collisions, utilize their shoulders and bodies more in contact, protect against the concussions and later-life brain maladies the brutal game creates at rates such scientists find alarming.

The same notion would apply for players from preps to pros, too.

"There may be one day a week you put them on," Dr. Cantu said Friday in the first of a two-day, Duquesne University seminar entitled "Is Football Bad for the Brain?"

Dr. Cantu is a noted neurosurgeon and co-founder of the Boston-area Sports Legacy Institute that has helped to lead the NFL's recent reform movement through its study of long-term brain damage in middle-aged or older athletes.

"Keep them off, so you don't use your head as a battering ram," said Dr. Cantu.

This idea was endorsed by Julian Bailes, a former player and team physician who presides over West Virginia University's department of neurosurgery along with its Brain Injury Research Institute. He, in fact, counseled the WVU football coaches to decrease contact in practice to one day each week, "and I'd like to reduce that."

He said he also has spoken to NCAA officials and NFL commissioner Roger Goodell about efforts limiting, if not eliminating, helmets as a device for hitting and injuring.

"We've got to gravitate toward getting the head out of the game as much as we can," Dr. Bailes said. "The purists are saying you can't do that. Yes, we can. We can eliminate it in practice if we want to. I think we need to look at getting rid of what I call the obligatory, mandatory head contact."

Over the years, coaches and players have learned to put away the salt tablets, to cease the potentially fatal practice of blistering two-a-days, to lift their helmets to see what they are tackling and avoid spearing.

Dr. Bailes said he proposed to Mr. Goodell two years ago that linemen should stand or squat upright, removing themselves from the three-point stance and their brains from potential peril.

"You could have helmet padding 6 inches thick, it's not going to help," he continued.

"We're stuck with the immutable fact that homo sapiens have a brain floating in fluid. At some point, the helmet and craniums are going to stop [moving], and the brains inside are going to continue. It rubs inside the rough areas of the skull ... and it bounces back."

That's how concussions occur. That's how, with repeated concussions, NFL retirees are found to develop depression and dementia at rates three times more than the general population.

Kevin Guskiewicz, a Latrobe native and onetime Steelers trainer, has placed meters in the helmets of players at the University of North Carolina -- where he heads the Center for the Study of Retired Athletes. Dr. Guskiewicz's research shows that players can absorb 100 hits to the head in what are considered "light," helmets-only practices. Concussion-causing hits occur at the crown of the head seven and eight times more often than the sides or frontal lobe of the brain, studies there found.

His desired rules change?

"I definitely think something has to be done on special teams," he said. "At the professional, collegiate and high school, we're seeing a disproportionate level of concussions on punt returns and kick returns."

He suggested something similar to hockey's offsides, where a number of players stay behind a specific line.

"We need to make this game a safer sport," he said. "Because it's not going away."

Joseph Maroon, the Steelers' longtime neurosurgeon and a member of the NFL's concussion committee, said the recent changes -- such as a stricter return-to-play policy delivered to teams in December -- illustrate that 2009 was what he called "the tipping point" for the league.

"They're reducing the number of head hits in practice," Dr. Maroon said. "They're looking at the way practice is carried out. They [increased] suspensions, penalties and fines for intentional hits [to the head]. They're taking very strong action, and they're considering others."

"It's like never before," Dr. Bailes said of the NFL's reaction. "I think the commissioner and the league have done more than ever."

Also on the first day of the seminar, presented by the Cyril H. Wecht Institute of Forensic Science and Law:

Dr. Cantu revealed his research found that a fatal form of follow-up concussion, called Second Impact Syndrome that kills three to four high-school players annually, can be detected by a CAT scan. Sports-related brain injuries never before revealed themselves in imaging.

His co-worker at the Sports Legacy Institute, Dr. Ann McKee, announced the finding of another protein -- TDP43 -- that causes degeneration in the brains of such older athletes diagnosed with Chronic Traumatic Encephalopathy, the disease that results from a history of head trauma. The protein called tau also does that.

Dr. Maroon's research echoed Dr. Bailes': Gobble up Omega 3 fatty acids, and they may help to prevent and cure the inflammation of a traumatic brain injury.

"Quite frankly, I think everybody should be on it," said Dr. Maroon, who was part of a January 2009 study in which an NFL team showed reduced cardiovascular risk factors when regularly ingesting them

He proposed downing 2 to 3 grams of such fatty acids as DHA or EPA daily. "I think it's like Vitamin B -- it's a natural anti-inflammatory."