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A conversation with Daniel Garza about football and concussions

A conversation with Daniel Garza about football and concussions

The long-term consequences of football-related concussions have become a focus of national attention. Over the past decade there has been a steady drumbeat of research correlating football collisions with chronic cognitive problems prompting congressional hearings and new rules on managing concussions in the National Football League.

But football-related head injuries are not just an issue for professional athletes. A 2006 study from the National Center for Injury Prevention found that 47 percent of high school football players say they suffer a concussion each season, with 35 percent of those reported multiple concussions in a season. Findings published in 2009 showed differences in physical maturity, neck strength and endurance among high school athletes could increase players’ risk for concussion.

Daniel Garza, MD, associate director of Stanford’s Lacob Family Sports Medicine Center and medical director for the San Francisco 49ers, and colleagues recently launched a study where Stanford football players are equipped with mouthpieces containing high-tech sensors to investigate these issues. In this Q&A, Garza fields questions on football-related concussions.

Why don’t football players’ helmets and equipment adequately project them against sustaining concussions?

It is questionable whether any helmet can prevent concussion. In reality, helmets were designed to help prevent skull and facial fractures. This is not to say that I do not hope for engineering advances that may make helmets better at preventing concussion.

An estimated 85 percent of sports-related concussions go undiagnosed, according to the most recent data collected by the American College of Sports Medicine. What are the main reasons for concussions going unreported?

We should make a distinction between “undiagnosed” and “unreported.” The main reason for a concussion going unreported by the athlete is that the player frequently wants to stay in the gam – in many ways this is just part of the mindset of an athlete. In other instances, the reason is the altered state caused by the injury itself, which impairs the athlete’s judgment.

The most common reason for a concussion going undiagnosed is likely related to not being reported. Another reason might be a lack of training in the subtleties of diagnosing concussions on the part of the sideline personnel. In either case, the answer lies in education – of the players, parents, coaches and medical staff.

Other studies have examined head impacts in football using sensors embedded in helmets. Why did you and colleagues decide to use the mouthpiece devices for the current study?

At Stanford we look for novel approaches to problems. The mouthpiece represents a new metric in assessing head impacts previously only possible in helmeted sports. Opting to use a device to allow us to expand research to a variety of athletes, including women’s sports, seemed like a natural fit.

Next year, the study will be expanded to include the Stanford women’s field hockey and lacrosse teams. What does the current scientific evidence tells us about the brain-injury risks of athletes competing in sports other than football?

Recent data finds that football has the highest risk for concussion. In women’s sports it is soccer, depending on the age group. Given the problems with diagnosis and reporting, however, we can’t rely too heavily on the data. Mouthpiece measurements of the impact to the head are amazing.

Previously: Mouthpieces tell researchers about force and direction of football head impacts, Using high-tech devices to study football and concussions, High-tech mouthpieces used to advance medical understanding of concussions in football, Researchers develop new test for diagnosing concussions on the sidelines, Deceased athletes’ brains reveal the effects of head injuries, When can athletes return to play? Stanford researchers provide guidance and New concussion guidelines for NFL players
Photo by John McStravick

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