How Athletic Culture Still Suppresses Concussion Research

A researcher's struggle to get players and leagues to cooperate in a study of traumatic brain injury


The last time Dr. Paul Echlin attempted to research concussions occurring in young ice hockey players, one of the two participating teams dropped out halfway through the study.

Now, two years later, Echlin managed to get all of the data needed for a massive, 4-part analysis of traumatic brain injury among college varsity players -- but not without meeting enough opposition that he was inspired to write an accompanying editorial decrying the competitive culture that keeps concussions dangerously under studied and underreported. All were published in a special issue of Neurosurgical Focus.

In the course of this new study, 20 percent of the men and 25 percent of the women followed suffered a concussion. The numbers were only half of what Echlin's team reported in 2010, but were 3 and 5 times higher, respectively, than what had previously been reported for collegiate ice hockey.

But no one, Echlin wrote -- not the kids, not the coaches, not their parents -- wanted to acknowledge possible concussions if it meant interfering with their playing.

The way Echlin told it to me, the entire experience of following the teams had the air of a middle-school argument: One coach who had signed on with the study talked behind the researcher's back about how the whole thing was a waste of time and money. The comments made their way back to Echlin, who included them in his editorial along with some disturbing examples of what his team physicians observed:

At the game, the player took an elbow to the head. She got up immediately, and although she felt some mild symptoms at the bench (nausea), she noted that she had felt that before and did not have any prolonged symptoms or diagnosis of a concussion. She was not assessed by the study observers at that game, and she played next evening's game. She continued to feel sick over the next few days/weeks ... Her symptoms initially mostly consisted of a headache, but she also experienced nausea with minimal activity (walking to classes) and after a couple of weeks noted increased sensitivity to light. She was approached by the trainer who did objective concussion testing (SCAT2), but didn't notice any abnormalities except for some symptoms that they both attributed to having been sick ... the player specifically asked the trainer not to disclose to the doctor her current symptoms so that she could continue playing and the trainer obliged.

"It's about a culture that really wants to see this violence and doesn't want to evolve with our knowledge about brain injury," said Echlin.

This specific incident happened in Canada, yes, but the culture Echlin takes issue with extends to the entire world of competitive, high-contact sports, including football.

Yesterday, a new study was published by researchers at Boston University School of Medicine, who looked at the donated brains of professional athletes, war veterans, and other head-bangers, and found evidence of chronic traumatic encephalopathy (CTE). A chronic brain injury reminiscent of Alzheimer's, CTE occurs "as a consequence of repetitive mild traumatic brain injury."

They found evidence of CTE in professional along with college and high school football players, as well as in hockey players, boxers, and a wrestler -- and the families of the deceased reported troublesome and irregular behavior leading up to their deaths, including memory loss and personality changes.

One problem is that despite the dramatic consequences, concussions might not initially seem like such a big deal. Symptoms can seem minor, or may take time to manifest. That's why it's so important to have a trained specialist on hand, said Echlin, and for coaches to trust that this specialist will work in the players' best interest. Echlin's team found neurological changes not just in the players who had been diagnosed with a concussion, but also in many of those who hadn't been -- meaning the injuries were missed or ignored. For a coach to tell a player, "You look okay, get back out there," he said, isn't going to cut it.

The team also found that once players sustain a concussion, they're more susceptible to future incidents. Even if they seem like they're able to "shake off" one minor head injury, it's a quick progression to the compounding problem identified by the researchers at BU. After every concussion, said Echlin, players need time and space to recover -- and this includes time off from school for cognitive recovery.

The majority of U.S. states have enacted laws requiring that any young athlete suspected of having sustained a concussion is immediately removed from play. But Echlin argues that no real changes are going to be seen until we change the underlying culture of contact sports.

It's certainly not going to come from people entrenched in the culture, he added, like Peyton Manning, who provides simple instructions for how to cheat the concussion test in order to stay in the game.

"I don't think anybody really knows the risks at this time. We're just trying to find it out medically. And we know that there's been so much cover-up," said Echlin.

"We want people to be active, we want them to play these sports," he insisted, but at a certain point we need to separate the game from its components of intentional violence. And Echlin thinks it's physician's jobs to spread the word about the risks -- he believes that players and their parents would think twice about not taking injuries seriously, and maybe even about playing contact sports at all, if they really understood all of the potential consequences.