No Risk, No Glory

It surprises me at times, as to how a topic can go from being ignored to suddenly being front page news and the “talk of the town”. Not that long ago, no one spoke of the long term effects of the radiation from CT scans. And now, there are multiple papers that address the issue. There is also an entire new market for software and hardware that tracks overall radiation dose to a patient over the course of a lifetime. This information, when the option exists, gets added to a person’s electronic medical record and can follow them even amongst different hospitals and imaging centers.

Concussions in sports are now a huge topic and it has become a critical area of research. And like CT radiation dose, the prevention and management of concussions has sparked a new and quickly growing market for measuring the force of impact to the head, as well as neurologically testing the sports player who has suffered concussions in the past.

To what sports does this topic apply? Clearly, American Tackle Football is a leader in causing repeated trauma to the head. Of late, new rules in professional (and amateur) football have made it so that concussions are less likely and that players with suspected concussions must even be medically cleared before resuming play. Interestingly, many professional football players are complaining that all of the new rules have effectively turned tackle football into “flag football” (i.e, minimal contact if any). I heard one player state that a risk of concussions and neurological damage 30 years down the line will not stop a kid (like my own son) from playing the sport he loves. And they are right.

But the professional American Tackle Football leagues cannot be as cavaliere with this issue. After years of studies and reports and litigation, the NFL recently agreed to pay out close to 800 million dollars to players who suffer(ed) from the long term effects of concussions. While this sounds like a great deal of money, it is arguably a “small” price to pay by the NFL to get past this issue. Also, when this amount is split up amongst all of the players who filed suit, it suddenly becomes a small sum relative to healthcare costs and other support costs for the players with brain damage.

American Tackle Football is by no means the only sport that must deal with this issue. In soccer (the “real” football), the soccer ball imparts a great deal of force to the head of the player. And in soccer, head shots are a common means of moving the ball around. In rugby and hockey, the force of impact to the head is literally crushing. But sure enough, all of the players, whether amateur or professional, show off their (toothless) smile after a game. And then of course, there is boxing, Interestingly, even after the greatest of them all, Muhamed Ali, was suffering from what appeared to be post traumatic brain injury (from all the direct blows), still the issue of head injuries in sports did not take off like it has now. Why? I have no idea. But I would love to hear some opinions.

In any case, there is a clear market for measuring trauma to the head of a player, reducing the effect of the impact to the head, tracking brain function after a head blow, and determining the best medical way to manage the initial concussion, and long term damage from concussions. Each one of these topics is an area for research and for a technological aid or solution. Startups and existing companies are very aware of this fact and are coming out with solutions as we speak.

I have NO affiliation with any of the companies or research teams that I am about to mention. I just wish to demonstrate existing options for the issues I noted above.

Shockbox is a company that sells a sensor that can be attached to the top of a helmet. This sensor provides immediate wireless transmission to your smart phone of the hit count to the player’s head. This technology provides even more information which can likely be further analyzed with other tools. Also, this type of information is ideally suited to be stored in the player’s personal health record (so that the player’s doctor could review it later).

Just today, I received an article by the (amazing) health writer for the Jerusalem Post, Judy Siegel-Itzkovich. She discusses how a “New test detects concussion impairments easily overlooked”. This test was developed by researchers at the University of Pittsburgh Medical Center and the University of Pittsburgh. The test, called vestibular/ocular motor screening, allows clinicians to be 90 percent accurate in identifying patients with a concussion. This link is just one of very many that discuss this type of testing and the general topic of testing for concussions.

Another point that Ms. Siegel mentions is that some concussions can generate symptoms for months. If such a person were to receive another head injury before fully healing from the first, the damage could be even worse than just the sum total of the two blows.

The question will soon be, what to do with this information? What if half of the football team is found to have residual concussion signs and is thus barred from further playing? I am not exaggerating when I say that the ability to diagnose even subtle concussions can destroy certain sports.

Considering the money involved, even in amateur sports, the likelihood is that some startup will develop a (patented) technology for truly absorbing the majority of the blow to the head. As such, the worst concussions will be mild and will heal quickly. The ironic part of all of this, is that the same technology will work its way into the army, and become a means of protecting soldiers against head trauma. Sometimes, there is a lot more money in sports than in fighting wars. And in such a case, everyone benefits.

As a physician, let me say this. If you have a child playing a contact sport, then read up on it. Understand what the likelihood is of long term brain damage, whether minimal or significant. Then speak to your child. It is nearly impossible to stop a young excited athlete from playing the sport he or she is passionate about. But at least, you should know the facts. In my case, my son, at 6’3″ and 350 pounds, loves playing American Tackle Football so much, that all I could do is warn him. But after my talk with him, he smiled and uttered the well known phrase (which is the title of this post) “No Risk, No Glory”. What can I say to that?


About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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