To Play or Not to Play: Sports and Cognitive Dysfunction

We are facing a terrifying reality: 100 million Americans are at risk of cognitive dysfunction due to changes in cerebral structure. But it’s not from CTE.

Cognitive dysfunction is a well-known complication of diabetes.

In 2015 the CDC released a report identifying the shocking fact that 100 million Americans are living with diabetes or prediabetes. Brenda Fitzgerald, MD, the Director of the Centers for Disease Control, acknowledges that this alarming statistic is complicated be the fact that “the majority [of the afflicted] don’t know it.”

“Now, more than ever,” says Fitzgerald, “we must step up our efforts to reduce the burden of this serious disease.”

To prevent diabetes, the Harvard T.H. Chan School of Public Health recommends improving diet, increasing exercise, and reducing behaviors such as smoking and drinking alcohol. In positive athletics-based initiatives (like the nonprofit organization the Good Athlete Project), professionals recognize the power of athletics to not only improve life skills, but life outcomes in the area of physical health, psychological wellness, and disease prevention.

The potential for positive impact through sports is enormous, which is why those who aim for their dismantling, especially contact sports like football, are so misguided. Football has become the primary target ever since Dr. Benet Omalu dissected the brain of legendary Pittsburg Steeler, Mike Webster. But do we really understand this issue?

America’s multi-billion-dollar business, filled with super-humans and bottomless marketing budgets, is in the public spotlight. To improve human outcomes, we must strip the issue of glitter and drama, and ask ourselves a simple question: do we want to ban football? Or do we want to keep people safe?

“If the goals is to keep brains safe, then we have to consider all areas of possible trauma.”

If the goal is to keep people safe – keep brains safe – then we have to consider all areas of possible trauma. For instance, falls are the number one cause of TBI (traumatic brain injury) across the population. Some will say that a fact like that is irrelevant, since participants are not opting into the environment, like they would be with contact sports. Fair. So let’s take a closer look at sports.

According to one study, women’s ice hockey has the highest incident rate of concussion with nearly one concussion per 1000 exposures to potential concussion while playing the sport in either practice or games. If we follow the motivation of those who would like to eliminate the sports in which concussion rates are higher than we’d like, then women’s hockey has to go. Next would be football which, during spring practices saw .54 concussions per 1000 exposures, and .37 during the regular season. After that, men’s hockey and women’s soccer (which tied at .41 per 1000 exposures). And don’t forget about men’s soccer (.28), wrestling (.25), men’s lacrosse (.25), women’s lacrosse (.25), women’s basketball (.18), and field hockey (.16). In other words, sports in general, though they are outnumbered in frequency by those who trip and fall, would have to be dismantled.

One might also consider that some seemingly innocuous sports are far more dangerous that we might initially think, though they don’t generate the same amount of attention. Equestrian – that’s right, horseback riding – accounts for more concussions per participant than any other traditional sport.

We have yet to see public outcry against horses.

Football is not the demon the media has made it out to be. That said, it needs to get safer. It’s becoming safer. In 2018, the Ivy League changed the kickoff rules by moving them up 5 yards, from the 35 yard line to the 40, to increase the likelihood of touchbacks (when the ball lands in the endzone and is not able to be returned by NCAA rules). Concussions on the kickoff went from approximately 1 in 100 to 1 in 500.

The steps to improve health outcomes in sports can only be identified if we stop falling victim to headline-hysteria and starting empowering ourselves with facts.

And if we want to keep brains safe, remember the fact that 100 million Americans are currently living with diabetes or prediabetes, which is linked to cognitive impairment.

Then note that there have only been 300 documented cases of CTE in all of the world’s literature.

“There have only been 300 documented cases of CTE in all of the world’s literature.”

Neurodegenerative disease is a problem we have to solve. A different problem than the one implied by clickbait headlines like “Is Letting Children Play Football Equivalent to Child Abuse?”

To be perfectly clear, I’d like to acknowledge that my heart goes out to families who have loved ones going through stages of dementia. My family has felt it too. Late in her life, my grandmother’s battle with dementia slowly stole her ability to think clearly and to recall information. Her condition deteriorated until she passed. Her children, my aunts and uncles and my own mother, were shaken. Even as a teen I remember wishing desperately that there was something I could do to help my grandmother, or to ease my family’s pain.

If I could go back in time, maybe I could have followed the CDC’s recommendations and convinced her to exercise more, to take care of her nutrition, and to sleep well.

She didn’t play football. So that would not have helped.

If you’re looking for a really interesting read shining a light on the “other” side of the concussion conversation in football, check out the book “Brainwashed” by friend of the Project, Merril Hoge. He uncovers some of the unseen narratives in football, the inconclusive science behind CTE, and his experience alongside hundreds of other NFL veterans: http://brainwashedbook.com/

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