What You Might Not Know About Football Concussions

Almost lost this week among the shock of UAB shutting down football, Jameis Winston's rape allegation hearing and the allure of championship weekend has been an unimaginable tragedy.

Kosta Karageorge, a 22-year-old Ohio State football player, was found dead in a dumpster Sunday after being reported missing several days earlier. Karageorge apparently died of a self-inflicted gunshot wound, a tragedy unto itself. Worse, despite his age some believe his suicide could be related to the lingering effects of concussions sustained on the gridiron.

The episode points to a harsh reality most don't want to believe: Could this sport, this spectacle enjoyed by millions, be ruining the lives of its participants?

It's not an easy subject to talk about, and not a lot of fun to read about either. But concussions in football are not going away.

One day before Karageorge's body was found I visited Georgia Southern to cover the football team's win over ULM. While there, the people at my alma mater kindly gave me a glimpse of the school's concussion research program. Obviously GSU's study has no direct relationship to the Ohio State case in particular. Still, the incident illustrates yet again why this research is so important.

Despite the ongoing presence of concussions in national sports headlines I was shocked how little I knew about what a concussion is and why it's a difficult injury to study.

Here are a few things that surprised me.

You've probably had a concussion at some point

Dr. Barry Munkasy, one of GSU's lead researchers, asked during my visit if I'd had a concussion before. I've never played a down of football outside some pickup games back in the day, so I answered no.

"Have you ever had your bell rung?" he asked.

Oh yea, I know that feeling.

"Then you've had a concussion."

That alone was a revelation. I figured concussions only happened during those ear-splitting hits you can hear through the entire stadium.

Southern's research involves placing sensors in players' helmets measuring the impact and direction of a hit (the fancy name is Helmet Impact Telemetry System, or HITS). When a hit exceeds 98Gs (the impact of a 20-25 mile per hour car crash, according to the researchers) a beeper alerts trainers to check on the player. That doesn't mean there's been an injury though, players have been known to take hits in excess of 400Gs without sustaining a concussion.

Thus, the HITS system can't be used to test for concussions, but can be used later to see which types of impacts tend to correlate with them.

Dr. Barry Munkasy describes the HITS system (photos by Jim McDonald)

Resistance to brain injuries varies from person to person

Concussions are vastly underreported

The Centers for Disease Control and Prevention estimate there are 1.6 - 3.8 million concussions annually in the United States that occur during sports and recreation activities.

What stands out about that number is the huge variation between the low and high ends. If you haven't noticed, 3.8 is more than twice as many as 1.6. Concussions aren't easy to diagnose in the first place, then there's the peer pressure element for "tough guys" who want to stay in the game at all costs.

It's hard to measure the effects of an injury you aren't aware of.

The good news? Georgia Southern is one of a number of schools the United States studying concussions. A major reason is there's lots of money out there thanks to high interest in the subject. GSU's research comes courtesy of a $385,000 grant from the National Institute of Health, and the school's piece of the research puzzle involves measuring the long-term effects of concussions.

Impacts to the head can be measured real-time during Georgia Southern football games.

It's hard to measure the long-term effects of a concussion

The underreporting issue causes enough problems in the immediate term, much less the long term. Munkasy brought up legendary boxer Muhammad Ali, whose body has been riddled with Parkinson's disease for years.

"Was his disease caused by his boxing, or was it just naturally occurring for that man at his his age?" Munkasy asked me.

The need for a control group is an issue across all types of scientific research. We don't have a clone of Muhammad Ali that didn't box, and we don't have a clone of Kosta Karageorge that didn't play football.

Concussions affect actions as simple as walking and standing

A major portion of Georgia Southern's research involves recording players as they walk up and down a specialized mat. Yes, it's that simple, the mat measures how they walk.

If a player suffers a concussion (remember, soccer and basketball players and even cheerleaders get them as well) they're asked to walk up and down the same mat again. After a concussion, walking patterns tend to be simplified and more careful, even if the player doesn't realize it. These patterns can be tested over the weeks and months to measure the recovery process. GSU also records walking patterns each season to see how things change over a player's career.

Variations include tests for hand-eye and foot-eye coordination. One test is a sort of wack-a-mole game with lights, while the lower body test resembles the old arcade game Dance Dance Revolution.

Brain scans cannot test for a concussion

"Most of the scanning techniques that are available do not reveal concussions " Munkasy told me.

This means the work of diagnosing a concussion is left to an athletic trainer. Making matters worse, symptoms aren't consistent either. One person with a concussion might feel dizzy or "see stars," while another might have completely different effects from his injury. The key is identifying that something is not right.

Then there's the matter of recovery. It's hard to objectively measure when someone has recovered from a concussion. Sometimes a person never fully recovers. So how do you know when is the right time to let the player return to action, and when it might be time to hang up the cleats for good?

The 4th International Consensus Statement on Concussion in Sport defines a concussions as, "a brain injury defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces."

Confused yet?

Bottom line, what I learned last weekend is concussions are not simple injuries.

But they are a phenomenon with the potential to ruin lives, and one day possibly to dislodge football's status as America's best and most beloved sport.

It will be some time before we fully understand concussions. But thanks to the work of these researchers, we're doing our best to figure it out.