Pittsburgh Steelers safety Troy Polamalu admitted this July that he doesn't report every "buzz" he feels. If he did, Polamalu estimates he'd have been diagnosed with 50-100 concussions -- though sometimes "you can't even be conscious enough to lie." Football is for tough guys, and tough guys play through the pain.
Of course, as science has advanced, we've learned concussions are more than just pain. Recent research on the pathology of brains, conducted by the Boston University Center, suggests that over time a high level of exposure to intense physical contact can cause permanent brain damage. Potential risks include chronic traumatic encephalopathy (CTE), which can cause depression and suicide in older athletes. Many suspect that CTE, a condition caused by a high number of concussions, could have led to Junior Seau's recent suicide.
Dr. Chris Giza, who specializes in neurology at UCLA, has teamed up with professionals across the country to form the National Sports Concussion Outcome Study (NSCOS) to examine the long-term effects of contact on athletes. Giza and his colleagues are looking at the effects of concussions, but also at the impact of all biomechanical force applied to an athlete. Giza said that any type of registered biomechanical force -- force applied to the body that registers in the brain -- can affect the brain's ability to function. "There have been a lot of studies that have suggested that even if an athlete doesn't get a lot of symptoms indicating a concussion, or maybe they don't report them or feel them, there is still a biomechanical force to the brain, and some people in the field have termed it sub-concussive injury," Giza said.
There has yet to be a definitive study about the long-term effects of concussions and biomechanical forces on athletes. Millions of people play sports at all levels -- most Americans play sports as teenagers -- yet the true risk of contact sports over time remains uncertain. Giza and his team started NSCOS to follow athletes through their sports careers and beyond in order to gauge what exactly happens to an athlete's brain after years of contact.
"If there is a cumulative consequence for participating in contact athletics, are there ways we can mitigate these problems?" Giza asked. The question is one of many that could be answered by the NSCOS research. "We don't really have good information to answer that question. There are a lot of gaps in our understanding of the relationship between contact sports and long-term problems."
By focusing on such a wide time swath, the study could rewrite the rules for contact and non-contact sports. Giza and his team have received their first round of funding: four years' worth from the NCAA to follow collegiate athletes through their collegiate competition.
Giza and his colleagues have already taken the first steps in the study. "We're going to systematically capture preseason information about the athletes," Giza said. "We have a whole screening battery of cognitive tests, historical questions about head injuries and things like that, what position they're playing. We also want to follow what happens to them during their participation. Do they sustain concussions during participation? How much do they play? What level are they playing at? What position are they playing at for certain sports? As part of that measure of what's happening to them while they're playing, we also want to use some new technology to try to monitor the biomechanical forces they experience."
The collection of preseason data, which has been underway for a while, will be used as a foundation to compare the results of cognition tests and brain examinations during and after each season. The team has two technologies it will rely on to collect the data and determine what happens when an athlete experiences a biomechanical force, regardless of whether the contact results in a concussion.
"The only way to measure impact without people getting symptoms is to just measure how many biomechanical forces they're experiencing," Giza explained. "The way that this has been done for a number of years now, pioneered by Dr. Guskiewicz at UNC and also Dr. Broglio (who is at University of Michigan) is a helmet-based accelerometer system. It's called the HIP system, used with collegiate players and some pro players, and it measures biomechanical forces."
There are serious limitations to the helmet-based system, however, since not all contact sports use helmets (soccer and basketball for both sexes, and the vast majority of women's sports). To compensate for the non-helmet sports, NSCOS will implement mouth guard systems that are currently under review. "The solution to sports without helmets is a mouth piece based accelerometer system that we're exploring," Giza explained. "Right now that's being validated and compared to the helmet based system to see if that's going to give as good of data. But if it does, then that's really going to change our ability to estimate exposure because it will allow us to look at female sports and non-helmeted sports. That's the goal."
By following athletes through their college careers and beyond, the NSCOS team hopes to assess what effect concussions and biomechanical forces have on the brain immediately after impact and years later. Giza likened NSCOS to the Framingham Heart Study, which followed a group of adults to monitor their dietary and smoking habits. The researchers followed the subjects to see how many had heart attacks, strokes and other cardiovascular problems, and the study is still the starting point today for citing risk factors for heart attacks.
For now, the NSCOS focuses only on collegiate athletics, but hopes to expand in the future. The researchers are currently in the process of applying for more grants to move forward and conduct research at different levels. "We want to expand in a couple of ways," Giza said. "One is to expand to a broader age range, so we would certainly like to go down -- we have a little bit of resources from the NCAA funding to follow two middle schools we're identifying. If we receive additional resources, we would follow athletes after college, into the professional ranks and adulthood."
The ultimate goal of the NSCOS is to offer a comprehensive understanding of concussions and the permanent effects of contact in sports. So whether or not Polamalu wants to report his concussions, he won't need to if NSCOS research and technologies can report it for him.
"We're looking for any long term cognitive or neurological consequences," Giza said of the continuing objective for the research. "That can be based on how many concussions they've had, but we're trying to set it up so that even if they don't report concussions, or have diagnosed concussions, we can still see the effect of the impact."